Specialists Warn Against Fragmented Care via Online Pharmacies


As drugmakers push direct, online sales, experts warn about comprehensive medical review, unclear liability, and dismantling care coordination by pharmacists.

While online sales have already revolutionized shopping and made countless products available with a mouse click and a credit card, it took the societal shock of the COVID-19 pandemic to mainstream online health care entirely.

Now, one drugmaker is capitalizing on the telehealth trend by offering patients direct home delivery of medications, bypassing brick-and-mortar pharmacies and even doctor visits in some cases.

But while such services promise greater convenience and access, experts warn we may be sacrificing coordinated patient care in the process.

Weight-Loss Drugs Fuel Push Toward Online Pharmacies

Earlier this month, drugmaker Eli Lilly announced a new “end-to-end” digital health service called LillyDirect. This service aims to provide direct home delivery of Lilly medications to patients living with migraines, diabetes, and obesity.

Specifically, it will facilitate the shipment of drugs by using third-party pharmacies and independent health care providers, according to the company.

Eli Lilly’s press release touted affordability benefits as well, noting that qualifying patients can automatically access savings cards and free delivery when ordering medications through LillyDirect.

Given the high demand for weight-loss drugs like the newly-approved Zepbound, there is a good chance Eli Lilly’s telehealth initiative will be successful. Its popularity may spur many other pharmaceutical firms to roll out direct-to-patient services, too.

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But a big open question remains: How will this affect patients? Some worry that virtually removing face-to-face access to pharmacists and, at times, primary care providers may not be the optimal approach.

Vetting Vital Before Telehealth Prescriptions

Comprehensive patient information is key to safe telemedicine prescribing, Terri DeNeui, founder and chief medical officer of EVEXIAS Health Solutions, a provider of integrated wellness solutions and a board-certified nurse practitioner, told The Epoch Times. Clinicians must fully assess patients before issuing remote prescriptions, she said.

This assessment requires gathering a complete medical history, current medications, allergies, vital signs—heart rate, blood pressure, temperature—and lab results indicating normal liver and kidney function. “Liver and kidney function is important to understand for the metabolism and excretion of medications,” Ms. DeNeui added.

Another concern is new companies allowing patients to simply fill out a form and receive medications by mail, according to Ms. DeNeui.

“My question is, who is taking on the medical liability for these prescriptions?” she added. “Pharmacists are not licensed to assess and diagnose a patient for treatment, so there must be some sort of clinician directly involved in this process for safe and efficacious patient care.”

However, minimal standards of care for telemedicine visits and prescribing remain undefined, further compounding risks to patients, Ms. DeNeui said.

Online Pharmacies Are Mixed Bag for Patients: Expert

Direct-to-patient drug sales are a “double-edged sword,” according to Michael Ganio, who holds a doctorate in pharmacology and is the American Society of Health-System Pharmacists (ASHP) senior director of pharmacy practice and quality.

On the one hand, it increases access for patients who cannot see providers easily, given demanding work schedules or specialists booking months out. “So there’s certainly a convenience to telehealth and mail order,” Mr. Ganio said.

However, patient-centered care should entail support from a primary care provider and “hopefully” a regular pharmacy or pharmacist with complete visibility into the patient’s medical picture, he noted.

Care fragmentation in the U.S. health care system works against this ideal.

Referrals to disconnected specialists further separate management of chronic conditions like diabetes or hypertension from the primary coordinator role, Mr. Ganio said. Meanwhile, patients’ records and prescription information get scattered across sites lacking interoperability.

Not having a list of medications readily available at the pharmacy means that something could “slip through the cracks” regarding a drug interaction or allergy that was missed, Mr. Ganio added.

“So while I applaud the benefit of the increased access to a program like this [because] it provides more access for patients who may not otherwise have it,” he said, “there’s obviously that caveat, that concern that who is now responsible for the overall picture of that patient.”

This encompasses both general health stewardship by primary providers and meticulous medication management to avoid adverse reactions.

Local Pharmacists May Be Key to Balancing Telehealth Benefits and Risks

Balancing telehealth’s benefits while minimizing its risks is not an impossible task, according to Mr. Ganio.

“Your local pharmacist is one of the most accessible health care providers,” he said, noting ASHP’s advocacy for recognizing pharmacists’ direct patient care roles as follows:

  • Recommending and/or providing preventive care services.
  • Collaborating on tailored medication plans optimizing safety, efficacy, and convenience.
  • Educating patients about conditions, medications, lifestyle changes, and proper device use.
  • Assuring patients receive appropriate follow‐up from their doctors.

“You can come to the pharmacy and get rapid tests for flu or for strep or for COVID,” Mr. Ganio said. Recent research also shows that pharmacist-led hypertension treatment significantly improves control and is highly cost-effective.

With 97 percent of Americans living within 10 miles of a pharmacy, accessible expertise already exists abundantly if leveraged. State-instituted collaborative practice agreements also empower pharmacists to manage medications under physician supervision.

“So I think both [telehealth and in-person care] are very beneficial,” Mr. Ganio said. “You can get to the office, you can have a phone call, you can have telehealth for an urgent need, but for a chronic condition [or] chronic drug management, I think having an in-person health care practitioner is important.”


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