Senators Push Back as Trump Admin Greenlights Direct-to-Consumer Drug Sales 

The Department of Health and Human Services released guidance this week explaining how drug companies can legally operate direct-to-consumer platforms. These platforms let patients buy medications directly from manufacturers, often at lower prices than traditional pharmacies. The catch? Patients pay cash, not insurance.

This guidance clears the way for “TrumpRx,” an administration-backed platform designed to connect consumers with discounted medications. Think of it as a government-endorsed online drug marketplace.

The setup works like this: A patient gets a prescription through a telehealth visit, then buys the medication directly from the manufacturer’s website. No insurance claims. No pharmacy middleman. Just a credit card and a valid prescription.

According to legal experts at Sheppard Mullin, the government sees these arrangements as “low risk” under anti-kickback laws—but only if companies follow strict rules. Drug makers cannot use these platforms to market other products covered by Medicare or Medicaid. They cannot offer special introductory prices that later jump up. And they must keep the same price available for a full year.

“The American consumer has spoken, and companies now building these operations should be prepared for more aggressive investigations into telehealth relationships between pharmaceutical companies and the pharmacies involved,” the law firm wrote in its analysis.

Read more: Iowa Attorney General Files Sweeping Lawsuit Alleging Insulin Price Manipulation

That warning looks prescient. Just two days after the guidance dropped, Senators Dick Durbin, Peter Welch, and Elizabeth Warren sent a letter raising red flags about the whole system.

Their biggest concern? Telehealth companies might not be as independent as they claim. The senators pointed to past investigations where patients referred to certain telehealth providers had a 100% prescription rate for a specific manufacturer’s drug. That doesn’t look like independent medical judgment.

The senators also flagged potential conflicts of interest, specifically mentioning that Donald Trump Jr. sits on the board of BlinkRx, a pharmacy platform. They worry the TrumpRx system could steer patients toward certain companies for the wrong reasons.

GLP-1 weight loss drugs like Ozempic and Wegovy present a particular problem. Companies might offer cheap starter doses through these platforms, then push patients onto higher doses that get billed to Medicare or Medicaid. Regulators call this “seeding”—and it’s exactly what they’re trying to prevent.

The payment mechanics matter here. When patients pay cash, their purchases don’t count toward Medicare Part D spending limits. That’s important because it means these transactions exist completely outside the normal insurance system.

For companies considering these platforms, the compliance burden is significant. They need to audit their telehealth partners closely. If a prescriber writes suspiciously similar prescriptions, that’s a red flag. They need to guarantee price stability for 12 months. And they cannot use the platform as a marketing funnel for other products.

The bottom line: Direct-to-consumer drug sales are here to stay. The question is whether regulators and Congress can agree on the rules of the game. Expect more scrutiny of telehealth relationships and payment flows in the months ahead.