A Direct-To-Consumer Telehealth Platform Investigation: A Patient’s Perspective
By Peyton Agard Miles
Have you noticed an increase in medication-related advertisements on your social media? Are the ads targeting your symptoms? Do you feel influenced to buy the medication online?
If you have felt this way, I promise you are not alone. As a young adult patient with multiple chronic and rare diseases, my social media feed is littered with direct-to-consumer (DTC) pharmaceutical ads. Oftentimes, I feel like I cannot scroll more than a couple of minutes on my social media without being influenced to buy a pill, injection, or device promising to make my symptoms disappear.
After spending only 15 minutes on Snapchat, I received 5 total GLP-1 advertisements: 4 from Noom and 1 from Ro. As someone who has struggled with my weight throughout my life, I truly felt targeted. Not only that, but the advertisements frame taking a body-altering (and for some, a life-saving) medication as if it is a viral Tik-Tok trend.
As a young adult patient, it is incredibly disheartening to see, time and time again, the misrepresentation of a patient's experience taking medication. When the majority of us consider taking a medication, we weigh whether it is better to deal with the side effects of the medication or the condition’s symptoms we’re experiencing.
Most of these advertisements prevent this process for us, failing to clearly show the medication’s safety and efficacy information. If you do not know what information to look for, it is incredibly easy to be persuaded to buy into the quick fix without the entire story.
As Health Policy Lab Co-Chair, I am thrilled that these issues are beginning to reach policymakers. Senators Durbin (D-IL), Sanders (I-VT), Warren (D-MA), and Welch (D-VT) recently released an investigation into the relationship between two pharmaceutical manufacturers—Pfizer and Eli Lilly—and the telehealth companies that they have paid: Populus, UpScriptHealth, Form Health, Cove, and 9amHealth.
The investigation revealed some of the dishonest practices that exist in the relationship between pharmaceutical manufacturers and telehealth companies, and demonstrates how patients have been negatively impacted by these practices. As a patient myself, I was appalled at the fact that “UpScriptHealth, one of Pfizer’s telehealth platforms, advertised a job opening to prescribers with the statement, “on average, providers can complete 6-10 visits an hour” saying “a completed visit is either an approval or denial of prescription request.” A lot of advertisements emphasize telehealth platforms’ ability to connect patients directly with a medical professional in a telehealth format. The reality, however, is that companies like UpScriptHealth are primarily focused on pushing the medications, not providing the best patient experience.
Patients also rely on their providers to give them the information that is best for their health, which may or may not be medication. These telehealth companies are pushing a frighteningly high number of prescriptions to patients. For example, “it was revealed that by the telehealth companies that a 9amHealth patient was six-times more likely to be prescribed an Eli Lilly medication compared to another brand-name drug, and 66 percent of all Form Health prescriptions issued across all patients were for Eli Lilly medications.” Not only is the likelihood of being prescribed a medication by a provider who barely knows you and your conditions frighteningly high, but certain brand name medications are being pushed as a result of the behind the scenes relationship between the telehealth companies and the pharmaceutical manufacturers. Oftentimes, people are looking for the most cost-effective treatment option which is almost always the generic option, not the brand name. If telehealth companies are paying providers to prescribe specific brand names or even to push specific drugs, how can the trust between patient and provider be maintained?
While telehealth offers a unique opportunity to increase overall access to healthcare, the unethical relationships between the pharmaceutical manufacturers and the telehealth companies revealed in this investigation offers a more complicated reality. The ability to go directly from an advertisement - which may or may not give full safety/efficacy information - to purchase medication from telehealth companies that have pre-established relationships with the pharmaceutical manufacturers, compromises the integrity of the patient-relationship.
The patient-provider relationship will continue to be at stake because physicians from the telehealth companies are being directly compensated by pharmaceutical manufacturers. If physicians are receiving additional payments for prescribing specific brand name medications at the direction of the pharmaceutical manufacturers, there is the potential for the implication of the anti-kickback statute to be applied.
The anti-kickback statute basically explains that doctors cannot receive gifts in return for providing services - so any additional payments that a prescriber would receive from the pharmaceutical company for prescribing their specific brand name medication, has the potential to implicate the anti-kickback statute. It could also implicate the False Claims Act if the doctors bill Medicare or Medicaid without seeing the patient during the visit (like if the patient does not turn their camera on), or if they prescribe medications that are medically unnecessary.
The investigation demonstrated that direct-to-consumer pharmaceutical advertising on social media is part of a much bigger system of marketing and influence. Patients deserve transparency from both their advertisements and their providers to make fully informed decisions about their health.
