Drugmaker telehealth deals risk unnecessary prescribing, Senate probe finds

Partnerships between telehealth companies and pharmaceutical giants Pfizer and Eli Lilly raise concerns about conflicts of interest and inappropriate prescribing, according to a Senate investigation released Thursday.

The report by offices of several Democratic senators said the arrangements appear intended to steer patients to medications manufactured by those companies, which maintain websites touting drugs and providing links directing them to doctors who can prescribe them.

Such partnerships undermine the independent medical judgment of doctors, who may default to prescribing medications first instead of exploring other options and potentially “glossing over the comprehensive evaluation necessary for high-quality patient care,” concluded the report from the offices of Sens. Dick Durbin (D-Illinois), Bernie Sanders (I-Vermont), Elizabeth Warren (D-Massachusetts) and Peter Welch (D-Vermont).

In statements, Eli Lilly and Pfizer said their online portals are meant to make it easier for patients to navigate health care and they do not pressure clinicians to prescribe their drugs.

Eli Lilly said the report mischaracterizes the company’s online portal, which offers “patients educational materials, the option to connect with independent telehealth platforms or in-person care, and convenient home delivery of certain FDA-approved Lilly medications, if prescribed by an independent” provider.

Pfizer said its arrangements with third-party telehealth services are “structured to ensure clinicians can make their own independent decisions regarding patient care, including any therapies they may prescribe.”

Large pharmaceutical companies spend billions on advertising annually and have increasingly sought to capitalize on telehealth, which has exploded in popularity since the pandemic as an easier way to access care.

Relationships between such companies have not always fared well. Danish pharmaceutical company Novo Nordisk partnered with Hims & Hers in April before the relationship fell apart last month over concerns about the telehealth company selling an imitation version of Wegovy, the drugmaker’s blockbuster weight-loss drug.

In recent years, Pfizer and Eli Lilly started their own direct-to-consumer platforms, PfizerForAll and LillyDirect, that refer patients to telehealth companies that can offer their drugs. But the sites have drawn criticism from consumer advocates and lawmakers who fear patients are being pushed to buy expensive and unnecessary medication.

“In the same breath, drug companies are now advertising a drug and linking a patient to a doctor - ostensibly chosen by the drug company - who can write a prescription for it,” the Senate report said.

Eli Lilly said its affiliated providers “exercise their own clinical judgment in evaluating and making any care decisions. Lilly does not incentivize those platforms or its providers to prescribe Lilly medicines.”

Pfizer also said it does not compensate or “otherwise financially incentivize any telehealth clinician for writing prescriptions or making any particular treatment decisions.”

The investigation raised concerns about high rates of prescriptions issued.

In one example, 74% of nearly 4,400 patients routed by LillyDirect to telehealth providers received a prescription. Form Health, a telehealth partner specializing in obesity care, reported that 66% of its prescriptions were for medications from Eli Lilly, which produces the weight-loss drug Zepbound, despite multiple options available on the market.

It’s difficult to determine whether such prescribing patterns are inappropriate or reflect better access for patients who need the medications, said Chad Ellimoottil, a telehealth policy researcher and the medical director of virtual care at the University of Michigan Medical Group.

“It’s hard to draw conclusions without access to the underlying data, which is part of the problem,” said Ellimoottil, who was not involved in the Senate probe. “There is a lack of transparency with direct-to-consumer telehealth.”

Senate investigators found the telehealth arrangements do not directly pay doctors to prescribe drugs but they catalogued troubling signs that pharma companies reward doctors working with the telehealth companies.

For example, they found that telehealth company UpScriptHealth notifies Pfizer of which doctors wrote prescriptions. At least two providers working for Form Health received a combined 41 payments from Eli Lilly; the report did not say for what but noted providers are often paid “speaking fees.” One of the providers counted an Eli Lilly product as one of their most-prescribed medications, charging $230,000 in one year to Medicare, the taxpayer-funded insurance for older Americans, investigators said.

The online platforms appeared geared toward prescribing medications, the report found. Cove, one of Eli Lilly’s telehealth partners, allows patients to “preselect” the medication they may want before consulting with a provider.

UpScriptHealth, Form Health and Cove did not respond to requests for comment. Another company highlighted in the report, 9amHealth, said investigators misrepresented how it practices medicine. The company said 61% of its patients receive no prescription.

“Every prescription decision is made independently by licensed clinicians, based solely on medical necessity,” the company said in a statement.