Americans live in a paradox when it comes to prescription drugs. On one hand, patients know they need medications to stay healthy, manage chronic conditions, or simply function day-to-day. On the other hand, they resent — often deeply — the very industry that produces those lifesaving therapies. It’s a need-hate relationship, and it’s getting worse.
Pharma’s strategy of selling directly to patients through DTC advertising has done nothing to soften that resentment. In fact, it has arguably made it more visible. Yes, TV ads may help patients recognize symptoms or understand treatment options, but they do nothing to address the reality that too many people still struggle to afford the very drugs being enthusiastically promoted to them during prime time.
Here’s why the tension between patients and Big Pharma keeps widening.
1. Patients Understand the Value — But Not the Price
Patients don’t question whether insulin, asthma inhalers, GLP-1 drugs, or cancer therapies are medically necessary. They know they work. They know they can be life-changing.
But they can’t understand — or defend — the price tags.
When someone is told the drug they must take to survive will cost hundreds or thousands per month, any positive feelings about innovation evaporate. Pharma often argues that prices fund research, but patients see a system where the U.S. pays far more than any other developed nation. They see CEOs earning tens of millions. They see stock buybacks. They see rising list prices year after year.
Affordability overwhelms everything else. Even gratitude for medical breakthroughs.
2. DTC Advertising Highlights a Disconnected Reality
Pharma spends billions telling patients to “ask your doctor,” often implying that new drugs are the key to taking control of their health. But for too many people, asking their doctor is the easy part — paying for the prescription is the impossible one.
The ads never mention the part where:
- Your insurance may not cover the drug.
- Your deductible resets every January.
- The copay card expires.
- Your prior authorization gets denied.
- You have to choose between medication and rent.
Patients aren’t fooled. They know DTC ads are meant to sell, not solve. And when advertising pushes demand for drugs that patients can’t afford, frustration rises.
3. Pharma’s Affordability Programs Feel Like Band-Aids
Savings cards, patient assistance programs, “pay as little as $0” offers — they all sound patient-friendly. And sometimes they genuinely help.
But patients increasingly see these programs for what they are: temporary, complicated, and often restricted tools that exist because the underlying pricing system is broken.
Most savings programs:
- Exclude the uninsured.
- Don’t apply to Medicare beneficiaries.
- Reset annually with new paperwork.
- Get rejected by specialty pharmacies.
- Are quietly discontinued when a drug gains market share.
It feels less like generosity and more like a negotiation tactic: “We’ll help you for now — but don’t ask us to lower prices.”
4. Patients Don’t Hate Innovation — They Hate the Business Model
Contrary to what some industry leaders believe, patients don’t resent scientific progress. They don’t resent R&D. They don’t resent the people working in labs bringing new therapies to market.
What they resent is the business. The high prices. The lobbying. The lack of transparency. The sense that profits consistently outweigh patient access.
The relationship would be very different if people believed pharma companies were fighting for affordability with the same energy they fight for patent extensions.
5. Selling to Patients Without Supporting Patients Is a Losing Strategy
Pharma wants patients to request branded drugs. But patients want to know:
- Will I actually be able to afford this?
- Will my insurance company cover it?
- Will the price increase next year?
- Will the manufacturer pull support once the drug succeeds?
The biggest driver of distrust is simple:
Patients feel like customers only when pharma wants them to buy something — not when they need help paying for it.
Until that changes, the need-hate relationship will continue.
6. What Pharma Must Do to Rebuild Trust
Pharma can’t market its way out of a trust deficit. Patients aren’t looking for better ads — they’re looking for better access and honesty.
If pharma wants to repair the relationship, it must:
- Push for real affordability reforms instead of protecting outdated pricing structures.
- Be transparent about pricing, R&D costs, and how money flows through PBMs and insurers.
- Simplify patient assistance so it aligns with real-world patient journeys.
- Create patient-centric value strategies, not boardroom-centric revenue strategies.
- Show alignment with public health, not just shareholders.
Patients don’t expect drugs to be free. They expect the system to be fair. Right now, it isn’t — and they know it.
Patients need Big Pharma — the science, the innovation, the therapies that allow them to live longer and better lives. But they hate the feeling that their health is a bargaining chip in a massive profit machine.
As long as pharma keeps selling directly to patients without addressing the affordability crisis, the relationship will stay strained. And more marketing won’t fix a trust problem rooted in economics and lived experience.
