In our previous article, we explored how the Direct-to-Employer (DTE) model, exemplified by Eli Lilly's Employer Connect, represents a potential structural shift in pharmaceutical power dynamics. PBMs built their dominance by controlling three critical assets: demand aggregation, formulary access, and claims data.
DTE marketplaces create an opportunity to reclaim each of these. But seizing that opportunity requires intentional strategy; not just launching a platform and hoping employers adopt it. Here are three specific levers Pharma can use to capitalize on this competitive advantage.
PBMs built power by controlling utilization data. DTE models give manufacturers access to similar, and potentially more valuable, information.
PBMs built power by controlling utilization data. They controlled what employers paid for, which drugs were prescribed, who prescribed them, and how patients behaved over time. This data asymmetry gave PBMs enormous leverage in every negotiation.
DTE models could give manufacturers access to similar information, but with a key difference: the manufacturer is now the platform owner, not a data supplicant.
Ways Pharma Can Capitalize on This Advantage
Companies that control marketplaces control the rules. The PBM "formulary marketplace" is a perfect blueprint for what Pharma can build, on its own terms.
PBMs own the "formulary marketplace," forcing manufacturers to compete for tier placement. But what happens when the manufacturer owns the marketplace itself?
The Amazon Analogy
Amazon didn't win retail by selling products. It won by owning the platform, and its rules, where transactions occur. Similarly, PBMs own the "formulary marketplace," forcing manufacturers to compete for tier placement. DTE marketplaces create a similar opportunity for Pharma to establish and control the playing field.
Ways Pharma Can Capitalize on This Advantage
PBMs act as the "check valve" of prescription volume, but there's an upside version of this control that actually benefits patients.
PBMs act as the "check valve" of prescription volume for many brand-named medications, garnering control of demand, not always to the benefit of patients. In the future, certain legal and regulatory guardrails may prevent the replication of the downside of this control in both traditional and DTE models.
But there is still an upside opportunity that actually could benefit patients. Orchestrating demand means leveraging insights from the value delivered by ecosystem partners across the DTE marketplace to help employers and patients gain access to the best care for the best value.
Ways Pharma Can Capitalize on This Advantage
The Bottom Line: Don't Become What You Replaced
The DTE model gives Pharma manufacturers a rare window to reclaim data, marketplace ownership, and demand orchestration; all assets that PBMs have monopolized for decades.
But the strategic opportunity comes with a responsibility: the goal should be to build something better than the PBM model, not simply a Pharma-branded version of the same gatekeeping structure.
— Ophelia Johnson, E.fi
Manufacturers that combine data control, marketplace ownership, and transparent demand orchestration, while keeping patient outcomes at the center, will not only outcompete PBMs. They will build lasting trust with employers, patients, and the broader healthcare system.
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E.fi (E-fi) helps Pharma leaders design and execute new channel strategies, from DTE marketplace design to internal org structure. Let's talk about what this means for your organization.
Meet with Us →Disclaimer: For informational purposes only. Not legal, financial, or other professional advice. Not a substitute for independent evaluation or professional advice. No guarantees regarding outcomes or results.