Chip Parkinson, CEO of Gifthealth, says specialty medicine represents the clearest opportunity for direct-to-patient models to prove their value at scale.
Specialty drugs already account for more than half of all drug spend in the United States, yet only around 2% of patients use them, creating a narrow but enormously costly segment.
Parkinson argues that concentration of cost and friction is precisely where direct-to-patient platforms can deliver their most significant return on investment.
He expects platforms to move away from defaulting to cash pay and instead begin routing specialty patients through whichever channel, cash or insurance, is cheapest and fastest for them.
That routing logic, Parkinson suggests, is also the mechanism by which cash and insurance payments stop functioning as entirely separate journeys for patients.
Rather than maintaining two distinct tracks, Parkinson expects the industry to converge onto a single set of rails, with patients directed automatically toward the lower-cost option available to them.
The regulatory environment is also beginning to provide the clarity that cautious manufacturers have been waiting for before committing fully to direct-to-patient approaches.
Parkinson noted that the HHS Office of Inspector General, in guidance issued earlier this year, asked for public feedback on a full safe harbor for direct-to-patient arrangements, going beyond a simple advisory bulletin.
He expects that rulemaking process could advance in 2027, giving manufacturers currently sitting on the sidelines a firmer and more durable legal foundation than currently exists.
The combination of regulatory progress and smarter routing logic points toward an industry moving decisively past its pilot phase into broader, more confident adoption.
Parkinson envisions more brands launching hybrid direct-to-patient and insurance models from the outset, rather than treating direct-to-patient as a secondary or experimental channel.
That shift, he argues, should translate into faster adoption rates, faster first fills for patients, and stronger medication persistency across specialty drug programmes.