LillyDirect: What Lilly Actually Changed, and What You Can Copy

Lilly did not build a better customer experience. It removed two of the three people from its market, and that is a different kind of move entirely.

LillyDirect gets written about as a digital platform, which is the least interesting thing about it. Strip the website away and what is left is a pricing and channel decision that changed who Lilly has to satisfy in order to get paid. That distinction matters to you, because most companies are about to copy the wrong half of it.

What did Lilly actually change?

The route, not the experience.

When the platform launched in January 2024, David Ricks framed it around burden. The press release said a complex US healthcare system "adds to the burdens patients face when managing a chronic disease." Speaking to Axios the same week, he was blunter about the model: "We're used to buying consumer goods directly from manufacturers all the time on online websites."

Underneath the language, three things changed at once. A self pay price, so coverage stops being the gate. A telehealth route to a prescriber, so access to a physician stops being the gate. Direct fulfillment, so the pharmacy counter stops being the gate.

Notice what is missing from that list, and compare it to your own plan. No survey. No workshop. No experience function. Three structural changes to how the product reaches a patient, made by commercial leaders.

Did it work?

On Lilly's own account, yes, and at a scale nobody in this industry predicted two years ago.

At the J.P. Morgan Healthcare Conference in January 2026, Ricks told the room that "basically a million people a month go online and buy GLP-1 medicine directly from a drug manufacturer." He also said the vials sold through the channel had become roughly the second best selling obesity product after Zepbound in an autoinjector.

Read that carefully. The million a month figure describes the whole direct channel across manufacturers, not Lilly alone, and both numbers are the CEO's own claims rather than audited disclosures. Treat them as directionally real and precisely unverified.

Even discounted, the signal holds. A route that did not exist in 2023 is now moving product at a volume that competes with the company's own flagship presentation. Ask yourself what share of your brand's volume moves through a channel you did not have three years ago.

Which part of the problem did it solve?

One of three, and naming which one is what makes the case usable.

We model the distance between your science and your patient as three sequential paths. The Path to Prescribe , where a patient is identified, diagnosed, referred and a clinician decides. The Path to Fulfill , where that decision survives coverage, prior authorization, cost and dispensing. The Path to Adhere , where the patient stays on therapy long enough to get the benefit your trial demonstrated.

LillyDirect is a Path to Fulfill solution, and an elegant one. It takes the stage where most earned value is lost in the US and shortens it from weeks to days. It does very little for the other two, which is not a criticism of the design. It is a reminder to check which path you are actually funding.

Why did it work, in terms you can use?

Because it dissolved three of the four conditions that make consumer models fail in pharma, rather than managing around them.

Your market has three people in it. A physician chooses, a payer covers, a patient uses. Lilly did not solve that. It deleted the payer from the transaction by setting a cash price, and routed around the access problem with telehealth. One buyer, one decision, one path.

Your feedback loop is partly closed by law and partly invisible by structure. A direct channel hands Lilly first party data it never had. Who ordered, who refilled, who stopped, and when. That is the loop closing, and it is the most undervalued asset in the whole program.

Your value event is sustained therapy months after the transaction your system counts. In a refill channel you can see persistence directly rather than inferring it from claims data that arrives late and incomplete.

The fourth one is the hinge. Regulation governs claims, not burden. Nothing in the rules prevented Lilly from doing any of this, because none of it is a claim about efficacy or safety. It is an attack on friction, and friction was never the regulated part.

What will most companies copy, and why is that wrong?

They will build the website. The website is the least transferable part.

The portal is downstream of a pricing decision. LillyDirect works because a meaningful number of patients will pay cash for a GLP-1, which is true of GLP-1 medicines and almost nothing else in your portfolio. In oncology, in rare disease, in most specialty categories, the payer cannot be deleted because the therapy costs more than any patient will put on a card.

So if you run a brand where coverage is mandatory, copying the channel gets you a handsome site that changes nothing. Your three person market is still three people. Your gate is still the prior authorization, and the published numbers on that gate are getting worse. A 2026 JAMA study summarized by Johns Hopkins found insurer rejections reached 40.7% of initial brand name attempts in 2024, up from 24.3% in 2018. Of those rejected scripts, 48.4% were never followed by a fill of that drug or anything in its class within 90 days.

The transferable lesson is not the portal. It is that Lilly identified the specific structural gate between its science and its patients, and then changed the structure rather than improving the experience around it. That question has a different answer for every brand you run.

What does it cost to own the whole path?

Scrutiny, and the detail is worth studying before you design your own.

In July 2025, after a nine month investigation, Senators Durbin, Welch, Warren and Sanders published a report on manufacturer telehealth platforms. Three figures from their findings on LillyDirect are the ones to note, not as a verdict on Lilly but as a description of what any company inherits when it owns the whole path.

Patients routed to a telehealth visit received a prescription 74% of the time. At one partner, more than 500 of 620 LillyDirect patients were prescribed a medication, against 39% of that partner's overall patients. LillyDirect users seeing a contracted physician were six times more likely to receive a Lilly product than another brand.

Durbin said the findings "shine a light on potential conflicts of interest and inappropriate prescribing." Lilly has maintained that it does not incentivize physicians to prescribe its own medicines.

Hold both facts at once, because both are true. The channel removed real burden for real patients. It also put the company in a position where every conversion rate becomes an exhibit, which is a structural consequence of integrating the path rather than evidence of intent.

If you build one of these, design the governance before the interface. Decide in advance how a prescriber is selected, what the patient sees before they meet one, and who audits the prescribing pattern quarterly. Those are answerable questions, and they are much harder to answer after a subpoena than before a launch.

What do you do if you cannot delete the payer?

You work the seams instead, and you measure the path.

Most brands will never have a cash option. For those, the gate is the interval between the prescription and the patient, and the work is unglamorous.

Find where patients stop moving. Put a name on each of those seams. Measure script to start conversion and time to therapy across your Path to Fulfill. Measure persistence and barrier resolution speed across your Path to Adhere. Then measure realized value against the value your brand had already earned, which is your Realization Rate.

Put those numbers on a commercial leader's scorecard rather than in a quarterly experience readout. We call the money sitting in that interval value leakage, the discipline that recovers it Customer Excellence, and the bar it is built to clear Consumer-Grade.

Lilly took the shortcut available to a company with a cash paying category. The rest of the industry has to do it the long way, and the long way is still a commercial system change rather than a CX program.

Key takeaways

LillyDirect is a pricing and channel decision with a website attached, and it solves the Path to Fulfill rather than the whole distance to the patient.
It worked by deleting the payer from the transaction, which is available to you only in categories where patients will pay cash.
The direct channel closed a feedback loop pharma has never had, giving Lilly first party data on ordering, refill and discontinuation.
Nothing in regulation prevented any of it, because none of it was a claim. Regulation governs claims, not burden.
Owning the whole path from advertisement to prescription invites scrutiny of your conversion rates, so design the governance before the interface.

Questions to ask your leadership team

For your lead brand, what is the single structural gate between the prescription and the patient, and who owns it?
Would any meaningful share of your patients pay cash, and at what price? If none would, the direct channel is not your answer.
What would you learn about persistence if you could see refills directly, and what are you inferring today instead?
Which of your current constraints are regulatory claims rules, and which are operational burden you have simply never challenged?
If you launched a direct channel, who in your organization would audit its prescribing patterns, and how often?

About the author

Wayne Simmons is the founder of The Customer Excellence AGENCY and the author of The Customer Excellence Enterprise (Wiley, 2024). He is founding faculty of the MS in Customer Experience Management at Michigan State University's Broad College of Business. He led global customer excellence in Pfizer's first Chief Marketing Organization and in Bayer's Customer Powerhouse. Related reading: Lilly and Novo solved one path, two are still open, Why consumer CX does not translate to pharma and How to measure customer experience in pharma

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[PRACTICE NOTE] Your Call Plan Isn’t the Problem. Your Customer Context Is.

March 15, 2026

Why healthcare professionals now judge pharmaceutical engagement against the best experiences in their lives, and what that means for the future of commercial leadership. When commercial performance falters, the reflex inside many pharmaceutical organizations is to adjust the machinery of field execution. Leaders revisit call plans, recalibrate targeting models, and increase the volume of activity in the hope that more precision or more frequency will restore momentum. For decades this system has been treated as the central instrument of commercial performance, determining which physicians are prioritized, how frequently representatives engage, and how resources are deployed across territories. Yet the growing gap between commercial effort and commercial impact suggests a deeper issue. T he problem is rarely the design of the call plan itself. It is the context in which healthcare professionals now operate. Physicians are navigating increasingly complex clinical, administrative, and informational environments, and that evolving reality now shapes prescribing behavior far more than the cadence of promotional interactions. What many organizations are experiencing is a widening Customer Context Gap. Commercial systems were designed for a time when prescribing decisions could be influenced primarily through promotional interaction and product information. Today physicians operate inside a far more complex reality shaped by administrative burden, reimbursement constraints, digital information overload, and growing expectations for seamless support across the entire care journey. In this environment the physician’s decision is influenced not only by clinical evidence but also by how easily a therapy fits into the practical realities of care delivery. When commercial models remain anchored in promotional activity while the customer’s context has fundamentally changed, even the most disciplined call plan struggles to deliver the outcomes it was designed to produce. Closing this gap requires a different way of thinking about commercial performance. The question is no longer how to optimize promotional activity but how to align the organization around the real journeys through which physicians help patients receive therapy. Prescribing decisions unfold within complex sequences of clinical evaluation, reimbursement navigation, patient readiness, and ongoing support. When commercial strategy is designed around these journeys rather than isolated interactions, the role of the field force begins to evolve. Representatives are no longer positioned primarily as messengers of information but as partners in removing barriers that slow care. Organizations that recognize this shift begin redesigning their commercial systems accordingly, aligning field engagement, digital support, access programs, and patient services around the same goal: helping healthcare professionals help patients move from clinical intent to successful treatment. From Promotional Activity to Customer Journeys The pharmaceutical industry has historically organized commercial activity around the moment of promotion. Call plans, targeting models, and message sequencing were designed to influence prescribing behavior primarily through informational engagement with healthcare professionals. While this model brought structure and scale to commercial operations, it reflects an earlier era in which the path from clinical awareness to prescribing action was comparatively linear. Today the journey is far more complex. Physicians must navigate an intricate landscape of clinical evidence, treatment guidelines, payer requirements, prior authorization processes, patient affordability concerns, and adherence challenges. Prescribing a therapy is no longer a single decision point. It is the beginning of a chain of events that determines whether a patient ultimately receives and remains on treatment. This is why the commercial conversation must expand beyond the traditional moment of prescription to encompass three interconnected journeys. The first is the Path-to-Prescribe , where scientific evidence, clinical education, and confidence in the therapy shape the physician’s willingness to recommend treatment. The second is the Path-to-Fulfill, where access, affordability, patient readiness, and operational support determine whether that recommendation ultimately becomes therapy in the patient’s hands. The third is the Path-to-Adhere , where ongoing patient support, monitoring, and engagement determine whether patients remain on therapy long enough to realize the intended clinical benefit. Science drives the Path to Prescribe, where evidence, clinical education, and confidence in the therapy shape the physician’s willingness to recommend treatment. Experience shapes the Path to Fulfill, where access, affordability, and patient readiness determine whether that recommendation becomes therapy in the patient’s hands. Sustained outcomes depend on the Path to Adhere, where ongoing support, monitoring, and engagement ensure patients remain on therapy long enough to realize its intended clinical benefit. When commercial organizations focus almost exclusively on the first while leaving the latter journeys fragmented and burdened, a significant portion of therapeutic value is lost between intention and impact. In many therapeutic areas, the result appears in the persistent gap between prescriptions written, prescriptions filled, and therapies sustained—gaps that reflect not a failure of science but a failure of system design. Recognizing these three journeys shifts the unit of focus from promotional activity to the real-world pathways through which care is delivered. It reframes the role of the field force, the purpose of digital engagement, and the design of patient support programs around a single objective: reducing the friction that stands between clinical intent, treatment initiation, and sustained patient outcomes. Customer Context Is the New Commercial Variable For much of the pharmaceutical industry’s history, commercial performance was largely explained by a familiar set of variables. Product efficacy, clinical differentiation, promotional reach, and sales force execution determined the trajectory of most brands. When performance lagged, leaders adjusted those levers by refining segmentation, optimizing targeting, and recalibrating call plans. Today those traditional levers still matter, but they no longer explain commercial outcomes on their own. A far more powerful variable has entered the equation: customer context. HCPs now operate within an environment defined not only by clinical complexity and administrative burden but also by rising expectations shaped by their experiences outside healthcare. Physicians are also consumers. In their personal lives they interact daily with companies such as Apple, Amazon, Tesla, and Netflix that anticipate their needs, remove friction, and simplify complex processes through thoughtful design. These experiences quietly reset the benchmark for competence, responsiveness, and respect for their time. When those same physicians step into their clinical roles, they do not shed those expectations. They carry them with them. The contrast between the seamless orchestration of their consumer experiences and the fragmented systems surrounding many healthcare interactions becomes difficult to ignore. What once felt acceptable now feels unnecessarily burdensome. This dynamic represents the Consumer-Grade Imperative. Healthcare professionals increasingly evaluate pharmaceutical engagement not against other pharmaceutical companies but against the best experiences they encounter anywhere in their lives. In this environment even a clinically superior therapy can struggle if the surrounding system makes it difficult to initiate treatment, navigate reimbursement, or support patient adherence. Customer context therefore becomes the new commercial variable. It determines whether scientific differentiation translates into practical adoption. It shapes whether prescribing intent becomes therapy initiation and whether therapy initiation becomes sustained patient outcomes. Call plans were designed to manage activity. Customer context requires organizations to manage journeys. The Field Force in the Era of Customer Context Recognizing customer context as the defining commercial variable inevitably reshapes how the role of the field force is understood. For decades the pharmaceutical sales representative has been positioned primarily as the carrier of scientific information. Call plans optimized the frequency and sequencing of these interactions to ensure that physicians received consistent messaging. That role does not disappear, but the environment surrounding it has changed profoundly. Physicians today are navigating administrative burden, payer complexity, digital information overload, and increasing time pressure. In this environment they are not simply seeking more information. They are seeking clarity, simplicity, and support that helps them navigate the complexity surrounding treatment decisions. This shift transforms the representative from a messenger of information into something far more valuable: a partner in removing friction from the care journey. Conversations move beyond repeating clinical claims toward understanding the practical barriers that physicians and their teams face as they attempt to initiate and sustain therapy for patients. The most effective field forces are therefore supported by commercial systems designed around journeys rather than activities. Representatives are equipped not only with scientific messaging but with the insight and coordination required to address obstacles across prescribing, reimbursement, and patient support. Field engagement becomes a catalyst for problem solving rather than simply a vehicle for promotion. From Call Plans to Customer-Aligned Commercial Systems If customer context has become the defining commercial variable, then the systems designed to support the field must evolve accordingly. The traditional call plan was built to manage activity. It provided structure for how frequently physicians were engaged, how territories were covered, and how resources were deployed. Yet activity alone does not determine whether therapies ultimately reach patients. What determines impact is whether the commercial system surrounding the physician reduces or increases the burden of delivering care. A customer-aligned commercial system begins with the journeys through which physicians help patients move from diagnosis to treatment and beyond. Marketing clarifies the scientific story. Sales provides trusted relationships and real-time understanding of physician needs. Access teams simplify reimbursement pathways. Patient support programs reduce administrative burden. Digital engagement reinforces and extends human interaction. The result is a commercial system that operates less like disconnected functions and more like an integrated network designed to help physicians help patients. This is the essence of Customer Excellence. It aligns the entire commercial enterprise around the real-world context in which care is delivered. The problem was never the call plan. The problem was the context. Key Takeaways Commercial performance in pharma organizations has traditionally been managed through field execution mechanics, yet the effectiveness of those mechanics increasingly depends on how well they reflect the real-world context in which physicians operate. Customer context has become the most pivotal commercial variable as administrative burden, payer complexity, and consumer-grade expectations reshape how prescribing decisions are made. HCPs now evaluate pharmaceutical engagement against the best experiences they encounter anywhere in their lives, raising the standard for clarity, responsiveness, and ease. Optimizing promotional activity alone is no longer sufficient. Commercial success depends on reducing friction across the journeys physicians navigate as they move patients from diagnosis to treatment. Customer Excellence represents the structural response, aligning marketing, sales, access, digital engagement, and patient support around the real journeys of care delivery . Diagnostic Questions to Consider Are we optimizing the activity of our field force, or designing commercial systems that support the real journeys physicians navigate to help patients receive therapy? How well do we understand the administrative, reimbursement, and operational barriers physicians encounter after they decide to prescribe a therapy? Do our commercial systems reduce the burden placed on physicians and their staff , or unintentionally add to the complexity of care delivery? Are we benchmarking our engagement against other pharma companies , or against the best experiences physicians encounter in their lives as consumers? Have our investments in digital platforms simplified the physician’s experience, or multiplied the number of disconnected interactions they must manage? Are we still managing performance through activity metrics alone , or beginning to understand the context that ultimately determines whether therapies reach patients? Closing Reflection The pharma and life sciences industry has spent decades refining the mechanics of field execution. Call plans, segmentation models, and targeting systems brought structure and discipline to commercial organizations. Yet the environment surrounding physicians has evolved far more rapidly than the systems built to support them. Healthcare professionals now operate in a world defined by consumer-grade expectations for clarity, responsiveness, and ease. When the experience of engaging with a pharmaceutical company fails to reflect those expectations, the contrast becomes impossible to ignore. Organizations that recognize this shift will redesign their commercial systems around the realities of modern care delivery. They will move beyond managing activity and toward understanding the context in which physicians help patients receive treatment. In doing so they will close the gap between scientific innovation and real-world impact. Your breakthrough science deserves experiences worthy of it. Together, we turn customer excellence into real-world impact. About the Author Wayne Simmons is a hands-on commercial excellence architect and founder of The Customer Excellence Agency, where he partners with pharmaceutical and life sciences leaders to turn customer-centric ambition into durable commercial advantage. He previously served as Global Customer Excellence Lead within Pfizer’s Chief Marketing Organization and has held leadership roles with Bayer Pharmaceuticals and The Ritz-Carlton Leadership Center. Wayne writes The Customer-Centric Marketer newsletter and is the author of The Customer Excellence Enterprise: A Playbook for Creating Customers for Life. The Customer Excellence Agency: Advancing the Pursuit of Excellence in Service of Science.

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