Pharm-to-Table: Why Big Pharma Wants to Be Your Pharmacy Now

On Monday, Novo Nordisk announced that patients can now buy Ozempic directly from the manufacturer for $499 per month. No insurance, no prior authorization, no middlemen. Just click, pay, and your GLP-1 shows up at your door.

If you’ve been following Drugstore Cowboy, you know how jarring that number is. My pharmacy’s current wholesale acquisition cost for the exact same box of injector pens is $972. While most people will see the headline that the price was cut in half, what I see as a pharmacy owner is that Novo can sell Ozempic to you for half of what I pay to stock it on my shelves—and still make enough money to keep the board happy.

This is not a sale. It’s manipulation. And it marks a bigger shift that has come to be referred to by industry folk as “Pharm-to-Table”: drugmakers cutting out the pharmacy middleman and going straight to the patient.

I’ll start by giving credit to Halle Tecco for coining the term. It refers to drug manufacturers bypassing the legacy system of pharmacies and insurance and selling medication Direct-to-Consumer.

You’ve seen versions of this DTC system before in consumer markets:

Each one took a product and went direct, bypassing retailers and wholesalers, claiming it was about “bringing customers closer.”

Pharm-to-Table is that same model—but with prescription drugs.

Novo has NovoCare. Eli Lilly has LillyDirect. Both companies are testing a future where the manufacturer isn’t just the producer. They’re the prescriber’s partner, the fulfillment pharmacy, and the cashier.

What makes this radical is that, for decades, pharmaceutical companies wanted nothing to do with being the retailer. Too messy, too risky. They were in the business of making drugs, not running call centers, shipping operations, or pharmacy hotlines. Liability, infrastructure, and optics kept them out of that lane.

So why now? Because the money in staying hands-off has evaporated. The middlemen have siphoned off too much. The compounding boom has eaten away at brand credibility. And politicians have discovered that drug pricing is one of the rare bipartisan points of agreement.

The difference is the stakes. Glasses, cars, and razors aren’t injected into your body. These are consumer goods. Drugs are not lifestyle products. They’re lifelines.

The first reaction many people had to Novo’s $499 price was disbelief. How can cutting the price in half still be profitable?

The answer lies in the Rube Goldberg machine of the U.S. drug supply chain.

Here’s how the money usually moves:

By the time the patient swipes their card, the true economics are hidden behind spread pricing, rebates, and contracts no one outside the C-suite can see.

But why should PBMs and wholesalers get to extract $500 of value from every sale while providing zero in return? When Novo bypasses the legacy system and sells Ozempic directly:

They keep the spread for themselves. Which means they can cut the patient’s cost in half and still net more than they would after paying off middlemen.

This isn’t generosity. It’s basic arithmetic.

And if you read my newsletter My Pharmacy’s $2 Million Ozempic Problem, you know exactly how upside-down that math has become. My pharmacy dispensed $2 million worth of GLP-1s in 2024 and lost $26,000 doing it. Pharm-to-Table is Novo and Lilly deciding they’re done letting PBMs, insurers, and pharmacies siphon those dollars.

If Pharm-to-Table looks like a sudden pivot, it isn’t. Drugmakers are being forced into this strategy by a perfect storm.

When FDA-approved GLP-1s went into shortage, compounding pharmacies flooded the market with copycats. Some were legitimate. Many were not. As I wrote in From the FDA to Instagram and Made in China. Injected in the USA, these versions are often sourced from overseas labs with no FDA oversight.

That means Novo and Lilly aren’t just competing with each other—they’re competing with a parallel shadow supply chain of semaglutide vials mixed up in rented office parks. And the competition is no joke. I spoke to the CEO of a major compounding pharmacy recently who told me he believes there are just as many patients on GLP-1 compounds as on the brand-name meds.

Pharm-to-Table is the drug manufacturer’s way of saying: “Skip the sketchy telehealth ad. Buy the real thing here.”

A few weeks ago, Donald Trump demanded that drug companies slash U.S. list prices to match the lowest prices charged abroad, hinting at tariffs of up to 150% on imported drugs if they refuse.

Never mind that he has no real mechanism to enforce it—just the threat is enough to spook investors and pressure companies to show they’re doing something.

Selling direct at $499 lets Novo and Lilly point to an easy talking point: “Look, we are making drugs more affordable.” It doesn’t solve the systemic problem—but it gives them political cover.

As I argued in Wall Street’s Loss Could Be GLP-1’s Biggest Win Yet, investors are realizing the GLP-1 market isn’t just about potency anymore—it’s about accessibility.

If pills and cash-pay platforms bring millions more people into the funnel, Wall Street will take the tradeoff. Ozempic’s direct-to-patient pricing isn’t a side hustle—it’s the blueprint for scaling GLP-1s from a niche therapy to a mainstream blockbuster.

I’ve been one of the loudest critics of compounded GLP-1s. Not because compounding is inherently bad—it’s a vital service when done correctly—but because the GLP-1 gold rush has attracted too many bad actors.

The FDA has already issued warning letters to compounding pharmacies for quality lapses. Patients have ended up with mislabeled products, questionable ingredients, or dosing errors. These aren’t hypotheticals—they’re documented cases.

Compared to that chaos, Pharm-to-Table feels reassuring. At least you know you’re getting exactly what’s written on the label and it passed FDA inspection.

If it’s a choice between Novo Nordisk shipping you authentic Ozempic for $499, or an Instagram clinic mailing you a compounded vial of “semaglutide base” with no track record? Take Novo every time.

As a pharmacist, here’s the part I can’t ignore. The American drug system is a mess, but it’s a mess designed with friction points that protect patients.

Patients benefit from the separation of power.

A doctor chooses the drug they believe is the best choice for a specific patient.

A pharmacist calls your doctor to flag a dangerous interaction.

An insurer refuses to cover something unproven or negotiates a better price.

These checks are frustrating, but they exist for a reason. And there’s a reason they exist independently of each other.

Pharm-to-Table collapses all those roles into one pipeline owned by the manufacturer. Your doctor might be routed through Lilly’s telehealth portal. Your prescription might be filled by a pharmacy contracted directly with Novo. Your payment might go straight to the manufacturer’s website.

When the same company writes the script, fills the script, and collects the payment, the priority shifts. It’s no longer about your health first. It’s about their quarterly earnings.

This is the same warning I raised in my explainer about the PBM Mafia. When a single group controls all the levers, patients lose. Whether it’s PBMs shaking down manufacturers or manufacturers cutting out every other player, consolidation is the danger.

GLP-1s are just the beginning. Pharm-to-Table will not stop with semaglutide. We’re already seeing it expand:

Any category where demand is high, margins are thick, and middlemen are costly is a candidate.

Pharm-to-Table is seductive.

But let’s not confuse convenience with safety. The messiness of our current system—the endless forms, the irritating prior authorizations, the frustrating back-and-forth between doctors and pharmacists—exists to create friction. It may not function perfectly in practice, but that friction protects patients.

Do we want the same company writing the prescription, filling it, and cashing the check?

Healthcare has its own separation of church and state—and we can’t afford to lose it.

Stay vigilant.

Alec Wade Ginsberg, PharmD, RPh
4th-Gen Pharmacist | Owner & COO, C.O. Bigelow
Founder, Drugstore Cowboy