Health Economics: Current Commentary Telemedicine Companies Providing Prescription-Only Medications Pros, Cons, and Proposed Guidelines Eduardo Hariton, MD, MBA, and Erin E. Tracy, MD, MPH In the past few years, there has been a significant increase in the number of direct-to-consumer telehealth companies offering prescription medications to women. Leveraging technology, these companies have the poten- tial to improve access to care and ensure that women have access to prescription-only medications in a conve- nient fashion. However, it is important to ensure that they are doing so in a safe, patient-centered way that observes evidence-based prescribing guidelines. In this article, we discuss the pros and cons of direct-to- consumer telehealth companies offering prescription medicine and suggest several guidelines to ensure that women are being cared for in an appropriate way. (Obstet Gynecol 2019;134:941–5) DOI: 10.1097/AOG.0000000000003529 T hrough most of the 20th century, patients had to visit a physician’s office for evaluation and con- sultation before obtaining prescription medications. In 1999, the first online pharmacy was established, and soon after, patients were able to order medica- tions without previously seeing a health care pro- vider. 1,2 As early as 2005, patients were able to purchase prescription-only medications such as com- bined hormonal contraceptives online after filling out a questionnaire. Nonetheless, the reach of these serv- ices was limited, and most patients obtained prescrip- tions in the traditional, in-person fashion. Since 2015, there has been significant growth in the number of technology companies focusing on women’s health care. Specifically, companies provid- ing telehealth services to women received more than $400 million in venture capital funding in 2018. 3 Within this area, there has been a dramatic rise of online direct-to-consumer telehealth companies offer- ing prescription medications delivered directly to pa- tients’ homes, with at least eight companies providing access to direct-to-consumer online combined hor- monal contraceptives. 4,5 Unlike early online pharma- cies, these companies are branding themselves as wellness companies and using catchy advertisements to attract patients to their sites. 6 This approach has proven very successful, and, as of March 2019, one of these companies had more than 200,000 users across the United States. 7 Direct-to-consumer companies are labeled as such because they advertise to and interact directly with a patient outside of the traditional health care clinic. Typically, after visiting the company’s website, the patient fills out a detailed health questionnaire that captures their symptoms and their pertinent medical history. Once this intake is completed, the patient’s information is reviewed by a licensed health care pro- vider, who may request more information from the patient as needed. Depending on the company, the state in which the patient resides, or patient prefer- ence, a video conference between the patient and the health care provider may be required. If deemed From the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Each author has confirmed compliance with the journal’s requirements for authorship. Corresponding author: Eduardo Hariton, MD, MBA, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA; email: hariton.md@gmail.com. Financial Disclosure Eduardo Hariton is a medical advisor to EverNow, a direct-to-consumer company whose mission is to increase access to menopause providers by creating an educational platform to help educate patients about menopause symptoms and treatment options, and then using a telemedicine platform to provide licensed providers that can evaluate patient symptoms and offer appropriate treatment. The leadership or employees of EverNow have not been part of this manuscript conceptualization, research, preparation, or submission. We have received no funding for our study and will receive no compensation. This study produced from conception to resubmission solely by both authors. Dr. Hariton is entitled to purchase an equity stake in EverNow, which he has not done to date. The other author did not report any potential conflicts of interest. © 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0029-7844/19 © 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. VOL. 134, NO. 5, NOVEMBER 2019 OBSTETRICS & GYNECOLOGY 941