Direct-to-consumer pharmacies could save commercially insured patients 85% on high-cost drugs

Embargoed for release until 5:00 p.m. ET on Monday 25 May 2026   

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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.   
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1. Direct-to-consumer pharmacies could save commercially insured patients 85% on high-cost drugs

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-05049

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A report comparing the Mark Cuban Cost Plus Drug Company (MCCPDC) to copayments or coinsurance under employer-sponsored insurance found that patients with high-cost generic prescriptions could lower their out-of-pocket costs from $140 to $25 by bypassing their insurance and using MCCPDC. Savings were frequent (nearly 80%) for any generic whose copayment or coinsurance exceeded $15. The study is published in Annals of Internal Medicine.  

Researchers led by John Lin, M.D., assistant professor of health services research at  The University of Texas MD Anderson Cancer Center and Jenny Xiang, M.D., assistant professor of medical oncology at The University of Colorado Cancer Center matched copayment or coinsurance amounts for filled generic prescription claims between January 2024 through January 2025 with direct purchase prices in 2025 through the MCCPDC. They calculated the frequency and extent of savings through the MCCPDC, stratified by prescription out-of-pocket cost categories, and identified disease areas where high out-of-pocket costs were frequent. Directly purchasing through the MCCPDC did not yield large savings for most prescriptions, where out-of-pocket costs were already low. However, they found that among generics with cost sharing of more than $15, nearly 80% of prescriptions would have had lower out-of-pocket costs had they been purchased through MCCPDC. For generics with a cost sharing of more than $100, median out-of-pocket costs were $25 through the MCCPDC compared to $140 through insurance. Additionally, disease areas with drugs that had higher cost sharing include oncology, urology, psychiatry, neurology, cardiology, and transplant. 

Prescription affordability in the United States is an issue patients face, even for those who are insured. The researchers conclude that patients with employer-sponsored insurance facing affordability challenges with their generics should consider DTC pharmacies whenever their prescription’s copayment or coinsurance exceeds $15. They should particularly consider DTC pharmacies for drugs with higher out-of-pocket costs.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author John K. Lin, MD, MSHP, please email Jamie Mauracher at PublicRelations@MDAnderson.org.

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2. Early use of tirzepatide better improves blood sugar control compared with standard care in type 2 diabetes

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-05602

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A randomized clinical trial compared tirzepatide with intensified standard care approaches in adults with a recent type 2 diabetes (T2D) diagnosis that was not adequately controlled on metformin alone. The trial found that starting tirzepatide early in T2D led to greater improvements in blood sugar, body weight, and waist size than intensified standard care, with more patients reaching normal blood sugar levels after two years. The study is published in Annals of Internal Medicine.

Researchers from Eli Lilly and Company conducted the SURPASS-EARLY study to assess the efficacy and safety of tirzepatide 15 mg or maximum tolerated dose versus intensified conventional care (ICC) in participants with early T2D who have inadequate glycemic control with diet, exercise, and metformin. In the randomized, open-label, parallel-group, phase 4 study, 794 participants with a T2D diagnosis within the past four years across 78 sites in 10 countries were randomly assigned to receive either tirzepatide or ICC over four years. ICC included a range of glucose-lowering medications commonly used in clinical practice and supported by treatment guidelines. Researchers measured changes in long-term blood sugar (HbA1c), weight, and waist circumference, and found that those taking tirzepatide early had better improved all these measures compared to ICC after 2 years in this report. The findings suggest that starting tirzepatide earlier if standard care is inadequate may provide stronger and more sustained metabolic benefits than current standard approaches.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Vivian Thuyanh Thieu, PhD please email Niki Biro at niki_biro@lilly.com.

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3. ACP says increased oversight of private equity in health care is needed to protect patients and the physician workforce

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-03148  

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Private equity investment in health care requires increased regulatory oversight and policies to better protect patients and physicians from the adverse impact of growing corporate interests, says the American College of Physicians (ACP). In a new paper, “Regulatory Framework for Private Equity and Corporatization in Health Care: A Position Paper from the American College of Physicians,” published in Annals of Internal Medicine, ACP examines the impact of private equity investment on clinical autonomy, health care costs, quality, access, equity, and innovation, and makes recommendations to help ensure that patient-centered care is protected.

In recent years, private equity investments in health care have increased substantially, growing from $41.5 billion in 2010 to $119.9 billion in 2019, with the trend expected to continue in the upcoming years. These investments have increasingly focused on primary care and multispecialty practices, driven in part by financial pressures on physician practices. Physicians have been leaving private practice due to high costs, inadequate reimbursement rates, and burnout. Instead of physicians funding and expanding their practices, investment patterns have shifted toward institutional investments by large firms that may not have expertise in health care delivery. The trend is concerning because some evidence associates private equity investment in health care with higher costs and, in certain settings, adverse effects on care delivery and patient outcomes.

In the new paper, ACP outlines a series of recommendations to better regulate private equity investments. Policymakers should establish safeguards to ensure that physicians retain control of patient care and discourage prioritizing profits over patients. ACP calls for greater transparency in health care investments, including requiring private equity firms to disclose information on patient experiences and outcomes. There should be regulatory oversight of private equity activities to prevent practices such as inappropriate self-referrals, excessive reliance on non-physician clinicians without appropriate physician involvement, or consolidation that reduces competition. ACP recommends increased scrutiny of practices that disproportionately affect vulnerable and underserved communities. Federal officials should strengthen enforcement and impose penalties on firms that violate the False Claims Act or engage in fraud or kickbacks.

ACP also recommends enhanced oversight of private equity entities that receive funding from federal payment programs, like Medicare and Medicaid. ACP calls for further examination of the impact of private equity and consolidation in the health care sector, including research into how these investments affect enrollment, spending, clinical outcomes, and health equity in Medicare, Medicare Advantage, and other federal health programs. Finally, ACP calls for additional research into how private equity affects the physician workforce and practice composition, including whether there are circumstances in which private equity investment could help expand access in rural communities or support investment in value-based care models.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To speak with someone at ACP, please email Jacquelyn Blaser at jblaser@acponline.org.

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Also new this issue:

The Human Factor in Clinical AI: Why Technology Alone Is Not Enough

Eun Jeong Gong, MD, PhD; Chang Seok Bang, MD, PhD; Jae Jun Lee, MD, PhD; and Yong Seok Shin, MD

Ideas and Opinions

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-00405