LAUSR

Direct-to-consumer (DTC) telemedicine platforms have gained popularity as telehealth business models. These companies provide a single platform for patients to directly initiate televisits and purchase prescription drugs. Early platforms treated minor dermatologic conditions with medications that historically lacked routine monitoring;they have since expanded their scope of practice. We aimed to characterize DTC companies providing dermatologic care, with analysis of the factors that enabled DTC growth, as well as the ethical and practical implications. Through a literature search and Google queries, we identified seven DTC dermatology companies employing variations of a model with three main components: a triage questionnaire, telehealth services (primarily asynchronous), and custom branded drug delivery. Rising healthcare costs, improved technology, and drug patent expirations have enabled DTC growth, with aggressive marketing fueling a growth in customer base. The rise of DTC companies prompts questions about patients acting as consumers in healthcare. While DTC offers greater autonomy for patients to receive care on their terms and convenience, the removal of gate-keepers could have unanticipated negative effects. For instance, DTC may make doctor-patient relationships transactional and raise financial conflicts of interests. Furthermore, there are uncertainties regarding quality of care;studies have reported poor adherence to guidelines, misdiagnosis and barriers to follow-up. DTC solutions bypass traditional healthcare systems, further fragmenting care and creating room for error. COVID-19 has increased telemedicine adoption, possibly fueling growth and funding of DTC companies. As such, it will be vital to monitor the regulatory, ethical, and patient-centered outcomes of DTC telemedicine.