Direct to Patient Engagement in Freefall

In this 45th episode of Bald Ambition, host Mookie Spitz sits down with attorney–pharmacist Darshan Kulkarni to dissect the fast-growing world of Direct-to-Patient (DTP) marketing and clinical trial models. He unpacks how DTP has evolved, why it appeals to pharmaceutical companies, and—most importantly—the hidden complexities that come with it. 

From state law inconsistencies to privacy, advertising, malpractice, and consent concerns, Darshan shows how what looks like a simple shift to “just using Zoom” quickly becomes a tangled web of compliance obligations. Whether you’re in legal, clinical operations, or marketing, this conversation breaks down the real risks and why they matter for anyone thinking about engaging patients directly.  

Their conversation reveals a system in freefall—chaotic, fragmented, and confusing at every level:

• Telemedicine blurred the boundaries between pharma, providers, and patients, raising questions of responsibility and compliance.
• Competing laws across states leave companies unsure whether they’re in full compliance or skating on thin ice.
• HIPAA, PHI, and data ownership are entangled with marketing funnels, referral pathways, and AI-driven documentation tools.
• PBMs (pharmacy benefit managers) continue to inflate costs while claiming to save money, adding another layer of distortion to the supply chain.
• Patients, providers, pharma, and tech firms are caught in a spaghetti bowl of shifting rules, competing interests, and massive financial incentives.

Darshan lays out clear recommendations for anyone navigating this uncertainty—whether you’re a pharmaceutical company, provider, tech startup, or pharmacy:

• Rethink your business model completely. Don’t assume past practices will hold up.
• Flow-chart every patient touchpoint. Map interactions across providers, pharmacies, telehealth platforms, and pharma.
• Bring legal oversight into the room early. Compliance isn’t an afterthought—it must be baked into design, engineering, and marketing.
• Stay on top of evolving regulations. Monitor FDA, FTC, DOJ, OIG, and state-level changes in real time.
• Balance compliance with patient care. Never lose sight of the ultimate goal: better, safer, more accessible health outcomes.

The Guest

Darshan Kulkarni is a Philadelphia-based food and drug lawyer who focuses on the legal and regulatory challenges of Direct-to-Patient (DTP) programs in pharma and medical devices. As the founder of the Kulkarni Law Firm, he helps companies balance innovation with compliance and addresses issues like privacy, advertising, informed consent, and multi-state telemedicine rules. Darshan also teaches FDA regulatory law and hosts the DarshanTalks podcast, where he breaks down the risks and opportunities of engaging patients directly.

His Firm

The Kulkarni Law Firm is a boutique life sciences law practice based in Philadelphia, dedicated to helping pharmaceutical, biotech, and medical device companies navigate FDA, FTC, and DOJ compliance. The Firm focuses on high-risk areas where law and business intersect—including Direct-to-Patient (DTP) programs, drug and device advertising, clinical research operations, and mergers and acquisitions. By combining regulatory insight with practical industry experience, the Firm supports clients in managing promotional review committees, structuring compliant patient engagement, and preparing for government scrutiny.

Resources

https://www.kulkarnilawfirm.com