An AI-based healthcare startup on Monday will start offering prescriptions to Utah patients without direct human oversight, the first time a state has allowed such technology to replace the role of a doctor.
The move, limited to acne medications, sets the stage for a new era in healthcare in which AI takes on a larger role in routine medical care. It also comes months after the state’s efforts to expand the role of AI in healthcare via its pilot program drew scrutiny and anger among doctors.
When patients first sign up for Nolla Health’s app, they are instructed to use it to scan their face. Then, rather than a doctor examining them, patients complete their medical history and personal information. Nolla Health’s AI software analyzes their skin, identifies the acne problem, rates the skin’s oiliness, and then generates a numerical “acne severity score” that ranges between clear skin and severe acne.
After combining the AI-generated score with personal medical information, the app will recommend medication from a list of eight approved treatments that would typically get reviewed and prescribed by a clinician.
In Utah, however, the pilot — aimed at the state’s estimated 5,500 to 11,000 acne patients who seek dermatological care yearly — will allow AI-generated prescriptions to be submitted directly to any pharmacy, circumventing laws that require licensed human professionals to prescribe medications.
Nolla Health’s program will operate in three stages. The first 100 patients’ AI-generated prescriptions will be reviewed by a physician before they are submitted to a pharmacy. The next 400 patients’ prescriptions will be submitted to pharmacies by the AI and reviewed retrospectively by a physician weekly. After that, a physician will review at least 10% of the total prescriptions issued once a month.
The New York City-based startup got its pilot green-lit under a division of the Utah Department of Commerce, which has begun authorizing companies to test AI products under relaxed regulations. For Nolla Health, that means prescriptions will carry the name of a clinician without a human professional actually writing it, Chief Executive Luis Wenus said in an interview.
The risks that come with the approved AI-prescribed medications are low, according to Wenus. The adverse effects of the eight approved medications, some of which are already available over the counter, are limited to localized skin irritation or dryness, according to the Nolla Health team. The program is also limited to topical medications which are applied to the skin, rather than pills or hormone therapies, which require more robust monitoring.
“With the topical skin treatments, the thing that can happen is obviously like your skin gets red or your skin starts peeling,” said Wenus. “The possible adverse reactions are just much, much lower risk than many other drugs.”
A key motivation for Wenus is making dermatological care more affordable and accessible for Americans. The app costs about $5 per month, with compounded medications available at about $50 per month. That is drastically lower compared with a typical dermatology visit which can run between $150 and $300, and it could help reduce wait times and the hassle of commuting to a doctor’s office, according to the company. What’s more, the app frees up time for providers to address more serious issues, like skin cancer or complex inflammatory diseases, the company said.
Wenus’ goal is to eventually expand the company’s scope outside of acne medication and become an “all-in personal doctor in your family, driven by AI.” The first step toward that goal starts in Utah, where Nolla Health’s AI tool will automate nearly every part of the care experience.
The launch comes amid widespread concerns about the dangers of AI agents. In September, American Medical Association Chief Executive Officer John Whyte engaged in a public debate over the proper place of AI in medical practice.
“These tools can play a very effective role, but they shouldn’t autonomously be trying to practice medicine, and if they are, then they need to be held to very high standards, just as humans are,” Whyte said in an interview. “And I don’t think they can meet that burden.”
Prescribing authority has been historically limited to physicians, some nurse practitioners and physician assistants. The state waived the Utah law requiring that a prescriber be a licensed physician, giving Nolla Health a “narrow exception,” said Zachary Boyd, director of Utah’s Office of Artificial Intelligence Policy, which authorized the pilot.
The OAIP’s program drew scrutiny after it approved a pilot by Doctronic, a startup that uses AI to approve refills for medications that were already prescribed by doctors. After its launch, the Utah Medical Licensing Board penned an open letter saying they were not consulted in the decision and that it “places Utah citizens at risk.”
Rather than stop the program, the OAIP removed two medications from Doctronic’s approved list after consulting with the medical licensing board.
The legal ambiguity has created an alternative ecosystem for the AI doctor. The OAIP has always required a special kind of malpractice insurance that covers AI-generated prescriptions, Boyd said. In Nolla Health’s case, the office has also built special “duty of care” provisions into their contract that help define the company’s responsibilities to the patient, which can help a court adjudicate cases where an AI has issued a prescription.
Boyd, however, doesn’t anticipate the same type of controversy for Nolla Health’s program. Doctronic’s pilot was approved to issue prescription refills for everything from painkillers to medications for depression. Nolla Health is limited to only acne medication, giving it a narrower scope and fewer risks.
The company is also the first to engage with the Utah Medical Licensing Board before getting authorization. After the discussions, the pilot was amended to include a third party physician appointed by the medical board to oversee the prescription reviews.
The Nolla Health program will operate for a year, with the potential to renew for two more years, at the discretion of the OAIP.
Inampudi writes for Bloomberg.
