United States – October 24, 2026 -- The direct-to-consumer cash-pay market in biopharma could reach $26 billion at its peak, according to Morgan Stanley healthcare services analyst Erin Wright, as U.S. patients take more control over how they access and pay for care.
GLP-1 obesity drugs show a branded product can run half its volume through consumer-led access
A branded prescription product in the GLP-1 market could support roughly half of its volume through a consumer-led access pathway, the analysis says. Patient demand for obesity treatment built before insurers were ready to pay for it. Patients can now choose a treatment, find a price within budget, obtain a digital prescription and fill it through a manufacturer-selected pharmacy or fulfillment partner. Many large-cap biopharma companies now operate direct-to-consumer platforms.
Morgan Stanley survey finds 36% of consumers would pay fully out of pocket
In an August 2026 Morgan Stanley AlphaWise survey of U.S. consumers, 25% of respondents had paid fully out of pocket for at least one healthcare service in the past year. 31% had done so for a medicine or treatment. 36% said they would be willing to pay entirely out of pocket for healthcare services, spending an average of $413 per year. Willingness is significantly higher among younger and upper-income consumers.
HSAs, the ACA and telehealth moved spending decisions to patients
Health Savings Accounts, created in 2003, and the growth of high-deductible health plans shifted more costs and decisions to consumers. The 2010 Affordable Care Act added insurance marketplaces and consumer protections. COVID-19 accelerated telehealth adoption, while wearables, direct-to-consumer diagnostics, cash-pay testing and direct-primary-care models extended self-directed care.
Wright warns the shift has limits and macroeconomic sensitivities
Payers are aligning more closely with consumer choice, and direct-to-consumer pharmacy models can expand medication access and transparency. Wright notes there are limits to how far the shift can go, along with macroeconomic sensitivities and other risks. Models that emphasize transparency and choice are still likely to play a growing role.