Adam Wolfberg, MD, is chief medical officer at Virta Health, where he leads a clinical team focused on treatment of diabetes and obesity.
The fastest, least-expensive way to find a doctor who will prescribe Zepbound for weight loss may be to visit the drug company’s website.
It didn’t used to be that way. For decades, pharmaceutical companies weren’t allowed to market to patients in the U.S. When the industry convinced regulators to allow patient-focused advertising, the floodgates opened. In 2023, pharmaceutical companies spent nearly $14 billion on consumer advertising. Still, patients had to talk to their doctor to receive a prescription, and their doctor could always talk them out of a bad idea.
Now, Lilly can send you to an online physician who will prescribe your Zepbound, and Lilly’s in-house pharmacy will ship the weight loss drug to your door. Don’t actually “need” Zepbound? Well, that’s between you and the doctor Lilly referred you to.
This is possible because of a vertically integrated software stack sitting behind the LillyDirect interface: structured intake forms, asynchronous prescribing and employer payment rails that bypass traditional insurance infrastructure. Lilly has built a direct-to-consumer fulfillment system that operates more like a software company than a pharmaceutical one.
(Although my employer, Virta Health, focuses on nutrition-first management of metabolic disease, our clinicians do prescribe Zepbound and Wegovy to clinically appropriate patients. We do not receive referrals from drug manufacturers.)
The shift isn’t only about convenience. Besides developing a relationship directly with the patient, I believe pharma is taking a swipe at the pharmacy benefits managers (PBMs) by undercutting them on price.
PBMs have been the unloved stepchild of the health insurance industry for a long time because their opaque system of controlling access and price has left everyone in the cost equation—patients, employers and pharmaceutical companies—feeling ripped off.
As of December 2025, Lilly was offering Zepbound directly to patients for $299 to $449 per month, depending on the dose, which was significantly below its reported list price of $1,086, per The Washington Post. It’s also lower than the price employers pay to their PBMs, even after price rebates are calculated, even though PBMs remain a dominant distribution channel.
Many employers, who foot most of the bill for healthcare services for employees and their dependents, have caught on. A whole industry has sprung up to manage a payment mechanism so that employers can take advantage of the direct-to-patient pricing, typically by providing employees with funds they can spend on specific medications or reimbursing those expenses.
Lilly even launched Lilly Employer Connect, a service that makes Zepbound available through companies that take the place of the PBM and the insurance company, such as CostPlus Drugs and Waltz Health.
It’s understandable why patients feel the process is maddening: In many parts of the country, primary care physicians in traditional brick-and-mortar practices have yearlong waiting lists, while telehealth care is available on-demand. The eligibility rules for some medications, particularly weight loss medications, are strict and can feel arbitrary, and the experience of navigating from doctor to pharmacy (and sometimes through the PBM’s snail-pace customer support process) can take lots of time and patience.
In this context, a pharma-provided avenue that’s digital, fast and fairly transparent can feel refreshing.
If buying weight-loss drugs from the manufacturer seems like an inevitable evolution of healthcare capitalism meets consumerism, there’s a reason we were slow to get here: What the model removes, by design, is the prescribing relationship as an independent check on what patients think they need. The screening tools these platforms rely on, structured questionnaires and decision-support algorithms, are efficient but narrow. They’re designed to qualify patients quickly, not to catch what a physician might notice over years of care.
For weight loss medications, which are fairly safe, this balance may be appropriate, although I do worry about inadequate medical supervision. A patient with untreated disordered eating could trick an online prescriber into writing them for Zepbound. However, what happens when the risks are greater? Should cancer patients be directing their own chemotherapy or purchasing oncology medications directly through the manufacturer?
Transparent pricing is a real improvement. The harder question is whether clinical guardrails can survive the direct-to-consumer software playbook pharma has now adopted. That’s a problem the health tech industry, not just regulators, will need to answer.
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