Your DTP programme has five vendors and no spine

Over the past few years, many pharma brands set out to build a direct-to-patient (DTP) channel. The website went live. A telehealth partner was selected. Pharmacy logistics were set up. An agency and a media partner started driving traffic. In rare cases, a data partner sent reports.

On paper, the programme was built. In practice, many never crossed the finish line. Demand was not the problem. In a June 2025 Model N and Dynata survey, 72% of respondents said they would buy medicine direct, but only 22% had.

What held them back was rarely the technology or the vendors. It was the organisation around them. The brand assembled new parts and kept the old silos. Marketing owned the media. Market access owned pricing and coverage. Patient services owned the hub. IT owned the site. Data and analytics owned the reports. Each vendor answered to whichever function hired it.

I have sat in a lot of DTP reviews, and the pattern rarely changes. Every vendor reports success. The agency shows engagement. The media partner shows reach and clicks. The telehealth provider shows consults completed. The pharmacy shows orders shipped. Every vendor is green, and the brand is red. Everyone is measuring activity. No one is measuring impact. The programme plateaus, because no one owns the full path from first click to refill.

That path is the spine of a DTP programme. Without it, a brand has parts, not a channel.

A three-legged race

DTP is less like a sprint and more like a three-legged race. You are tied to the people next to you. It does not matter how fast one runner is. If the partners are not moving in step, nobody crosses the line.

A patient who sees a strong ad, lands on a confusing site, waits days for a consult and then meets an unexpected price at the pharmacy does not care which vendor did its job. They simply do not start therapy. The leak is easy to see in the data. Of every 100 new prescriptions written, roughly 75 are filled and only 23 patients are still on therapy at 12 months. Each handoff is a place where the brand either keeps the patient or loses them, and in a siloed programme no one is watching the handoffs.

This matters most where the money is. In most programmes I have seen, the media that builds awareness is the largest single cost. If media is judged on clicks and traffic while new patient starts are measured somewhere else, the biggest line item in the budget is also the least accountable. A 2026 DigiPharma Insights and Freshpaint survey found that 83% of DTP marketers cannot connect marketing activity to a prescription fill. Brands end up funding the channels that are easiest to count, rather than the ones that bring patients onto therapy.

The tip of the spear

Every DTP programme that works has a tip of the spear: one person who owns the end-to-end result.

The title matters less than the skill set. This person needs to understand each element of the programme well enough to challenge it, from media and the digital experience to telehealth, pharmacy, access, and support services. They also need the instincts of a data-driven marketer, someone who reads a patient funnel the way a retailer reads a checkout page. Whether they sit in marketing or in an omnichannel centre of excellence is a local decision. What is not optional is the mandate to bring everyone to the same table.

That table is wider than most brands expect. It includes patient services, market access, marketing, IT, data and analytics, and every vendor partner. The job is simple to describe and hard to do: identify what is working, and address what is not.

Think of a conductor. A conductor hears the whole orchestra and still catches the one instrument out of tune. The tip of the spear does both, keeping the full patient journey in view and dropping down to a single channel, intake question, or pharmacy step when the numbers say something is off. Then, they bring the right people together to fix it.

Run it like e-commerce

The tip of the spear also needs a clear definition of success. In DTP, the most useful one comes from e-commerce, and it rests on three pillars.

Drive sales. In pharma terms, that means incremental new patient starts, not traffic or consults.

Increase the value of each patient. That means lifetime value, which depends on first fill, refills, and persistence.

Manage the cost of acquiring them. That means cost per acquisition, measured against new patient starts, rather than clicks.

Those are brand numbers, and they matter. But at the end of the day, Direct-To-Patient is about the patient. Every new start is a patient who got easier access to care, less friction from diagnosis to therapy, an option they could afford, and a better chance at a good outcome. Build the programme for the patient and the three numbers follow.

These three numbers give every function and every vendor the same scoreboard. The media partner is measured on its contribution to starts and acquisition cost, not reach alone. The telehealth and pharmacy partners are measured on how many patients they carry through to therapy and keep there. Patient services and market access are measured on how they protect lifetime value. When everyone is held to the same three numbers, the conversation shifts from "here is my slice" to "here is where patients are dropping out, and here is what we are doing about it."

A monthly review against those pillars, with the whole table in the room, becomes the programme's operating rhythm. It is where insight from one part of the journey changes decisions in another. That is how a programe actually gets optimised, rather than simply reported on.

Where to start

The first move depends on where the programme stands.

If a DTP programme already exists, audit it against the three pillars. Ask what it delivers in incremental new patient starts, what each patient is worth over time, and what it costs to acquire them. In my experience, most brands can answer one of those questions well and the other two only in part. The gaps show where the silos are.

If the programme is still being built, start with a map of the end-to-end patient experience, from first awareness to refill, and draw up a measurement plan before launch. Decide which numbers matter at each step, who owns them, and how they connect back to starts, lifetime value, and cost per acquisition. It is far easier to build the spine in from the start than to add it to a programme that has already been assembled in pieces.

So, here is a simple test for your next brand review. Put three numbers on one page: incremental new patient starts, lifetime value, and cost per acquisition. Then, ask who in the room owns each one, and who owns all three. If the answer is no one, you have found your starting point.

The brands that get DTP right will not be the ones with the most vendors or the most impressive launch. They will be the ones that put one person at the tip of the spear, gave everyone the same scoreboard, and kept asking how to be stronger tomorrow than they are today.

About the author

Aaron Uydess is the founder of Kairos Meridian, an independent next generation commercial consulting firm that works with pharma brands on how they build and drive commercial work as Direct-To-Patient, omnichannel, and AI change the job. Uydess has roughly 25 years in pharma commercial, most recently as an executive at EVERSANA and, before that, about a decade at Novo Nordisk.