Online doctor shops face crackdown over quick quiz prescriptions

Health Minister Mark Butler says he is concerned about Australian start-ups selling drugs online without doctors ever seeing patients’ faces or fully checking their identity, as one company pledges to improve its standards ahead of an anticipated crackdown.

The Medical Board of Australia is expected to tighten its rules for telehealth companies to potentially include banning doctors from prescribing drugs through an online quiz if they have not met the patient before.

This masthead reported that two major Australian start-ups, Eucalyptus and Midnight Health, were not holding video calls or checking identity documents prior to sending out weight-loss medication that can lead to serious side effects.

In a significant change, Midnight Health, which is majority owned by health insurer NIB, has vowed to strengthen its safeguards within two weeks, requiring photos or a video call for all weight-loss prescriptions. Eucalyptus, which owns the Juniper and Pilot brands and which has raised about $150 million from investors including Woolworths, has requested its doctors ask for photos from weight loss patients but won’t mandate that requirement.

NIB chief executive Mark Fitzgibbon also broke ranks with the rest of the telehealth sector to back in the Medical Board of Australia’s looming changes.

“There’s no question healthcare is going to shift to away from basic physical settings, where that’s appropriate, to more virtual settings,” he said in an interview.

“And with that will come new risks which we need to identify and manage. I think this situation with people faking their identity or faking their condition is very real.”

Fitzgibbon said the answer was not to be “Luddite” about the situation: “The answer is to think about … how can we mitigate that risk?”

Butler said the COVID pandemic had forced the health sector to adopt technology for the benefit of patients and doctors.

“But we need to make sure that that happens in a way that aligns with good clinical practice,” he said.

“I have been concerned at some of the reports about [business models] that have developed to fill what is clearly a shortage of access to traditional doctor services.”

The minister said he would not pre-empt the findings of a Medical Board review of telehealth prescribing rules, which is expected to be released imminently, but that he was determined to ensure that new technology did not erode standards.

“And I think there is a question mark over some of these business models that have been developed at the fringe,” Butler said.

Health start-ups see a huge commercial opportunity in weight loss, as three-quarters of adult Australians are estimated to be overweight or obese. But their business model has infuriated general practitioners, whose lobby group has accused them of undermining medicine.

InstantScripts, one of the largest online prescription start-ups, declined to comment.

Mosh, another telehealth company that already requires photos of identity documents for weight-loss medication, said it welcomed the board review.

“We firmly believe there is a pathway for asynchronous healthcare for patients in Australia, as long as the industry as a whole is regulated by minimum standards and guidelines,” co-founder Gabriel Baker said.

Eucalyptus chief executive Tim Doyle defended his company’s “high standards” and voluntary accreditation, saying that after this masthead’s previous reporting it had “encouraged its general practitioners to request photos in all obesity consults”.

“We think patient safety is critically important,” Doyle said. “We look forward to working closely with the government on this issue and have written to the minister about it previously.”

A spokesman for Woolworths Group, which has a stake in Eucalyptus, said it expected all the companies it invested in “to operate at a high standard and abide by any regulatory or other requirements”.

Dr Katie Allen, a former Liberal MP who pushed for greater access to telehealth during her time in office, said it could be a great way of delivering medicine but risked being abused by marketing-driven firms.

“Australia leads the way with delivering the best medicines at the right price for the right reasons,” Allen said. “We mess with that at our peril.”