How prescription drugs got the direct-to-consumer treatment

By finding ways to sell medications online, the likes of Kin Fertility, Folx and Alto are helping consumers get hold of their meds discreetly. How do their services work?

Kin Fertility can prescribe the contraceptive pill online, without the need for face-to-face doctor's appointments. (Photo: Kin Fertility)
CATEGORY DIVE

Getting a parcel in the mail from Kin, an Australian direct-to-consumer brand, is not so different to unboxing a Great Jones Dutch oven or a hair care set from Crown Affair. The company’s pink-purple boxes open up to reveal the words “ON OUR TERMS,” while inside the box itself customers can expect to find holographic packaging and stickers with yet more empowering slogans. Then there’s the product itself. It’s not a new bit of cookware, a beauty product or other impulse purchase. Kin is selling prescription birth control pills.

Launched in 2020, Kin asks customers to take a 40-question quiz and instant message with a doctor in order to get hold of its meds. The big idea, the brand’s founder Nicole Liu says, is that by taking this service out of the doctor’s office and putting it online, it makes contraceptive more accessible.

An ever-growing list of medications is getting the direct-to-consumer treatment, as more startups take on the challenge of modernizing this heavily regulated space. There has been Hims and Roman, two now-household names that sought to remove the stigma around erectile dysfunction, hair loss and other problems people are often too embarrassed to talk about. Then there’s Thirty Madison, a DTC healthcare company focusing on conditions like allergies, migraines and gastrointestinal issues, which raised $140 million in June. It too started by tackling male hair loss. Prescription acne treatments from Apostrophe and Software, UTI treatments from Velieve and tailored LGBTQ+ healthcare from Folx are now all available online.

An update to the healthcare system

In 2020, it’s estimated that Americans spent $67 billion out-of-pocket on prescription drugs. Meanwhile, just 45% of adults age 30 and under say they don't have a primary care physician, according to the Kaiser Family Foundation, creating a potentially lucrative customer base for brands that can blend the e-commerce experiences young shoppers are used to with more serious services.

Each brand has its own area of focus, but the model is particularly suited to medications that deal with intimate matters; the sorts of things people are not overly keen to discuss in a stuffy doctor’s office.

Michael Krueger, head of marketing at Alto Pharmacy, says that the discreet deliveries and online consultations digital pharmacies offer not only make it easier for people to access medications, but it also increases the likelihood that they’ll keep taking it as needed. “That’s the main piece we’re focused on from a mission perspective, but certainly we’ve heard some horror stories that [our living with HIV patients] have had to have in public settings, at the pharmacy,” he says. “The ability to correspond with us privately and to receive a discreet delivery is really valued.”

Kate Steinle, the chief clinical officer at Folx, says the brand’s mission is to shift “the idea of healthcare as something you need to do, a pill you need to swallow, or somewhere you go when you’re sick” to “a place of empowerment.” “You should be excited about interacting with healthcare, and the types of services we provide are to help create situations where people have empowerment for their sexuality or gender identity, where they can take control,” she adds.

Alto fills customers' pre-existing prescriptions to get them a better deal on price. (Photo: Alto)
Can consumers trust direct-to-consumer doctors?

There is a strong argument to be made that such services have the power to help people take control over their own health decisions, access the medications they need without stigma, and become more informed about the options available to them.

But for the direct-to-consumer pharmacy brands to do that, they need to be trusted by patients, the clinicians, and pharmacy partners with whom they work. Hims, Nurx and Roman have previously come under fire for not taking this role seriously enough, raising questions about how medications are dispensed, and whether doctors are being encouraged to over-prescribe.

Kin says the clinicians it works with are paid per consultation, rather than per script, in order to avoid such concerns. It also asked medical professionals to review its consultation process while in development, to make sure they would feel comfortable prescribing via the platform. Folx, meanwhile, prioritizes informed consent, where clinicians give a full run-down of the pros and cons of any medications the patient wants to discuss, with the reversible and irreversible changes one might expect when taking certain hormones also made clear.

When it comes to delivering consultations online versus in person, the brands say there is little difference. Kin asks customers to complete their own blood pressure checks (the only physical examination needed when prescribing the birth control pill), while Folx lets customers do blood tests via mail or in partner clinics. The medicines it provides do not require clinicians to be in the same room as patients to prescribe.

“The care that we can offer through virtual [consultations] is equivalent to what can be offered in person for this particular type of care,” Kate Steinle, Folx’s chief clinical officer says. “I worked in an in-person healthcare center for many years providing trans hormones, and physical exam is not part of it. It’s really about counseling and education, and discussing the side effects.”

Modern healthcare consumers

Healthcare is a heavily regulated system, and brands that want to get into the business of dispensing medicine online have to work within this framework.

The rules — which dictate everything from how patients must be consulted on different medications to how far away clinicians and nurses working together can live from each other — vary state-by-state and country-by-country, making it tricky for brands to expand quickly. While Hims launched in the U.K. in 2019, in a January 2021 interview the brand’s founder Andrew Dudum described the business as only just “getting our feet wet in that market.” Folx is currently available in 33 states, and plans to hit all 50 by the end of this year.

Regulations are a headache, but the reason we have more brands selling medicines online in 2021 than in 2011 isn’t down to any game-changing rule-changes. It’s consumers that have finally caught up.

It would have been technically possible for Alto to launch a decade earlier, Krueger says, “but the market wasn’t ready.” “We could have done this on landlines, but it works better for everybody in a world where you’re comfortable using an app.”

The pandemic has, of course, made the prospect of sorting out your meds using your phone, rather than making a visit to a doctor or pharmacist, far more appealing. According to Bloomberg, Hims carried out twice the number of telehealth consultations in the first half of 2020 than it did in all of 2019. In the third quarter of last year, it processed 600,000 orders.

Kin, which launched just before the pandemic hit Australia, says it also experienced a boost. “COVID definitely accelerated the demand for telehealth services — it was years' worth of change in consumer perception and doctor behavior in the space of a year,” Liu says. “It’s made people go from [thinking] ‘is it even safe to do telehealth?’ to ‘actually, telehealth is right now your safest alternative for relatively easy conditions [to prescribe for]’.”

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