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March 4, 2025 0

The unbalanced playing field between pharmaceutical manufacturers and telemedicine sites selling versions of approved drugs is finally being addressed in Congress. Congress acts on telemedicine drug advertising as senators push for FDA oversight. A number of large telemedicine direct sell sites have emerged in recent years. These sites diagnose, prescribe, and ship versions of popular drugs. When they advertise, they are not currently held to the same regulation as pharmaceutical companies.

Sites like Hims & Hers advertise compounded drugs or the forms of drugs without fair balance requirements. Frequently prescribed categories are weight loss, antidepressants, insomnia, and erectile dysfunction. They are not currently regulated by FDA even though they are manufacturing drugs and advertising them.

Senators Durbin (D-IL) and Marshall (R-KS) are co-sponsoring a bill to require FDA regulation of advertising from these telemedicine sellers.  Pharmaceutical companies have been at a competitive disadvantage because these sites often use compounded versions or created combinations of drugs. Drug companies lose sales because these telemedicine drugs often are priced lower.

Telemedicine sites have made diagnosis, prescription, and fulfillment easy for consumers. The problem is they can make efficacy claims without risk and warning information. Drug makers are held to a much higher standard and therefore have an unfair competitive landscape. These direct sale companies are offering a great perceived benefit for consumers. Answer a few medical questions, get prescribed, and receive the drug by mail. I imagine few consumers are turned down from getting prescriptions under the telemedicine process.

Telemedicine sites have made diagnosis, prescription, and fulfillment easy—but without the same regulatory standards as pharmaceutical companies, is it fair competition?

Congress is worried about inappropriate prescribing and the overpromise of efficacy without fair balance, prompting action on telemedicine drug advertising. Drug makers are concerned that compounders are violating patents and creating versions of their drugs which are not going through rigorous quality controls.

While DTC drug advertising receives lots of criticism, it is the most heavily regulated advertising category. Hopefully, that rigorous regulation will now apply to the burgeoning telemedicine industry.

Bob Ehrlich

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February 11, 2025 0

Robert Kennedy Jr. was favorably voted out of the Senate committee 14-13 on 2/4 and will now go before the full Senate for confirmation. This was the key hurdle passing a divided committee where Sen. Cassidy was the Republican who was the swing vote. Cassidy is a physician who was troubled deeply by Kennedy’s vaccine stance. Yet he voted yes as he was assured that Kennedy will not ban any approved vaccines. Kennedy will almost certainly be confirmed, albeit it narrowly, in the full Senate.

I watched the two days of Kennedy hearings last week. Nothing he said allayed my fears about his feelings toward the pharmaceutical industry. The problem with Mr. Kennedy is his skepticism about many drug treatments. His public attacks mostly have been focused on vaccines but clearly his testimony was anti-prescription drugs.

His most alarming comment was to say prescription drugs are the third leading cause of death in the United States. I will not spend much time refuting this incendiary comment except to say it is grossly misleading. All drug treatment is a benefit / risk assessment and while true serious adverse events can kill people, the overwhelming evidence is benefits far outweighs risks.

He is right that diseases among children have increased the past few decades. No one in public health has objections to his goal of determining why autism, diabetes, food allergies, and ADHD have increased. Perhaps there is an explanation related to diet, food ingredients, pollution, or increased diagnoses. By all means we should allocate public funds to finding out. The problem with Mr. Kennedy is he seems to have already figured it out and his numerous books, speeches, and policy statements say things that are untrue, exaggerated, or based on scant evidence.

His most alarming comment was to say prescription drugs are the third leading cause of death in the United States.

After seeing the speed the Trump team is acting on many policy issues, would a Kennedy HHS be given the go ahead to remake our health care system at warp speed? Would DTC be a casualty of that tear it down approach from Kennedy? While I know we have constitutional protection for business free speech, will Kennedy act anyway to ban DTC and await court challenges?

We can only hope our industry lobbyists can make the case that banning or severely restricting DTC is a bad idea. There are many steps HHS can take short of a total ban including making television harder to execute through new guidances, finding more violative ads, slowing down pre-clearance reviews, and leveraging price negotiations to get companies to “voluntarily” restrict DTC.

I am not expecting Armageddon, but this time the threats feel different. I would be surprised if DTC is not affected in some negative way under the new Kennedy-led HHS.

Bob Ehrlich