Direct-to-Consumer Drug Advertising Debate Resurfaces Amid Policy Scrutiny

The controversy over whether drug companies should be allowed to market prescription drugs directly to potential patients, which has simmered for decades, has begun receiving renewed attention from both the Trump administration and legislators. Total spending on direct-to-consumer advertising of prescription drugs topped $9 billion in 2024, according to MediaRadar, which monitors advertising.

Novo Nordisk, which manufactures Ozempic, spent an estimated $180 million in direct-to-consumer advertising in 2022 and $189 million in 2023, according to MediaRadar. By last year, the sum - including radio and TV commercials, billboards, and print and digital ads - had reached an estimated $201 million. Novo Nordisk declined to address those numbers.

The debate over direct-to-consumer ads dates to 1997, when the FDA loosened restrictions and allowed prescription drug ads on television as long as they included a rapid-fire summary of major risks and provided a source for further information. The introduction of Medicare Part D, in 2006, brought "a huge expansion in prescription drug coverage and, as a result, a big increase in pharmaceutical advertising." A study co-written in 2023 found that pharmaceutical ads were much more prevalent in areas with a high proportion of residents 65 and older.

The question has particular relevance for older adults, who contend with more medical problems than younger people and are more apt to take prescription drugs. "Part of aging is developing health conditions and becoming a target of drug advertising," said a researcher who studies health communication and decision-making at the Dartmouth Institute.

Industry and academic research have shown that ads influence prescription rates. Patients are more apt to make appointments and request drugs, either by brand name or by category, and doctors often comply. Multiple follow-up visits may ensue.

Only New Zealand and, despite the decadelong opposition of the American Medical Association, the United States allow direct-to-consumer prescription drug advertising.

Public health advocates argue that such ads encourage the use and overuse of expensive new medications, even when existing, cheaper drugs work as effectively. Drug companies don't bother advertising once patents expire and generic drugs become available.

In a 2023 study in JAMA Network Open, researchers analyzed the "therapeutic value" of the drugs most advertised on television, based on the assessments of independent European and Canadian organizations that negotiate prices for approved drugs. Nearly three-quarters of the top-advertised medications didn't perform markedly better than older ones, the analysis found.

"Often, really good drugs sell themselves," said the senior author of the study and director of the Program on Regulation, Therapeutics, and Law at Harvard University. "Drugs without added therapeutic value need to be pushed, and that's what direct-to-consumer advertising does," he said.

Opponents of a ban on such advertising say it benefits consumers. "It provides information and education to patients, makes them aware of available treatments and leads them to seek care," said a health economist at the Wharton School of the University of Pennsylvania. That is "especially important for underdiagnosed conditions," like depression.

Moreover, in a recent JAMA Health Forum commentary, direct-to-consumer ads lead to increased use not only of brand-name drugs but also of non-advertised substitutes, including generics.

The Trump administration entered this debate last September, with a presidential memorandum calling for a return to the pre-1997 policy severely restricting direct-to-consumer drug advertising.