Pharma Is Spending Billions Talking to Consumers. The problem is consumers may not trust the Messenger.

Research firm IQVIA estimates the industry spent greater than $6 billion on DTC TV ads alone in 2024. That figure includes 75 brands that spent $10 million or more on each commercial. Total TV ad spend accounted for nearly $50 billion over the last decade, according to IQVIA data. But there’s a problem lurking beneath all those impressions. Americans might see drug advertising. They just don’t necessarily trust it. Nor do they trust the pharmaceutical companies pushing new drugs on TV.

Watch television for one hour. Chances are you’ll see it. Cheerful individuals walking dogs. Pairs of people walking along a beach. Grandparents frolicking with grandchildren. Someone who seemingly has been given a new life thanks to some medication name so ridiculous, you swear it was made up by tossing Scrabble tiles at a conference-room table. And then we hear the tried-and-true conclusion: “Ask your doctor if ______ is right for you.”

For years, that line has been a staple of pharma DTC ads. And pharma keeps pouring money into it.

DTC advertising still works — just not quite the way pharma likes to think it does

The argument against DTC is often exaggerated. Yes, advertising can alert people to conditions they knew little about. It can prompt someone suffering silently with symptoms to discuss their condition with a healthcare provider. It can make patients aware of therapies they never knew were available.

Studies show direct-to-consumer advertising also increases consumer awareness, patient requests and prescribing. One 2026 study published in Annual Review of Public Health found DTC advertising increased awareness of medications, prescription requests to clinicians, actual clinician prescribing and pharmaceutical expenditures. So let’s stop arguing about whether DTC works. We know it does.

The far more relevant question is: How effective is it today, and what is it costing? One of KFF’s January 2025 surveys helps answer that question.

An astounding 97% of U.S. adults reported seeing or hearing an advertisement for a prescription drug. 53% of respondents said they saw them almost daily. Hard to argue with that kind of reach. But drill down into that data following the patient through the marketing funnel and you’ll see effectiveness drops off quickly.

Of those consumers exposed to ads for prescription drugs, only 18% reported an ad made them discuss the specific drug marketed with their doctor. In 2008, that number was 33%. Consider that. Pharma advertising is omnipresent, yet significantly fewer consumers report it leads to a conversation with their physician than it did almost two decades ago. That should be a concern for pharmaceutical marketers everywhere.

But the 18% who act can be extremely valuable

However, there’s another side to the KFF numbers. When advertising DOES get someone into the physician’s office, it can have a big impact. Of consumers who had discussed an advertised medicine with their doctor, HALF reported that their physician prescribed the drug they asked about. But physicians aren’t just blindly honoring requests from patients wooed by television commercials.

45% said their doctor prescribed a different drug instead, 32% were told to try an OTC medicine and 62% said their physician suggested behavioral or lifestyle changes. That’s a critical distinction. The commercial may start the sale, but it doesn’t necessarily close it. And the conversation with the healthcare professional is clearly the crucial step. Consider how Americans view Pharma vs. physicians.

Pharma has a trust problem

In April 2026, KFF surveyed Americans about which groups they trusted to “do what is right” for the public. Only 21% answered that they had a great deal or fair amount of trust in pharma companies. Doctors and healthcare providers? About 70%.

If you work in pharma marketing, that gap should keep you up at night. Reach is bought. Frequency is bought. Prime-time TV is bought. Streaming video is bought. Paid search is bought. Social is bought. Programmatic ads are bought. Trust isn’t, though. And Gallup has a similar story. Their 2025 survey of American industries found only 28% of Americans viewed the pharmaceutical industry positively, while 58% viewed it negatively.

Pharma’s score was actually up significantly from 2024, when only 20% viewed it positively. But it was still near the bottom of Gallup’s list of 25 industries. It’s one of the weirder contradictions in healthcare marketing. Americans love their pharmaceutical products. They praise and benefit from pharmaceutical innovations. They’ll happily direct message their doctors about drugs they’ve seen advertised. But they do not necessarily trust the industry itself.

Price may be undoing billions of dollars of brand advertising

There’s another number pharma marketers should care about. 60%. Earlier this year, KFF reported that six in ten Americans were worried about affording their prescription drugs — the largest share KFF had seen since the polling firm started asking the question back in 2018. Even more troubling? Four in ten adults said they had taken some cost-related medication-saving action. Skipping doses. Not filling prescriptions.

Now think about the patient experience. You see a commercial. A slick, hopeful advertisement that paints a picture of how this breakthrough treatment can help patients. You talk to your doctor about it. They think it’s a good idea. You head to the pharmacy. Enter insurance denied, prior authorization, deductible, copay, formulary exclusion hell. Every heartfelt promise your brand made to you as a consumer crashes into the frustration that is the American healthcare system. And patients don’t always know – or care – whether the manufacturer, PBM, insurer, employer, or pharmacy is responsible for their medication being denied. All they know is that paying for that drug makes them feel poor. So pharmaceutical companies could be pouring billions into awareness, only to have the healthcare system chip away at their advertising-induced goodwill.

There is evidence that DTC economics are deteriorating

Maybe the most valuable DTC metric doesn’t involve awareness at all. Think ROI.

Last year IQVIA took a close look at specialty pharmaceutical launches, and the findings were stunning. Early stage companies now spend about $169 million on average on DTC media during the first three years of a typical launch. That’s up from about $140 million just a few years ago.

When it’s done right, DTC advertising clearly works to drive patients faster. Specialty launches that spent $1 million or more on DTC advertising averaged nearly twice as many patients per treating provider in year one as launches with little or no DTC budget. But the return on that investment? Dramatically different.

IQVIA calculated that for specialty products launched in 2013, there was about an 85: 1 ratio of gross sales to DTC spending during the first two years. For launches in 2022? About 1:1. Ninety-two specialty products launched in 2022 generated about $1.3 billion in combined sales, while spending about $1.1 billion on DTC advertising during their first 24 months.

That’s not evidence that DTC suddenly doesn’t work. It’s proof that the old formula of more media = more demand = successful launch needs to be reexamined.

Pharma advertising is competing against pharma advertising

One issue is saturation. When nearly everyone sees PDA and more than half of Americans see it daily, another spot isn’t necessarily increasing awareness. It may just be increasing commercials. Consumers are being asked to remember countless brand names for diabetes, obesity, cancer, psoriasis, migraine, depression, asthma, cardiovascular disease, and autoimmune disorders. Each brand is fighting for differentiation. So everyone raises their spending. Creative gets louder. Media frequency escalates. Before you know it, Pharma brands aren’t just competing against other brands. They’re competing against the pharmaceutical industry’s background noise. Another impression’s marginal value decreases.

Maybe DTC’s biggest problem isn’t advertising. It’s credibility.

Pharma marketers have long viewed awareness as the last mile between patient and prescription. Today the last mile may increasingly be trust. Consumers live in an information-rich world that didn’t exist when the blockbuster DTC model was developed. They Google it. They watch patients talk about medicines on TikTok and YouTube. They go to Reddit. They read reviews. They ask their friends. They follow influencers. They research side effects. They compare notes. And then many of them talk to someone far more trustworthy than any pharmaceutical company: their doctor.

That means the future of DTC marketing shouldn’t just be smarter advertising. It should be better overall patient communication. Educate about the disease. Make clear who is actually a suitable candidate for treatment. Clearly communicate benefits and risks. Be transparent about cost. Simplify the patient assistance process. Help patients navigate insurance coverage. Give doctors valuable tools to educate patients, not just create demand they then have to address. And above all, stop treating consumers like they won’t know when they’re being sold to. They will.

The industry needs to stop measuring exposure and start measuring value

Impressions dashboards are here to stay. Reach, frequency, website visits, and branded search will all keep reporting numbers that make us proud. But they can also mask how we’re really doing. Yes, reaching 100 million people is impressive. But is it more impressive than reaching five million patients who needed the information and actually trusted what they heard?

The harder questions are: Did patients learn more about their disease? Did patients who needed treatment finally seek it? Did patients ask their doctors about therapy? Did they start on treatment? Could they afford the treatment? Did they adhere? Did they get healthier? And most importantly, after hearing from the manufacturer, did those patients trust that company more — or less? Much harder KPIs to track than simple impressions. But much more relevant to the ultimate goals of pharma marketing.

DTC isn’t dead. The old DTC model may be.

Pharma can – and should – still advertise to consumers. Consumers can’t inquire about treatments they don’t know about. Diseases are under-diagnosed. People ignore symptoms for years before seeking treatment. It’s true that advertising can – and does – trigger important discussions that might not otherwise take place. But the industry also needs to accept that the playing field has changed.

Sure, 97% of Americans report seeing ads for prescription drugs. But only 18% report that a drug ad has encouraged them to ask their doctor about the advertised medication.

Only 21% of Americans trust pharma companies to do what’s right for the public.

60% of Americans worry about whether they’ll be able to afford their prescriptions.

The opportunity is right there in that chart. Imagine what would happen if you put all those stats on the same PowerPoint slide. The story they tell is much more powerful than any advertising reach report. Pharma doesn’t need to build awareness. Pharma needs to earn back trust, affordability and credibility. Throw another billion dollars at TV commercials, and you’ll probably sell more medicine. But if pharma wants DTC marketing to work effectively for the next decade, it has to sell something far more valuable first: trust in the brand.