Prevalence of DTC in Pharma

Over the past decade, IQVIA has catalogued hundreds of brands that have used DTC advertising in their promotional strategy. Totaling just under $50 billion in combined spend over 10 years, drug ads on TV have become ubiquitous. But it’s not just about the sheer volume of spending. Brands take very different approaches to when and how they invest in DTC, and what happens when they pause or stop. This diversity in strategy gives us a rich set of real-world examples to analyze what works, what doesn’t, and why.

For brands in their first year on the market, television advertising is often a key means of raising brand awareness and creating consumer demand. Between 2020-2024, just over 20% of launched products, or 66 brands, spent at least $1 million on DTC advertising and had at least $1 million in gross sales in their first year on the market. The resulting analytics make many segmentations, forecasts, and models possible.

TV or Not TV? That is the Question—An Immunology Case Study

In 2024, one out of every three dollars in pharmaceutical DTC spend occurred in immunology, with 15 brands in the class spending at least $10 million on TV advertising. Add to that, from 2020-2024, four of the top 10 DTC spending launch brands were immunology products. As more brands entered the market, indications expanded, promotion intensified, and the number of defined daily doses, or more commonly understood as days of treatment, increased by 72% in the U.S. market¹.

Given the intense level of competition and a solidified presence of market leaders, DTC advertising has become an important cost for doing business for immunology brands entering the market. Over the past decade, 16 brands in the class spent at least $1 million in their first 36 months post launch on DTC and 10 spent at least $100 million. Plotting DTC spend versus gross sales and observing the number of patients (as denoted by the size of the bubble), there is a clear relationship between DTC spending, the number of patients on a brand, and cumulative gross sales. Brands that spent more on DTC tended to have more patients on treatment.

DTC ads don’t just boost awareness—they also help to spark real conversations between patients and doctors. When patients ask about a treatment they’ve seen advertised, they often walk out with a prescription, even if it is not always for the exact drug they requested. In a year-long study of 148k gastroenterology treatments, 1 in 10 involved a patient request, and over 80% of those requests led to a prescription, especially for conditions like Ulcerative Colitis or Crohn’s Disease. Bottom line: DTC ads drive action, not just attention.

When it comes to building a successful brand, however, DTC advertising is just one piece of the puzzle. While DTC campaigns can boost public awareness and help get a product in front of more eyes, true brand success is built on a much broader foundation. Clinical effectiveness, robust evidence, smart promotional strategies, compelling messaging, and strong market access all play critical roles. Consider again the immunology market as an example. Some of the industry’s most recognized, market-leading, and successful brands highlight how DTC investment can increase public awareness, complement other strategies, and ultimately drive more patients onto a branded product. However, while DTC is a powerful tool that amplifies brand presence, it works best when part of a well-rounded, evidence-based approach.

Not Without Controversy

DTC advertising by pharmaceutical companies, while advantageous for patients seeking treatment and manufacturers aiming to expand their brands, has come under rising political scrutiny. Supporters of DTC advertising invoke First Amendment protections for commercial speech, yet critics argue that these advertisements often lack sufficient information on potential adverse effects and highlight that the United States is one of only two countries globally permitting televised pharmaceutical ads. This year, the FDA announced renewed emphasis on regulations intended to create greater accountability in pharmaceutical advertising, particularly on television, though the measures could extend to other areas of DTC marketing as well.

The FDA’s formal statement outlined a proposed regulatory framework designed to increase oversight of pharmaceutical advertising in paid media, ushering in a period of heightened transparency and accountability. Advocates for additional regulation contend that DTC advertising has led to increased medicalization and has prioritized corporate interests over public health. As part of this reform, the FDA seeks to close the “adequate provision” loophole to ensure more comprehensive information for consumers. While the proposal stops short of a full ban, it signals substantial changes for the industry. This evolving landscape will require life sciences companies to adjust, but there are still ways for brands to thrive. 

Measuring DTC Impact on Drug Demand

For pharmaceutical manufacturers with DTC advertising embedded in their brand strategies and sales forecasts, a meaningful reallocation of spend away from broad-reach awareness channels like linear television raises new questions about how demand dynamics may shift because of these changes. While DTC promotion drives patients to treatment and demand is often seen to accelerate in correlation to spend, the actual methodologies of attributing the impact are complex. Additionally, not all DTC spend has a positive return on investment. There are many brands that invested heavily in DTC but missed other market dynamics, making it a high-risk, high-reward strategy.

In a study of the first few years on the market for specialty products, the DTC impact on demand generation and provider productivity is clear. Measuring campaign success via patient and HCP productivity allows for comparisons across classes, time, and investment. Specialty brands that spent at least $1 million on DTC averaged nearly double the number of patients per provider as those that did not spend on DTC. This advantage, on average, was held through the first five years on the market.

Even with a doubling of the patient to HCP productivity ratio, the investment does not always mean that DTC has a positive return on investment. In the same study, a simple ROI equation of average gross sales divided by DTC spend across the first 24 months in market shows how the investment hypothesis has changed over the past decade. The stark decline in ROI has happened as airwaves became more saturated, DTC promotional spend increased 50%, and market access challenges proliferated for launch brands.

This is exemplified by 9 specialty brands that launched in 2022 that combined for $1.3 billion in gross sales while cumulatively spending $1.1 billion in DTC over their first 2 years in market. Beyond DTC, brands still need to account for other promotional costs, the total cost of access, patient support programs, and other discounts. Even without regulatory changes designed to decrease DTC TV advertising for pharmaceuticals, the average return on investment at launch has been declining for over a decade.

It can be argued that the awareness and advocacy built by DTC takes time to show positive investment, especially in modern markets. Early brand awareness by patients and providers creates brand recognition that can appear later in the brand lifecycle. Any return on investment analysis should consider both short-term and lifetime values and net revenue adjustments that account for the brand costs of promotion and access when evaluating strategy and measuring impact. Beyond ROI analytics, it is also important to consider campaign optimization and effectiveness as part of a modern marketing strategy.

Key Questions for Commercial Leaders

While potential changes to DTC regulations under the Trump Administration have been a topic of conversation for several years, the emerging policy could have an immediate impact for many manufacturers and brands that have DTC as part of their 2026 brand strategy. It is also important to measure reactions relative to the actual guidance in the market in conjunction with legal and regulatory consultation.

Many questions are emerging that need to be urgently addressed to inform commercial strategy and 2026 forecasts:

• Who wins and who loses? Will reductions in DTC spend help or hurt incumbent or challenger brands?
• For competitive classes, how will changes in promotion spill over to market share and patient acquisition? What is the best way to model the impact?
• How can shifts in consumer or digital promotional strategy offset a reduction in DTC? Patients as consumers is a growing focus of the industry. Sophisticated strategies exist to ramp up highly targeted consumer outreach. Social media is an important aspect but also under scrutiny.
• What is the role of Connected TV (CTV) advertising in a new world? How will new regulations on linear TV impact digital TV and channel mix? With many households cutting the cord over the past few years and 83% of households connected to streaming services, linear TV viewership was already in decline².
• Who are the healthcare providers that are most promotionally sensitive to DTC advertising? How and geographically where will markets change?
• How will reductions in DTC advertising impact brand awareness and promotional response? Will messaging need to change?
• Can unbranded or disease awareness campaigns be effective in driving consumers into the health system? Does evidence need to change to support new strategies?
• How will changes in DTC utilization impact launch trajectories which were already compressed? Will we see further launch suppression for new products entering the market in 2026 and beyond?

What Will Promotion with New DTC Guidance Look Like in the Future?

As the life sciences industry contends with sweeping new DTC advertising regulations, and the potential legal challenges they may provoke, a central strategic question is coming into focus: How will these changes reshape the future of promotional engagement with consumer audiences? Many of the most successful brands have relied heavily on linear television to improve brand awareness, create market differentiation, and drive patients to treatment.

For growing classes like obesity, consumer activation and advocacy are key strategies and a critical factor in why the recent launches were so successful. For intensely competitive classes such as immunology, changes in the promotional mix for major players will create both headwinds and tailwinds in the market.

Conclusion

DTC television advertising continues to play a pivotal role in shaping brand awareness and patient engagement within the U.S. pharmaceutical industry, with billions invested annually and immunology leading recent spending trends. While DTC campaigns have proven effective in driving patient action and boosting prescription rates, the landscape is rapidly evolving. As regulatory scrutiny intensifies and traditional DTC advertising is observed to yield diminishing returns, life sciences leaders must proactively adapt and urgently reassess their promotional strategies. Success will depend on being able to:

• Embrace agile, data-driven digital strategies to build brand awareness and drive patient engagement, future-proofing your brand for growth in a competitive and complex landscape.
• Adapt quickly to new FDA regulations by reviewing current DTC investments, optimizing channel mix, and strengthening evidence-based messaging.
• Explore innovative consumer outreach including Connected TV and targeted digital campaigns to offset potential reductions in traditional TV spend.
• Engage cross-functional teams (legal, regulatory, marketing, analytics) to model the impact of regulatory changes and ensure compliance while maximizing commercial opportunity.

In this period of transformation, organizations that act decisively by reassessing their DTC investments, refining messaging, and future-proofing their strategies will be best positioned to thrive and deliver meaningful impact for both patients and brands. The ability to leverage robust analytics and targeted consumer outreach will be critical for sustaining brand growth and patient adoption in an increasingly competitive and regulated environment.

With IQVIA’s extensive data archives, the foundational insights needed to assess how shifts in direct-to-consumer (DTC) promotion influence brand awareness, patient adoption, and physician engagement are already within reach. As promotional strategies increasingly embrace digital channels, IQVIA Digital is uniquely positioned to deliver agile, data-driven solutions that align with the evolving needs of life sciences organizations. Now is the time to translate insight into action and impact. Please contact your IQVIA representative for more information.

1. Understanding the Use of Medicines in the U.S. 2025. IQVIA Institute for Human Data Science. April 30, 2025. Accessed September 22, 2025. https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/understanding-the-use-of-medicines-in-the-us-2025

2. Commissioner O of the. FDA Launches Crackdown on Deceptive Drug Advertising. FDA. September 9, 2025. Accessed October 21, 2025. https://www.fda.gov/news-events/press-announcements/fda-launches-crackdown-deceptive-drug-advertising