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People looking for Accutane (isotretinoin) for acne and other medications for skin treatments are increasingly going online for speed and lower costs, driven by shortages of appointments and the pandemic-driven explosion of telemedicine, plus cheap online prescriptions.

The Reddit forum on Accutane, r/Accutane, had a discussion recently about high costs for Accutane (generic isotretinoin), and one of the answers was “If you live in NY, FL, NJ, MI, CT, WY, NV, or UT – check out HoneyDewCare. I was having the same issue and found them after posting here. I couldn’t afford Accutane through a regular pharmacy. They are $60 a month for monthly visits and questions, and found me a specialty pharmacy that I pay $65 monthly and the meds get shipped to me.”

A Google search for isotretinoin online brings up dozens of online options, with other providers covering all 50 states and a flood of choices on TikTok. It’s an example of the growing trend of online medication prescribing for all sorts of conditions and ailments, from ADHD to anxiety to acne, a trend that increased with the shortage of doctors and the boom in telemedicine during the pandemic.

Many of these providers also don’t have clear credentials and don’t take insurance — meaning a patient will have to submit for reimbursement, if applicable, although the costs may be lower than with insurance. This represents another growing trend in healthcare: Providers don’t take insurance, and people are putting away their insurance cards and paying cash because the price seems better — even if the payment doesn’t fall against their deductible.

Another dermatology provider, Piction Health, writes that it will cover acne, moles or lesions, psoriasis, eczema, hair and nail issues and other skin issues. The site says: “New patient cases are $80, with lower fees for returning patients. … Our pricing is less than half of a typical dermatologist visit and includes evaluation by a board-certified dermatologist, counseling call with provider, calling in prescriptions and lab tests, and helping get in-person care quickly when needed.”

People on Reddit complained of in-person office visit costs, and rising medication costs. “$60 per office visit and another $100 for out of pocket accutane,” one person wrote.

Medication costs are a sore point: “Previously I had hit my deductible of $750 and then didn’t pay a dime for my isotretinoin. When I went to fill it this time, the pharmacy at the drug store told me it would be $580 since my now deductible is $3.000. I about passed out. I called the previous pharmacy and asked how much it would be out of pocket and they said $65 per box. (40 mg 2x a day).”

Another: “Each visit with my dermatologist is already $99 and then it seems like most months I will be expected to pay another $100-250 for the isotretinoin (depending on the dosage).”

Price examples: $49 a visit or $39 a month

HoneyDew, like other online prescribers, claims speed and ease of use and cost are all better with its telehealth services. Compliance with the iPledge rules — a series of regulations designed to protect against the birth defects that can be caused by isotretinoin — are required, which is clearly one element of friction in Accutane purchasing.

“The average wait time for a dermatologist appointment is over 33 days. Honeydew will get you ongoing, expert care right when you need it,” the site says. “Honeydew saves you an average of 10 hours/year by eliminating travel and waiting rooms. What’s your time worth?”

“We help you get insurance-covered medications and special discounts. Our customers save as much as $600/year on medication.”

Membership costs $299 a year or $39 a month. Costs for medications vary. The site says: “At this time, the Honeydew membership is not processed through insurance. However, it is eligible for HSA and FSA reimbursement and you may be able to receive out-of-network reimbursement from your insurance company. Your insurance can also be used to cover the costs of prescriptions or labs in your treatment plan.”

At Cortina, the initial consultation is $49. Cortina says it has treated 100,000 patients and is available 24-7 in all 50 states.

Nurx no accutane

Other online sites offer similar services. Some sites also say they’ll deliver. But some sites that have active online prescribing for other medications will not prescribe these medications. Nurx, for example, says on its site: ‘Nurx does not prescribe isotretinoin or Accutane, because this medication requires more monitoring than we can provide via telehealth at this time. We treat mild and moderate acne, but if we determine that a patient has severe acne we may refer the patient to in-person care.”

HoneyDewCare was founded during the pandemic by an acne patient, David Futoran, and his dermatologist, Joel Spitz. “Honeydew came into being when Futoran saw Dr. Spitz for his acne. And yes, that appointment took four months to schedule. The two bonded over the flaws in the system and decided to join forces to build a better way.”

Spitz told The Roslyn News: “The traditional brick and mortar experience for acne care is broken across the nation,” he said. “Wait lists can be as high as four months and it’s very difficult to get a hold of your care team. Moreover, providers don’t track your progress with photos and there is no infrastructure to manage mediating lifestyle factors including diet and stress.””

The company has an active presence on TikTok.

GoodRX and other sellers

At GoodRX, the online prescription pricing service, prices on July 7 near me in the Westchester suburbs just north of New York City, the prices shown for 60 capsules of 40 mg Accutane ranged from $105.40 at Rite Aid to $919.68 at Walgreens. The price entries say “get free savings” and urge the viewer to select a pharmacy to get a coupon. When you click and find the printable coupon, it’s understood that the coupon will be accepted by the pharmacy and will give you that stated price.

We have learned over several years of watching the marketplace that people sometimes object that the GoodRX coupons they were given were not accepted by the pharmacy. We don’t fully understand the reasons, and we don’t know how often this happens, but if you have a GoodRX coupon promising savings — or a drug discount card from another entity — be prepared for it to be rejected.

Some patients buy generics without using their insurance from Mark Cuban Cost Plus Drugs, the company founded by the zillionaire to reduce drug costs. While isotretinoin is the generic for Accutane, it’s not available on Mark Cuban Cost Plus Drugs (probably because of the iPledge regulations for safety.

HoneyDew prescribes not only Accutane, but also “non-prescription products like a cleanser, moisturizer, or mild topical cream,” the site says.

At ClearHealthCosts, we do not give medical advice, but it’s common sense to recommend that you do due diligence and do not order from just anybody online claiming to be a dermatologist with a prescription medication for a price that seems to good to be true.

Our “saving money on prescriptions” post has some information about checking online sites, and about buying medications in general.

TikTok and private equity in dermatology

Reddit is only one place online where conversations about dermatology take place. TikTok is full of “skinfluencers” and “dermfluencers” like Dr. Muneeb Shah, who has 18 million followers. Dermatology practices do extensive marketing online, including via TikTok personalities.

Shah told the online publication Glossy that “last year he was approached for sponsored content by the teledermatology platform Cortina, a seven-month-old startup founded by a faculty member at Harvard Medical School. Impressed by its dedication to using board-certified dermatologists, he decided to join as an investor and board member. He now serves as the company’s medical content advisor, where he advises the company on its social content — with a focus on TikTok.”

Dermatology is particularly full of private equity owners — with these for-profit private companies seeking quick returns by snapping up dermatology practices. A Medscape article citing a National Institute for Health Care Management study said dermatology was one of the top specialties for private-equity-employed physicians.

“Of these specialties, the number of physicians working in private equity–acquired practices was highest in dermatology, gastroenterology, urology, ophthalmology, obstetrics and gynecology, and orthopedics,” Medscape wrote.

The reason, of course, is the money. Yashaswini Singh, MPA, a doctoral student at the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and coauthor of the study, told Medscape: “In dermatology, you have a mix of surgical procedures that are covered under insurance, but also a lot of cosmetic procedures that are most likely to be self-pay procedures. This offers private equity several mechanisms to which they can increase their revenues.”

The iPledge issue

One thing that complicates isotretinoin (Accutane) purchases is the fact that the medication can cause birth defects. So people who can get pregnant need to get pregnancy tests or counseling to continue treatment, under a revised regulatory system that went into effect in late 2021.

Thousands of patients have complained bitterly about the obstacles presented by the new system, named the iPledge system — particularly men who don’t think the lockout should affect them and dermatologists whose patients can’t get their medication on time.

Insurance problems and re-ordering delays have led to intense frustration among consumers. A young man who is a college student, the son of a friend, has experienced repeated delays in obtaining his prescription, in part because of these challenges, and the ripple effects of the iPledge implementation.

“During 2 days of hearings on potential modifications to the isotretinoin iPLEDGE Risk Evaluation and Mitigation Strategy (REMS), there was much agreement among dermatologists, industry representatives, and Food and Drug Administration representatives that provider and patient burdens persist after the chaotic rollout of the new REMS platform at the end of 2021,” Dermatology News wrote recently. The hearings were designed to address widespread complaints about the program.

“On March 29, at the end of the FDA’s joint meeting of two advisory committees that addressed ways to improve the iPLEDGE program, most panelists voted to change the 19-day lockout period for patients who can become pregnant, and the requirement that every month, providers must document counseling of those who cannot get pregnant and are taking the drug for acne.

“However, there was no consensus on whether there should be a lockout at all or for how long, and what an appropriate interval for counseling those who cannot get pregnant would be, if not monthly. Those voting on the questions repeatedly cited a lack of data to make well-informed decisions.”

What you can do

As always, we do not give medical advice. Here are some suggestions about how to navigate the healthcare marketplace and, we hope, save money.

  • Check credentials of any online prescriber.
  • Be a good consumer — if it seems too good to be true, maybe it is.
  • Read the small print: Do they deliver to your state? What happens if they don’t come through on your prescription?
  • Do you need to have paperwork for your insurer for reimbursement? Are you sure the seller will give you that?
  • Online reviews are, of course, a mixed bag. But sometimes you can tell instantly from the reviews that you are better off moving on. It doesn’t take too much for someone to set up a website and announce that they are selling something.
  • As with many searches for online prescriptions, a number of non-U.S. sites and sources spring up in the results. You should be aware that buying medications from overseas can be fraught with difficulty. Here’s our “how to save money on prescriptions,” which has some suggestions about vetting sellers.
  • If you’re buying on cash, it will be up to you to seek reimbursement from your insurer, if applicable. The initial outlay may be significantly lower than what the sticker price is via insurance, but quite often your out-of-pocket is lower than the sticker price. Do your homework.
  • If a person springs up on TikTok claiming to be a dermatologist with a dynamite deal on Accutane, you should ask yourself if you would trust your health to anyone with a TikTok account — even if they have thousands of followers.

Jeanne Pinder  is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded...