Online Health Companies Are Booming: Here’s What Consumers Should Know Before Clicking

How consumer telehealth platforms work

Telehealth sites can differ from traditional providers, and vary among themselves, in key ways, including:

Communication. You might consult with a doctor, nurse practitioner, physician assistant or other health care professional via video or phone. But unless your state requires video or phone contact, some sites instead rely on questionnaires and secure online messaging with providers. In some cases, you might send photos (of your thinning hair, for example).

Payment. While some experts use the term “direct-to-consumer” to refer only to telehealth sites that take no insurance, some consumer telehealth sites do take insurance for consultations and prescriptions. Some sites that don’t take insurance use subscription plans, bundling consultations and regular medication deliveries under one fee.

Medication types. You might get prescriptions for federally approved brand-name drugs or generics. Some sites partner with pharmaceutical companies to offer specific brand-name drugs, such as popular GLP-1 drugs for weight loss. But others rely on compounded drugs — custom-made medications that aren’t approved by the Food and Drug Administration (FDA) but are legal to sell under certain rules. Some sites also offer their own versions of over-the-counter drugs and supplements.

Whether this all adds up to good medical care is unclear, says Dr. Ateev Mehrotra, a health policy researcher at Brown University. “We don’t have a lot of robust data,” he says. But he and other experts see both promise and peril in this new medical reality.

Potential benefits

Consumer telehealth platforms can offer quick, easy access. If you face a long wait to see a doctor in person, as Trotsky did, or live in a community with too few providers — an increasingly common situation — the appeal is obvious.

There’s also the “convenience of doing this in between meetings or the comfort of your own home,” says Dr. Kristen Lo Sicco, a dermatologist specializing in hair loss at NYU Langone Health. She also consults for Ro.

Another benefit, experts say, is the chance to address a condition, such as erectile dysfunction or hair loss, that you might be embarrassed to discuss with your regular doctor. Telehealth companies often specialize in “stigma-bearing conditions,” Nagappan notes.

Also, drug prices at telehealth sites are sometimes lower than those elsewhere, Lo Sicco says: “That’s often true for the compounded hair medications.”

Potential risks

Getting medical care from a website or app with no relationship to your usual health care providers has potential risks — especially if “no one ever tells your current pharmacy or your current doctor that you’re doing this,” says Joey Mattingly, a researcher and associate professor at the University of Utah College of Pharmacy.

Ideally, he says, patients share the information with their other providers so that potential drug interactions or other dangers aren’t missed.

Consumers also face risks if they don’t tell — or if telehealth providers don’t ask — about all the conditions they have and drugs they take. “One concern is that these clinicians often don’t know the full history of the patient,” Mehrotra says.

Misdiagnosis is also a concern, Lo Sicco says. For example, she says, some kinds of hair loss that cause permanent scarring need to be confirmed with an in-person exam. Getting the wrong treatment, she says, could mean losing the chance to save remaining hair.

That’s one reason, she says, that she “would prefer that all patients who use direct-to-consumer platforms for dermatology still establish care with their primary dermatologist.… That would be the best of both worlds.”

Compounded drugs that aren’t reviewed by the FDA for safety, quality or effectiveness — but are sold by many online platforms — also raise concerns.

“Compounding is an incredibly valuable tool,” Mattingly says; it has long been used to tailor treatments — for example, to alter ingredients for people with allergies.

But telehealth companies, as well as other prescribers, now offer compounded drugs on a much larger scale, taking advantage of FDA rules that allow them to sell copies of prescription drugs during shortages — as happened for a while with some GLP-1 drugs — but also to sell near-copies with tweaked formulations or dosages, Mattingly says.

Some prescribers, he says, may simply add a vitamin to standard weight loss drugs. But others make more significant changes, like offering GLP-1 drugs in microdoses despite a lack of strong scientific support for the idea, Mattingly says.

The FDA says some telehealth consumers have overdosed on compounded weight loss drugs by misusing multidose vials. That suggests, Mattingly says, that some online providers aren’t properly educating patients on how to use the products.

In addition, the FDA has accused some telehealth companies of illegally advertising medications without adequately detailing side effects. While Zebley, of the telemedicine association, won’t comment on particular companies’ practices, he says, “Our principles are very clear. Advertising must be truthful and non-misleading.… We’re asking to be held to the same standard as the rest of health care.”

Other concerns about consumer telehealth

Getting medication from a telehealth site isn’t always cheaper, Nagappan says. A subscription plan may cost more over time, she adds by way of example, especially if you don’t use all the services or medications — and as with any subscription, it might be hard to cancel or it may live on as a forgotten credit card charge long after you stop using it.

Another concern is privacy. While the doctors, nurses, pharmacists and some other providers you encounter online may be covered by the same federal and state laws that keep your health information safe in other settings, that doesn’t mean all the information you give to the website or app is, says Allison Hoffman, a professor of law and health sciences at the University of Pennsylvania.

Rather than try to decipher dense online privacy policies, she says, “I would approach these kinds of websites knowing that they’re trying to use my health data to the extent that they can under the law,” which may include targeting you for advertising and other marketing purposes.

Reputable telehealth companies take extensive measures to protect user data, explain how they use it and give people choices about how it is shared, Zebley says.