Fictional direct-to-consumer pharmaceutical advertisement still, generated by ChatGPT on June 16, 2025.
Since the late 1990s, direct-to-consumer pharma ads have become a pop culture fixture. But the practice is facing fresh threats after Senators Bernie Sanders (I-Vt.) and Angus King (I-Maine) introduced sweeping legislation that would ban prescription drug advertising across all platforms: television, radio, print, digital, and social media. The End Prescription Drug Ads Now Act has an ally in Trump’s Health Secretary Robert F. Kennedy Jr., who campaigned on eliminating pharmaceutical TV commercials.
With bipartisan momentum and an HHS Secretary hostile to drug ads, one might expect the circa $18 billion pharmaceutical advertising industry to be fretting. But Ahmed Elsayyad, president at Ostro, a digital marketing company that works with major drug manufacturers, indicated that the threat of a DTC ban was barely registering on their radar of risks. “I have not seen any impact whatsoever from these proposals in terms of pharmaceutical marketing budgets at all,” Elsayyad said.
In any event, industry trade groups like PhRMA (Pharmaceutical Research and Manufacturers of America) and BIO (Biotechnology Innovation Organization) have supported DTC advertising, lobbying against any potential bans on First Amendment grounds. The industry has framed DTC ads as an important way to raise awareness about diseases and treatment options.
Ahmed Elsayyad
Public opinion on prescription drug ads is broadly negative, with recent polls showing growing support for reform. As of June 2025, 66% of 1,000 American voters support limiting direct-to-consumer (DTC) advertising, and 79% favor eliminating the industry’s tax deductions for ad expenses.
While it is difficult to interpret how effective such ads are given consumer privacy protections, they appear to be persuasive in terms of indirect measures. One survey found that 48% of physicians disagreed with a direct-to-consumer-advertising request but complied with it in order to accommodate the patient.
Transition from public opinion to pharma’s real concerns:
Given this groundswell of opposition and the bipartisan political momentum, one might assume the pharmaceutical industry would be worried about the potential threat of DTC restrictions on their bottom line. But Elsayyad indicated ongoing concerns over pricing. “There’s a lot of conversation right now about manufacturers’ products being expensive and ‘most favored nation’ status.”
On May 12, 2025, President Trump signed an executive order directing drugmakers to match the lowest prices paid by other developed countries, a policy that could curb U.S. drug prices significantly. According to the White House, Americans pay more than three times what other OECD nations pay for brand-name drugs, even after accounting for discounts.
This isn’t Trump’s first attempt at such a policy. During his first term, he tried to enact a similar most favored nation policy, but it didn’t survive. The current iteration has teeth: if manufacturers don’t voluntarily comply within 30 days, the order directs HHS to impose MFN pricing through rulemaking, consider drug importation from Canada, and potentially revoke drug approvals.
“If you had a ‘Most Favored Nation’ status, then I think there would be a question on whether or not a lot of these drugs would actually get to market,” Elsayyad said.
MFN could threaten R&D economics
The industry’s real worry may be losing pricing power in the U.S. rather than TV ad time. Deloitte’s most recent estimate found that the average cost for Big Pharma to develop a drug in 2024 was $2.2 billion. Part of the reason for the high cost is the fact that bringing a drug to market is still something of a gamble, with multiple studies showing the likelihood of approval from Phase 1 clinical trials remains in the ballpark of 10%, with a recent IQVIA study pegging the number at 10.8%.
This reality explains why the U.S. market is a core focus. “Right now, when manufacturers in the U.S. do a drug launch, they’ll first target the U.S.,” Elsayyad said. “It is the most lucrative area, and they’re trying to recoup the R&D costs,” he added.
A silver lining for DTC?
Demonizing DTC advertising obscures the full reality. “I don’t think completely banning DTC advertisements is necessarily a net positive. I think you need a more nuanced policy,” Elsayyad said. “I think the bigger question is whether or not DTC marketing is better for society, right? That’s the core question.”
Consider mental health, where pharmaceutical advertising helped drive one of the most significant destigmatization campaigns in modern medicine. “There was Prozac, Zoloft, Paxil. These were all depression medications that were out in the market, and then you had DTC advertisements that made it more normal to go out and say, ‘Hey, maybe I should ask my doctor about this anxiety or depression medication,'” Elsayyad said. Before these campaigns, depression and anxiety were whispered diagnoses, sources of shame that kept millions from seeking treatment.
The public health wins extend beyond mental health. Elsayyad pointed to smoking cessation, where Chantix advertisements motivated many Americans to finally attempt quitting. He also recalled “back in the late 1990s, the DTC campaigns for Lipitor and how much that helped people go get tested for cholesterol.”
An evolution already underway
No matter what happens with DTC advertising in the U.S., it is clear that the landscape was already evolving with the pandemic serving as a catalyst. “During COVID, a lot of offices put up ‘no rep’ signs,” Elsayyad recalled. While direct to physician marketing remains common, not all physicians support the practice. “The reality is, post-COVID, a lot of people kept those [signs] up.”
Direct-to-physician advertising is also less popular among younger physicians. “You have millennials now that are physicians that don’t necessarily want to interact with a rep at all. So as a result of that, they need a different way of engagement,” Elsayyad said.
The data backs him up: A 2016 survey found that only 18% of millennial physicians find pharmaceutical manufacturer promotion influential when considering new treatments, compared to 48% of older doctors. This skepticism extended to DTC advertising as well. A total of 81% of millennial physicians believe direct-to-consumer advertising becomes a burden because patients ask for medications they don’t need.
Elsayyad has encountered a number of younger physicians who fit this mold. “You have millennials now that are physicians that don’t necessarily want to interact with a rep at all,” he said.
Filed Under: Drug Discovery
