Amazon, Costco jump into virtual health care marketplace — but dangers lurk
Online, direct-to-consumer health care is popping up seemingly everywhere, including among such retailers as Amazon, which now offers same-day online medical appointments at $85 a visit, and Costco, which partnered with Sesame to offer its members virtual primary care appointments for as little as $29.
WeightWatchers Clinic advertises that it can prescribe the popular injectable weight loss and diabetes drugs Ozempic and Wegovy for a monthly membership fee of $84 a month, which doesn't cover the cost of the medications themselves. (Without insurance coverage, they cost more than $1,000 a month.)
Others that have joined the direct-to-consumer online health care marketplace include such companies as Ro, hims.com and forhers.com, which provide prescription treatments for such conditions as hair loss, erectile dysfunction, premature ejaculation, birth control and anti-aging skin treatments, along with weight loss drugs.
It's a market jump-started by the coronavirus pandemic, and it's here to stay, said Dr. Mark Fendrick, a primary care physician who also is a professor at the University of Michigan and director of the U-M Center for Value-Based Insurance Design.
Sometimes, virtual health care is better, doctor says
Virtual care makes medicine much more accessible to the masses, he said, especially for people who live in remote areas that lack enough primary care physicians; those who live in urban areas for whom insurance coverage or transportation might be a problem, and for people with high-deductible insurance plans who want more affordable, quick care.
As many as 1 in 10 Americans ages 50-64 said they have used direct-to-consumer health care services, and more than 42% said they may be interested in using it in the future, according to new data from the National Poll on Healthy Aging, which is based at the U-M Institute for Healthcare Policy and Innovation.
Among those younger than 50, Fendrick estimated the use of these services could be as high as 1 in 3.
"There are some things that are so much better managed by telehealth than in-person, like blood pressure," Fendrick said. "Someone with high blood pressure who is on a medicine may never need to come in and see me. It's actually better for them to be at home because the blood pressure I want to know is not when you're stressed about the drive and seeing your doctor in the office. I want to know what your blood pressure is ... during an ordinary day.
Some dangers lurk on online prescribing
"But if you have severe abdominal pain or a joint injury or something like that, these are patients that need to be seen. ... It's clinical nuance, which means that it depends on who the patient is, what's going on with the patient, where they live, have you seen them before, et cetera, et cetera."
Of those surveyed who tried direct-to-consumer virtual care, most said convenience was the driving factor. While more than 60% said they received prescription medication, mostly for a one-time treatment, only one-third told their regular health care provider about the prescription.
And that's what concerns Dr. Aron Sousa, dean of the Michigan State University College of Human Medicine, who also is an internal medicine physician.
If virtual health care providers don't have access to a patient's electronic medical record and don't offer continuous and comprehensive care — it could cause dangerous drug interactions and unmonitored side effects.
"The erectile dysfunction meds in combination with particular heart medications are genuinely bad," Sousa said. "So if somebody is just providing you these medications, and there's no electronic health record, and there's no real other health history ... that's a setup for people to have a bad outcome.
"The question is whether or not they provide the infrastructure around the provider to make sure your care is safe and it's not just a prescription mill. Are they actually thinking about what's happening to you and listening to you, and examining your whole record — who you are, overall?"
Virtual providers can't test through a computer screen for viral or bacterial infections or make other assessments that can be done only in person, Sousa said. That could lead to the overprescribing of antibiotics, which can further contribute to antibiotic resistance.
20% of Michigan adults don't have a doctor
Still, with some caveats, the concept of mainstream, easy-to-access virtual health care is a good one, said Dr. Phillip Levy, a professor of emergency medicine and associate vice president for translational science at Wayne State University.
"Many people either don't have a regular doctor or don't have health care resources in their community and may not get access to certain services that others in more affluent communities can get access to," Levy said.
About 20% of Michigan adults and 8% of children in the state don’t have a primary care physician — a situation expected to worsen in the years ahead as a doctor shortage intensifies, according to a 2023 report from the Milbank Memorial Fund, a nonpartisan foundation that centers its work on health policy.
In the U-M survey of 2,656 adults ages 50 to 80, about 20% said they used virtual, direct-to-consumer health services because they lacked access to their regular doctor, didn't have a regular doctor at all or needed access to care when their health provider was not available or the office was closed.
The data illustrates the potential reach for such online care, which could be leveraged to more broadly offer smoking-cessation treatments and to boost access to blood pressure medication, Levy said, along with weight loss and diabetes drugs such as Wegovy, Ozempic, Zepbound and Mounjaro.
The benefits of those injectable drugs go beyond helping people drop a few pant sizes. Studies have shown they can regulate blood-sugar levels and reduce the risk of heart attack or stroke. Online prescribers, Levy said, could have an especially big impact in underserved communities.
Still, "when you're talking about Ozempic and Mounjaro and that whole class of drugs, they do have significant effects and they really should be guided under the care of a physician or a clinician who can at least monitor for side effects and ... who someone could talk to if they have questions," Levy said.
More: What you need to know about surgery risks with weight-loss drugs Ozempic, Wegovy
Side effects for these drugs range from nausea, diarrhea, vomiting, and constipation to such serious problems as thyroid cancer, pancreatitis, gall bladder problems and gastroparesis.
Levy said he hopes that the availability of these drugs through virtual direct-to-consumer providers won't just deepen the chasm between the haves and the have nots when it comes to health care.
"Do we take a resource that could be very beneficial as a solution for access gaps across a range of products and try to drive from a health care perspective things in that direction? Or do we accept that this is going to be a convenience type of offering for perhaps relatively affluent people who just want what they want when they want it the way they want it?"
Big buyers like Amazon can soak up tight supply of drugs
The companies providing this type of virtual care "are making money off of it," Levy said. "There's not any question about the financial success of this approach. It really is just a question of what's the right way to frame it from a societal and health care perspective."
The direct-to-consumer model of care could widen inequities because big players like the WeightWatchers Clinic or Amazon have greater purchasing power to buy in-demand drugs for which there are shortages. People with the money to buy them outright from those direct-care virtual health providers can avoid the problems others face with securing insurance coverage and finding the drugs in stock at pharmacies.
"People run low and can't provide it, and usually, that's not random," Sousa said. "Usually, if you're part of a bigger purchase order, you have an easier time getting supply."
Eli Lilly, the pharmaceutical company that manufactures Mounjaro and Zepbound, launched LillyDirect earlier this month, allowing people to order the drugs directly from the company — either through telehealth appointments or by coordinating with a person's regular physician. The company says it will help patients secure insurance prior authorizations for the drugs and coordinate coverage.
"If you think this issue is not important, watch what's happening on Wall Street and the fact that now, people can get weight loss drugs, which are very powerful and very interacting, direct" from a manufacturer, Fendrick said. Shares of Lilly's stock rose to a new, 52-week high of $642.92 Friday.
Gaps in US health care
It's vital, Fendrick said, for all physicians to ask every patient whether they've been treated virtually and whether they are taking any medication prescribed by another doctor, even one from an online service like Amazon or hims.com.
The growing demand for this type of direct-to-consumer online care reveals deeper problems within the U.S. heath care system, Sousa said.
"In a country where our life expectancy is not going up, it's actually going down, if we're going to address things that take people's lives and shorten their lives, we need to have a more robust primary care system," Sousa said.
"Maybe that's the marker that Amazon or these other places are laying down is that there's a hole that they're trying to fill for people who feel like they want to conveniently get some particular service. But really, as a system and as a country that wants its people to live as long as the people in Canada or other places, we need to do a better job having our system provide that kind of care."
Contact Kristen Shamus: kshamus@freepress.com. Subscribe to the Detroit Free Press.
This article originally appeared on Detroit Free Press: Health care, online prescriptions via Amazon, WeightWatchers
