Updated December 8, 2025 at 3:44 PM EST
From birth control to GLP-1 shots for weight loss to erectile dysfunction medication, telehealth companies have made it easy to get drugs shipped right to your door. But what started out as a way to access health care is now driving the consumerization of medicine.
It wasn鈥檛 always this way: Telehealth took off during the pandemic. The industry realized back in 2017 that it could make more money marketing drugs and handling cash payments than from patient care, said Katie Palmer, health tech correspondent with STAT.
But concerns with this model mirror issues around direct-to-consumer marketing for drugs.
鈥淎nytime you have a medical interaction that鈥檚 mediated by an ad, you run the risk of a patient getting a drug that happens to be well-marketed instead of the drug or the care that is best for them,鈥� Palmer said.
Plus, Palmer expressed concerns about how this model could drive up health care costs overall.
Here & Now鈥檚 Rob Schmitz spoke to Palmer about the evolution of telehealth and how it鈥檚 driving the consumerization of medicine.
8 questions with Katie Palmer
How has telehealth evolved over the years?
鈥溾�夿asically, before the pandemic, telehealth companies existed, but they were having a hard time making money off of providing care. Insurance barely reimbursed for virtual care, and it was relatively little used.
鈥淪tartups before the pandemic, around 2017, a little bit before, started to realize they could make a business out of marketing, cash pay services and drugs, the products, directly to patients instead of the care. And then the pandemic obviously gave that industry a huge shot in the arm. Venture capital poured into these kind of companies. Once telehealth became something that everybody needed, all of a sudden use just went through the roof.鈥�
Are doctors involved in the process?
鈥溾�奩es. In the very early stages of these kinds of companies, you鈥檇 have rogue online pharmacies where you could get drugs without a prescription. But in all of these cases, you鈥檝e got providers, whether it鈥檚 nurse practitioners or doctors or physician assistants doing the prescribing behind the scenes.鈥�
鈥奃o they work for the companies that are making profits off of this?
鈥淭echnically, they have to work for a different entity. So the telehealth company that you鈥檒l see marketing the drugs is a marketing business essentially. And to comply with corporate practice and medicine laws, the medical groups that actually employ the doctors and the prescribers have to be separate entities that sort of contract with the telehealth brands. So those medical groups are always owned by doctors, and that鈥檚 how they have to comply with laws.鈥�
鈥奃octors are licensed within a state. How does that work on a national kind of platform?
鈥淵our doctor needs to be licensed in the state where you, the patient, are physically located. So for telehealth companies, it becomes really valuable to have doctors licensed in multiple states so they can see patients in as many different places as possible.鈥�
鈥夾re insurance companies involved in any of this?
鈥淢ost of the companies that I鈥檓 talking about, these so-called direct-to-consumer telehealth companies, operate exclusively in cash. And that means they don鈥檛 accept any kind of insurance, and it鈥檚 just a relationship with the patient paying cash.鈥�
鈥奌ave regulators kept up with how quickly this market is growing?
鈥淲hat is evolving potentially a little bit right now is this gray area in the regulation of marketing, which is usually done by the [Food and Drug Administration] for branded drugs, but because these telehealth companies aren鈥檛 the drug makers, they don鈥檛 necessarily fall into the same regulations that traditionally would apply to what you think of as drug ads.
鈥淲e recently saw the FDA issue a bunch of warning letters to telehealth companies for the way that they鈥檙e marketing compounded drugs specifically. So there鈥檚 definitely some movement, but it鈥檚 still [a] really big gray area. And I鈥檇 say some people would call it a loophole in the drug ad regulations.鈥�
鈥奌ow are they able to sell drugs that are not FDA-approved?
鈥淐ompounding has existed for a long time. Usually, compounding is used to help people get access to medications when FDA-approved drugs don鈥檛 work for them.
鈥淪o a traditional example is you give a kid a version of a drug in liquid form as opposed to a tablet because they can鈥檛 swallow a pill. And you can also use compounded drugs in the event of a shortage, which is what we saw with the GLP-1 drugs. What鈥檚 happened with these telehealth partnerships, though, is that access to compounded drugs has just been expanded into this mass market through partnerships between compounding pharmacies and telehealth companies, marketing those drugs specifically.鈥�
Many of the experts that you spoke to raised concerns that this shift into selling drugs directly to consumers is driving a disturbing commercialization of medicine. How do people in the medical field expect this to change health care in the U.S.?
鈥淧retty uniformly among the physicians that I speak to, whether they work in telehealth or in more traditional care settings, kind of just see this as the way of the future for good and for bad. There are definite advantages to making it easier for patients to get access to the drugs that they want, which may include the drugs that they need. And yeah, basically, we鈥檝e all come to expect speed and efficiency with the internet and the way that e-commerce has grown alongside it. And it basically seems like there鈥檚 no turning back the clock to a lot of people.鈥�
This interview was edited for clarity.
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