Eli Lilly weight-loss drug platform draws experts' concern

Experts and industry analysts largely agree Eli Lilly's new direct-to-consumer platform will increase access to patients who may benefit from its new anti-obesity drug Zepbound, but questions are being raised surrounding appropriate care coordination and the business model behind the offering. 

Eli Lilly on Jan. 4 launched LillyDirect, a website that connects people with independent providers for obesity medications, including Zepbound. The new service also includes prescriptions for certain Lilly insulin products for diabetes patients and a migraine drug, as well as direct home delivery of its medications through third-party services. Mounjaro is not part of LillyDirect, though it may be added later, company CEO David Ricks told The Wall Street Journal. 

For weight-loss prescriptions, the drugmaker is working with Form, a telehealth provider that specializes in obesity medicine. In interviews with NBC News and The New York Times, Mr. Ricks said physicians who prescribe Zepbound through Form will not be compensated by Eli Lilly. Form also prescribes other weight-loss drugs, including Novo Nordisk's Wegovy. 

Still, "It would be helpful to understand that relationship more clearly and transparently," Zeev Neuwirth, MD, told Becker's. Dr. Neuwirth is the former chief of clinical care transformation at Charlotte, N.C.-based Atrium Health (now part of Advocate Health) and author of "Beyond The Walls: Megatrends, Movements, and Market Disruptors Transforming American Healthcare."

Mr. Ricks in previous interviews has said providers with Form and 9amHealth — with which Lilly is working on diabetes drugs — will not have knowledge of whether a patient came through the LillyDirect platform.

"Here is where we need to get specific," Dr. Neuwirth said. "These are relatively new telehealth companies, and small. … I think you're going to know that this influx of patients you're getting are coming from Lilly. So my question is, what are the firewalls between Eli Lilly and these companies?" 

One expert who spoke with the Times expressed concern over whether people would hear about all their options if they are using the platform and note interest in a specific medication.  

"I just find it a bit disingenuous to think that people are just going to get this totally neutral, balanced care," Andrew Krafston, MD, an obesity medicine specialist and endocrinologist at Ann Arbor-based Michigan Medicine, told the news outlet. 

Becker's reached out to Eli Lilly regarding concerns around potential conflicts of interest. A spokesperson for the company said Eli Lilly does not receive compensation from third-party providers for referrals, and that providers "are not incentivized by Lilly to promote Lilly products." 

Some physicians have also raised concerns around appropriate prescribing practices and follow-up care. 

"The American College of Physicians is concerned by the development of websites that enable patients to order prescription medications directly from the drugmaker," the organization said in a statement published Jan. 5. "While information on in-person care is available, this direct-to-consumer approach is primarily oriented around the use of telehealth services to prescribe a drugmaker's products. For telemedicine services to take place responsibly, there should be an established and valid patient-physician relationship, or the care should happen in consultation with a physician who does have an established relationship with the patient."

Eli Lilly has said access to independent telehealth providers through LillyDirect may "complement a patient's current primary care team." Form's founder and CEO, Evan Richardson, also told the Times it has protections in place to ensure prescriptions are appropriate, such as collecting patients' medical records, confirming they meet the criteria for weight-loss drugs and coordinating care with a patient's primary care team. 

On the same day LillyDirect was launched, Eli Lilly also published an open letter warning against "cosmetic use" of its weight-loss drugs. 

While there are concerns, many experts say LillyDirect will make access easier for many people who would benefit from weight-loss medications, particularly those who face barriers in getting to see a specialist in person. The new platform also ensures patients are not getting counterfeit medications or compounded versions, which the FDA has previously warned about. 

"The most important issue here is that this new delivery channel, this new prescribing channel, is held to the same standards — the same ethical, regulatory, clinical and safety standards — as any other provider, with transparency," Dr. Neuwirth said. "That's really, really essential. And we need to be monitoring this, studying this like we do any other aspect of care delivery," especially as experts anticipate other weight-loss drug makers to launch similar platforms, he added. 

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