Patients Are Taking the Driver's Seat in Healthcare

Healthcare companies are rethinking their business models as patients gain more control over how they access care and purchase medicine. Our analysts Erin Wright and Terence Flynn unpack this shift and the emerging opportunities.

Read more insights from Morgan Stanley.

----- Transcript -----

Erin Wright: Welcome to Thoughts on the Market. I'm Erin Wright, US Healthcare Services Analyst at Morgan Stanley.

Terence Flynn: And I'm Terence Flynn, Morgan Stanley's US BioPharma Analyst.

Erin Wright: Today, how the consumer is moving into the driver's seat across healthcare.

It's Monday, September 14th at 7:00 AM

We're recording in New York City, where Morgan Stanley's twenty-fourth Annual Healthcare Conference is happening this week. One of the biggest shifts we're seeing across the industry is patients gaining more choice, transparency, and control over how they access care and medicine. You can already see it in everyday behavior. In our AlphaWise survey earlier this year, thirty-four percent of US consumers said that they'd chosen to take a voluntary wellness lab test in the past three years, and roughly two-thirds already own a wearable or plan to buy one.

And now we're seeing the same trend reshaping how people buy medicine and choose care. So Terence, let's start with biopharma. For years, direct-to-consumer pharma meant advertising and nudging people to ask your doctor about what particular treatment is best for them. What's different this time around? And what's different in this next wave of direct access?

Terence Flynn: Yeah, absolutely. Thanks, Erin. So for most of the industry's history, the patient sat at the end of the value chain and had really limited control over the product, the price, or the route through which the drug was obtained.

Manufacturers marketed to doctors and consumers, but the transaction was itself intermediated. So we think that's starting to change here. It's no longer simply about more consumer advertising or another cash pay discount. There's a parallel access infrastructure that's building here where the patient can increasingly start the initiation of the treatment journey themselves, obtain a prescription, often digitally through a telehealth provider, and then fill this prescription through other non-traditional channels.

And so there really is a shift in the model that we're starting to see here. But again, we're not talking about replacing insurance here; we're talking about areas where friction is high and where a cash pay price is viable.

Erin Wright: So Obesity has been the clearest proof point, as we are seeing patients asking providers about GLP-1s. Where else are we seeing this?

Terence Flynn: Yeah. So manufacturers are actually already selling over twenty-five branded drugs directly to patients at cash prices. Now, the common features of these drug classes are that they're self-administered, so essentially the patient can start and stay on treatment, and where there's limited in-person infrastructure that's needed, and where, as I mentioned, you have a lower price point or a coverage gap, meaning traditional insurance coverage doesn't exist.

Now, we're seeing this in large chronic categories. You mentioned obesity. Another one is, migraine headaches. There are also other areas that are amenable to telehealth, so think oral PCSK9 therapies, topical dermatology, non-opioid pain. So again, we think as more self-administered products launch, you're gonna see the addressable DTC pool expand.

Erin Wright: And ultimately what does this reveal about patient demand and gaps in reimbursement?

Terence Flynn: Yeah, I think GLP-1s, as you mentioned, Erin, provided the first proof point here that this new DTC model could actually be viable. And really the reason for that is that, the US employer coverage base right now, only about fifty percent cover these obesity medications.

And so for the other fifty percent, you have a gap in coverage. And that's really why people are seeking other channels for coverage. And so again, that really created this opening here for this new model. And so again, that's another consideration when you think about other medicines that could go through these channels is you have to think about the insurance coverage situation. And so for some areas like oncology, for example, insurance coverage is gonna be very high, and so those wouldn't be amenable to a DTC approach.

Erin Wright: So Terence, your analysis points to roughly twenty-six billion peak US opportunity. What makes a certain therapeutic well-suited for direct-to-consumer, and where is the opportunity most concentrated?

Terence Flynn: Yeah. So there are really four variables that we considered. The first is self-administration. So as I mentioned, you have to be able to administer the medicine yourself, meaning you don't have to go into the physician or hospital for an injection, for example. The second is that the diagnosis doesn't need an in-person confirmation. So think of something like a biopsy or something. So you'd have to be able to diagnose, as I said, over a remote telehealth channel. The third would be something that is a lower price point. Obviously, there are, like we mentioned, the GLP-1 medicines are at a different price point versus oncology medicines.

And then the last one would be any kind of legal restrictions. So sometimes FDA has a lot of restrictions around who can prescribe a medicine. These are called REMS. And so any medicine that had restrictions like that obviously would not be amenable to DTC. So again, we think through those different variables, and then we ultimately built up this twenty-six billion dollar TAM that represents about three percent of total branded pharmaceutical spend. Of that, about half is driven by the obesity or GLP-1 medications.

So Erin, that's a good bridge to healthcare services because consumerism isn't just about paying cash. What does greater consumer control actually look like?

Erin Wright: You're right. It's not just about paying out of pocket for healthcare. With now consumers becoming more proactive with their healthcare and preventative care, we are seeing a whole healthcare ecosystem shift, from health insurers now offering lifestyle savings accounts empowering patients with more choice on that front, health systems and hospitals are creating a digital front door and delivery of care twenty-four/seven on that front. And also, we're seeing more direct-to-consumer pharmacies and transparent pharmacies that are gaining traction.

Terence Flynn: And what does the Alpha Wise survey data tell us about consumers' willingness to pay out of pocket for care?

Erin Wright: So based on our AlphaWise consumer survey, twenty-five percent of consumers report paying entirely out of pocket for at least one healthcare service over the past year. That was actually higher than what we were expecting. Most commonly, this was attributable to behavioral and mental health services, about eight percent of the cohort.

Annual spend was about nine hundred and eight dollars, but maximum willingness to spend was about double that. So this suggests consumers are using out-of-pocket services and medications and are willing to spend to do so.

Terence Flynn: That's very interesting. How important are digital tools, wearables, and testing in actually accelerating this shift?

Erin Wright: So wearables are certainly a piece of the puzzle. What is new though here is that we're seeing wearable data align with actual biological data, where, for example, clinical laboratories are now partnering with these wearable companies and other direct-to-consumer healthcare platforms to offer subscription-based biomarker panels and other testing services. This is where this type of technology becomes more actionable from a healthcare perspective and really, frankly, empowers patients to take matters into their own hands.

Terence Flynn: So as consumers take more control, as you discussed, what types of healthcare service models are best positioned to benefit?

Erin Wright: There are certainly a host of companies across healthcare that are attacking this from several different angles.

But if we think about who in the industry has the most touch points into the consumer, into the patient, it would be your diversified managed care companies and vertically integrated managed care companies where we view that many of these larger insurers are best able to adapt to consumerism in healthcare. We're already starting to see that happen with stepped-up technology investments helping to facilitate greater transparency and access, whether it's across insurance, provider arms, technology, or, um, or pharmacy assets as well.

To sum it up, in biopharma, we're seeing a parallel access channel emerge alongside traditional reimbursement. And in healthcare services, consumers are gaining more control over how they choose access and pay for their care. Consumers aren't stepping outside of the healthcare system. They're taking a more proactive and more active role in how they navigate it.

Terrence, thank you for taking the time to talk.

Terence Flynn: Great speaking with you Erin.

Erin Wright: And thanks for listening. If you enjoy Thoughts on the Market, please leave us a review wherever you listen and share the podcast with a friend or a colleague today.