A group of U.S. senators is digging into the direct-to-consumer telehealth platforms launched by Eli Lilly and Pfizer this year in search of any indication the services could create conflicts of interest for prescribers.
Both LillyDirect and PfizerForAll are online platforms where consumers can make appointments for either virtual or in-person care and arrange for any resulting prescription medications and other health products to be delivered directly to their doorsteps.
In terms of the products offered through each site, LillyDirect, which launched at the start of this year, includes a digital pharmacy specifically focused on delivering Lilly’s own diabetes, migraine and obesity treatments. PfizerForAll, meanwhile, debuted this summer and includes offerings from a variety of companies in its vaccine-finder tool and Instacart grocery delivery menu—though the site does prominently feature information about Pfizer’s treatments in areas like migraine, COVID-19 and more.
Separate from those products, both platforms connect patients with independent healthcare providers who are ostensibly free to prescribe products from any company. The group of senators, however, is questioning that independence.
In near-identical letters sent to Pfizer and Lilly this week, four lawmakers—Democratic Sens. Dick Durbin of Illinois, Peter Welch of Vermont and Elizabeth Warren of Massachusetts and Independent Sen. Bernie Sanders of Vermont—probe whether being employed through a telehealth provider under contract with a specific pharmaceutical company may push doctors to prescribe that company’s products, potentially in violation of federal anti-kickback laws.
According to the senators, “This manufacturer-sponsored arrangement appears intended to steer patients toward particular medications and creates the potential for inappropriate prescribing that can increase spending for federal health care programs.”
The letters describe how both platforms feature information about Pfizer and Lilly’s medications, followed by links to connect with a doctor and fill prescriptions online.
“This creates the impression that any patient interested in a particular medication can indeed receive it with just a few clicks, and the appearance of Pfizer’s approval that these chosen telehealth providers can ensure a patient receives the given medication,” they wrote to Pfizer, swapping in Lilly’s name in an otherwise identical sentence in the other letter.
The senators assert that both platforms appear to open up potential avenues for Medicare fraud flagged by the U.S. Department of Health and Human Services’ inspector general in 2022, writing in the Pfizer version of the letter: “Unsurprisingly, a patient coming straight from Pfizer’s website to a telehealth appointment with a prescriber chosen by Pfizer is overwhelmingly more likely to ask for Pfizer’s medication. Further, that prescriber may have an incentive to prescribe such medication, whether or not it is medically necessary or clinically appropriate. Payments by Pfizer hold the potential to induce specific actions of the prescribing pen.”
The senators are requesting more information from both Big Pharmas about the nature of their relationships with their contracted telehealth providers.
They provided a list of 13 questions to each company, including queries about whether they “direct, encourage or educate” any of the telehealth providers’ affiliated doctors to prescribe their own medications and if they’ve had any involvement in the creation of the providers’ “discussion guides,” plus requests for data on the numbers of Lilly and Pfizer drugs prescribed by the doctors and more information about the financial arrangements between the pharmas and their telehealth partners. Answers are requested by Nov. 25.
In a statement sent to Fierce Pharma Marketing, a Lilly spokesperson said, “Lilly launched LillyDirect, a telehealth platform, to ease the burden of navigating a complex U.S. health care system for patients living with obesity, diabetes and migraine.”
“LillyDirect offers people more choices as to how and where they access health care, including via home delivery of select Lilly medicines by licensed third-party dispensing providers and listing both in-person and telehealth care providers as options,” the statement continued. “These providers are fully independent from Lilly, exercise autonomous clinical judgement in evaluating and making care decisions, are not incentivized to prescribe Lilly medicines and do not provide any compensation to Lilly for referrals. Importantly, all health care providers are welcome to use LillyDirect’s pharmacy fulfillment options, which means patients can access these convenient options with any provider they choose.”
“We look forward to explaining to Sens. Durbin, Warner, Welch and Sanders how LillyDirect helps patients manage their chronic disease,” the statement concluded, pointing to the platform’s FAQ page for further information.
Pfizer didn’t immediately respond to Fierce Pharma Marketing’s request for comment.
Editor's note: This story was updated to include a statement from Eli Lilly.