Ask About Direct-to-Consumer Rxs During Med Histories

More drug companies and third-party platforms are selling Rx meds directly to patients...such as Eliquis, Wegovy, Xofluza, and Zepbound.

These direct-to-consumer (DTC) Rx programs bypass traditional pharmacies...and are appealing to patients for their discounted and transparent pricing, convenience, privacy, etc.

But DTC meds create challenges in the hospital...especially for med reconciliation, perioperative management, and discharge planning.

Be proactive in identifying DTC meds when taking med histories. Standard questions such as “What pharmacy do you use?” may miss these meds...since patients often don’t think of manufacturer programs as “pharmacies.”

Plus traditional pharmacies usually won’t have records of meds that patients are getting DTC when you call them to verify the patient’s Rxs.

Train your team to specifically ask patients “Are you getting any medicines shipped directly from drug companies or online programs?” and “Do you use any online subscription services for your medicines?”

Anticipate that patients may not have complete info about their DTC Rxs available...or the DTC program’s contact info for verification.

Consider asking patients to show you the product packaging or to check their phone for DTC app or website records if available.

Watch for critical issues with DTC meds. For example, apixaban (Eliquis) generally needs to be held before surgery...due to bleeding risk.

At discharge, provide explicit restart instructions for DTC meds held during hospitalization. And confirm where discharge Rxs should be sent...to avoid duplication or errors with traditional or DTC pharmacies.

Be aware that most DTC Rx programs do NOT comprehensively screen for interactions, contraindications, etc...and rarely provide direct pharmacist counseling, which is essential for injections, inhalers, etc.

Plus DTC programs don’t always lead to cost savings. For instance, the flu antiviral Xofluza (baloxavir) is $50 DTC...compared to about $25 out-of-pocket for a course of generic oseltamivir (Tamiflu) at pharmacies.

Let patients know that most DTC programs don’t accept insurance for Rxs...and payment can’t usually be applied to deductibles or out-of-pocket maximums, which are meant to limit costs in the long run.

But patients can typically use FSA/HSA cards to pay.

Continue to help patients use cost-effective meds with our Guide for Helping Patients Afford Their Meds...and encourage comparing alternatives, costs, and coverage before jumping to DTC Rxs.

If patients want to get Rxs through a DTC program, note their rationale, your recommendations and any safety concerns you raised, etc...to protect both you and your patient if potential complications arise.

Emphasize that patients keep a current and complete med list and share it with all of their providers...for safety and continuity of care, especially when getting medications from multiple sources.

• Patient Education: My Medication List
• Chart: Guide for Helping Patients Afford Their Medications