Patients are generally seeking new sources of medical information beyond the primary care physician. A survey found that one out of every two patients asks the physician questions about a prescription, while nearly a third ask their pharmacist, and only 8% go to the drug website.

Drugmakers, long reliant on using DTC ads to drive patients into doctor’s offices, should rethink that strategy.

When Eli Lilly launched a DTC campaign in October for Trulicity, its weekly injectable diabetes drug, the drugmaker waited until it had achieved “good reimbursement, access and status” before launching the campaign.

The marketing model used to be “big and bold out of the gate on day one,” Keith Johns, Lilly’s senior director of diabetes marketing, said in an interview last fall. Now, “the industry is starting to challenge that model.”

See also: Lilly kicks off DTC campaign for Trulicity

A new survey suggests why. In the last three years, a third of Americans have changed primary-care physicians, and 40% have enrolled in a new health insurance plan, according to findings of the recent survey of 1,000 adults conducted by Finn Partners. This creates a new market dynamic for healthcare brands.

“The consumerization of healthcare is king, not the consumer,” said Gil Bashe, managing partner of health at Finn Partners.

That is, if a patient today requests a new drug or tries to refill an old one, that request may face more resistance from physicians with differing views about a specific medication or from payers that give certain medications preferred status on their formularies than it would have in the past.

This raises questions about the effectiveness of traditional branded pharmaceutical advertising campaigns, which perform best in a market where the drug is broadly available.

“That’s great if your brand has great formulary position,” Bashe said. If it doesn’t, such a campaign is “probably not going to work, and that will frustrate doctors and consumers.”

The survey’s findings illustrate the new health economy in which pharma marketers must compete. Not only are costs a larger concern for patients, and some payers are experimenting with indication-based payment models, but patients are generally seeking new sources of medical information beyond the primary care physician. When prescribed a drug, roughly one out of every two patients asks the physician questions about it, nearly a third ask their pharmacist, and only 8% go to the drug website.

A higher number of Americans are enrolled in high-deductible plans that require them to spend more on out-of-pockets costs for care. Even so, few patients are aware of financial assistance programs like copay cards—only 19% of the survey’s participants say they are very familiar with copay cards while 33% of Americans are not familiar with the term “prior authorization.”

Payers, facing their own rising costs, are narrowing the formularies, in some cases limiting or restricting access to high-priced drugs. In fact, pharmacy benefit managers like Express Scripts and CVS Health excluded more drugs from their formularies in 2015, compared to 2014. OptumRx, Aetna, Cigna, and Prime Therapeutics are expected to launch exclusion lists this year, according to a Bernstein analyst.

See also: Express Scripts’ Steve Miller takes on drug industry in pricing battle

The findings point to a broader issue for marketers, according to Bashe. Few pharma companies consider the patient’s journey through the US health system as they develop their marketing plans even though they are aware of the patient’s disease journey.

“The patient doesn’t really have full information at hand to be an equal player in the system,” he said. “Through that lens, we don’t see them yet as the customer.”

The growing importance of cost and convenience creates problems for drugmakers. Many patients today are more likely to visit a walk-in clinic than go to a doctor’s office; 33% of all respondents said a walk-in clinic is their first or second choice for health information. (Primary-care physicians and medical information websites were also cited as the top choices.)

The preference for walk-in clinics was most pronounced among the 18-29 age group. As more patients look to other sources beyond the PCP for medical information, they may also turn to the pharmacist dispensing their medications. In that regard, the doctor’s office is beginning to yield to the pharmacy.

See also: Q&A: Why McCann Health set up a pharmacy focused agency

About 47% of Americans ask their doctor questions about a drug, while 30% ask the pharmacist. Nearly half of respondents—43%—say that their pharmacist always or frequently recommends an alternative brand or type of medication in order to reduce out-of-pocket costs, and a similar percentage of Americans—48%—usually or always will accept that recommendation.

“The role of the pharmacist in a formulary driven world is becoming far more dominant,” Bashe said, later adding: “The pharmacist is becoming as good a choice for health counsel.”

Marketers are seeing a need to better communicate with the pharmacist. Late last year McCann Health launched the McCann Pharmacy Initiative, a new agency focused on pharmacist communications.