When a new service allowing people to shop online for prescription skin medications launched last month, Anne Marie McNeill had her doubts.
The site, Dermatology.com, is backed by drug manufacturer Bausch Health Companies Inc. Before receiving a prescription, a user had to complete a virtual medical consultation through an outside company called RxDefine.
To test McNeill’s doubts, a friend, sitting with McNeill at the kitchen table, uploaded close-ups of a red, scaly rash characteristic of lupus, a serious medical condition. The website soon came back with a recommendation for an acne medication, with no follow-up questions or even a diagnosis, according to McNeill, who is a dermatologist.
“There are responsible ways to do teledermatology,” she now says. “This is not one of them.”
In a private Facebook post, which Bausch shared with Bloomberg, McNeill didn’t mince words, calling the service a “fake consult serving pharmaceutical greed exclusively.” In the post, she threatened to tell her story to the public.
McNeill’s concerns were hardly unique. In the broader community of U.S. dermatologists, outrage had already been building. Some had discussed a boycott of Bausch products, and hundreds of dermatologists signed a petition that was sent to Bausch and seen by Bloomberg News asking the company to shut down the service.
Not long after, and just weeks after its launch, Dermatology.com closed down its online prescription service.
“We are re-imagining Dermatology.com to have a significant focus on patient health education, and are committed to helping patients find local dermatologists for in-office consultations,” a Bausch spokeswoman said in a statement. “When Dermatology.com is live again, the updated site will not include patient consultations.”
RxDefine, which ran the medical consults for Dermatology.com, didn’t return a request for comment.
Several other platforms, such as privately held Hims and Roman, offer prescription drugs online, making the purchase of medications almost as easy as buying clothing on the Internet. They have grown thanks to more favorable state laws and reductions of insurance drug benefits that put heavier financial burdens on individuals.
About a quarter of those who take prescription medications report it is somewhat or very difficult for them to afford the expense, according to a Kaiser Family Foundation poll last year.
That shift has pushed many patients to the Internet to scout out better deals. Many of the new online platforms, including Dermatology.com, let users sidestep health insurance entirely and pay cash for prescriptions.
The trend has also attracted interest from pharmaceutical companies, which see these new models as an opportunity to lower costs through online distribution, said Zachariah Reitano, co-founder of the telehealth company Ro.
First of a Kind
Dermatology.com appears to have been one of the first such platforms directly backed by a drug manufacturer, though other pharmaceutical companies have also expressed interest. In a release when the site’s online prescribing function launched in February, Bausch touted it as a first of its kind offering that could ease patient access to treatments for conditions like acne and wrinkles, with 15 products initially available and plans to expand that further.
“We believe that Dermatology.com has the potential to meet patient needs and help grow our dermatology business,” Bausch Chief Executive Officer Joseph Papa said to investors that month.
There are other examples of partnerships between drug companies and the online companies, though many appear to be structured differently. Ro is working with the biotech Gelesis Inc. to offer the weight-loss product Plenity.
Men’s health platform Roman, which Ro runs, also recently partnered with the drugmaker Pfizer Inc. to distribute generic Viagra manufactured by its Greenstone unit. In a release, both companies touted the agreement as a way for patients to have confidence their pills are high quality, calling Viagra “one of the most counterfeited drugs in the world.”
Yet as the controversy over Dermatology.com illustrates, drug companies walk a fine line in their shift to online platforms. They may also risk misleading patients about conflicts of interest, especially if an online platform sells only one drug company’s products but doesn’t state that clearly to users, said Carrie Kovarik, an associate professor at the University of Pennsylvania’s medical school who has researched teledermatology.
“The conflicts out there are rampant. It’s not just the pharmaceutical companies,” she said. “There needs to be transparency about who you are, what you can provide and who you are connected to, business-wise.”
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