BERN, Switzerland — Roche Holding AG is considering a dramatic overhaul of its U.S. business model, exploring direct-to-patient drug sales as a way to bypass intermediaries, slash drug costs, and blunt the impact of escalating political pressure on pharmaceutical pricing.
CEO Thomas Schinecker confirmed on Thursday that the Swiss drugmaker is in active discussions with the U.S. government regarding the plan, which could eliminate middlemen such as pharmacy benefit managers (PBMs). He stated that these entities absorb nearly half of the profits from drug sales without assuming any of the risks associated with innovation.
“If the United States would like to cut prices by 50 percent, it’s very easy,” Schinecker said on a call with reporters. “We go direct. And this is one of the discussions that we’re having with the United States, and that would bring down costs quite quickly.”
The comments come as President Donald Trump’s administration considers sweeping reforms, including a “Most Favoured Nation” pricing policy that would require drugmakers to offer the U.S. the lowest prices they offer any other similarly wealthy country. According to RAND Corporation research commissioned by the U.S. Department of Health and Human Services, drug prices in the U.S. are, on average, 2.3 times higher than in 32 other OECD countries.
While the pharmaceutical industry has so far avoided Trump’s proposed tariffs, the president has floated the idea of levies as high as 200% on certain drugs. Roche said it has expanded its U.S. manufacturing footprint and stockpiled inventory to mitigate potential disruption. In April, the company announced a $50 billion investment in U.S. manufacturing and research and development.
“We hope that the US government, then also sees, with all the investments that we and other companies are making, that the companies are intending to produce the medicines that are needed in the US, for the US,” Schinecker said.
Solid Earnings Back Bold Strategy
Roche’s direct-to-patient pivot comes as it posted better-than-expected first-half earnings, buoyed by strong sales of cancer and allergy drugs. Operating profit rose 6% to 12 billion Swiss francs ($15.15 billion), above analyst expectations of 11.7 billion francs. Core diluted earnings per share reached 11.1 francs, beating forecasts of 10.5 francs.
Revenue increased 7% at constant exchange rates to 30.9 billion francs, slightly ahead of consensus estimates. The company reaffirmed its 2025 guidance for mid-single-digit sales growth and high single-digit growth in core EPS.
Standout performers included breast cancer drug Phesgo, up 55% to 1.2 billion francs, and Xolair for asthma and food allergies, which rose 34% to 1.45 billion francs. Roche’s eye treatment Vabysmo, though slightly below expectations, still generated over 2 billion francs and ranked among the top five growth drivers along with Hemlibra for hemophilia and multiple sclerosis therapy Ocrevus.
The U.S. remained a bright spot, with sales climbing 10%, driven by strong demand for Roche’s top four drugs. The Diagnostics division held steady at 7 billion francs, offsetting pricing pressures in China.
Industry Implications
If Roche moves forward with a direct-to-patient model in the U.S., it would join peers such as Pfizer, Eli Lilly, and Novo Nordisk, which are experimenting with telehealth-enabled direct distribution. But Roche’s strategy may go further, challenging the very structure of the U.S. pharmaceutical supply chain and potentially resetting expectations around pricing and access.
