Fletcher Prize Winner Evaluates Benefits and Risks of Direct-to-Patient Prescription Drug Platforms

Each year, we award a prize for the most outstanding scholarly paper on a topic in population medicine written by a Harvard Medical School or Harvard School of Dental Medicine student. We are pleased to announce that HMS student Kavya Shah has been awarded the 2026 Fletcher Prize in Population Medicine. 

Kavya aspires to a career at the intersection of clinical medicine and data-driven health policy, and cites his mentors as being critical to helping shape and inspire his winning essay, ‘Direct-to-Patient Prescription Drug Platforms — Promises and Pitfalls for Population Health’.

Tell us a bit about your paper, ‘Direct-to-Patient Prescription Drug Platforms — Promises and Pitfalls for Population Health’. What drew you to explore this topic?

My essay examines the rise of direct-to-patient (DTP) prescription drug platforms, which allow patients to purchase brand-name prescription medications directly from drug manufacturers without the use of insurance. DTP platforms have been promoted as tools to enhance price transparency and lower costs by bypassing intermediaries such as insurers and pharmacy benefit managers, but their increasing popularity over the past three years raises questions about medication safety and adherence. For example, these platforms can complicate clinicians’ ability to obtain accurate medication fill histories from electronic health records, which typically rely on insurance claims to capture pharmacy dispensing data. Any pathway that allows patients to purchase important treatments at lower prices is meaningful progress, but my aim with this essay was to evaluate who actually benefits from DTP platforms and what new risks they may introduce.

DTP platforms have received a lot of press coverage recently, especially after the launch of TrumpRx this past February. I first learned about DTP platforms in the news and was interested in understanding how they might affect U.S. prescription drug spending, which is nearly three times that of peer OECD countries. The idea for the essay later came through conversations with Dr. Robert Yeh, Dr. Rishi Wadhera, and Dr. Dhruv Kazi at the Smith Center for Outcomes Research at BIDMC—I’m very grateful for their continuous encouragement and mentorship as I wrote this paper. 

How did you hear about the Fletcher Prize, and why did you decide to submit?

I first heard about the Fletcher Prize through the Essentials of the Profession course for first-year students at Harvard Medical School. Essentials was a fantastic opportunity to learn more about the sociopolitical and economic drivers of health in the U.S., and I was particularly intrigued by Dr. Ben Rome’s lecture on the high costs of brand-name prescription drugs. Essentials helped me formalize ideas I had been thinking about regarding different levers to improve health care access, and gave me a framework to assess the population health impact of current rules, policies, and laws. The Fletcher Prize was a great way to continue exploring these ideas and study a new and emerging avenue for purchasing prescription medications.

About the Fletcher Prize in Population Medicine

The Fletcher Prize, named for Department of Population Professors Emeriti Suzanne and Robert Fletcher, who are national leaders in advancing the field of clinical epidemiology, is awarded by the Department for the best paper on a topic in Population Medicine written by a Harvard Medical School or Harvard School of Dental Medicine student. 

Papers are judged by an expert panel of DPM faculty and awarded with a $1000 prize. 

Learn more about the Fletcher Prize.