The elderly patient’s blood pressure had been dropping for weeks, and Chad Wittekind, his primary care provider, couldn’t figure out what was wrong. He had upped the dosage of one medication and added another, but couldn’t manage to regulate it.
The patient hadn’t reported taking any other new medications or supplements and hadn’t made any major recent lifestyle changes. So what could be causing the blood pressure irregularity?
It took a lot of questions and appointments to find the culprit: a drug he’d gotten through a telehealth website.
Like many other patients Wittekind has seen recently, this one had circumvented his primary care provider to get a drug over the Internet—in this case, an erectile-dysfunction medication. He’d gone to a website he came across online, filled out a form that a virtual health care provider quickly reviewed, and was sent the medication through the mail, but had been too embarrassed to tell Wittekind about the new addition to his regimen.
You might not think that Wittekind, a Columbus, Ohio-based provider who works in geriatrics, would be seeing many patients turn to the Internet to get drugs for conditions like erectile dysfunction, overweight, menopause, and depression. But the accessibility of sites like these and the ease of getting meds from them have made them an increasingly popular choice for Americans of all ages and incomes.
Here’s how it works: often after viewing an ad on social media, people click on little-known websites promising a fast and easy way to get medication for a specific condition. These sites accept credit cards, don’t take insurance, and don’t typically make you have a call with a doctor. Instead, you fill out a quick form about your medical history and current medications, and a medical provider you’ll never meet (and will probably never talk to) reviews the information within minutes to hours. If you qualify, they’ll write you a prescription—often a recurring one—and connect you to a pharmacy that ships the drug directly to your home.
Wittekind and other providers see this as a problem. They’re used to patients coming to them asking for some drug they’ve seen advertised on TV, but the fact that patients can now get these drugs elsewhere, without much screening, is worrying. Wittekind has had a patient receive ketamine tablets through a telehealth website, and another got a GLP-1 drug for weight-loss even though they had a BMI of 18.7, meaning they should have been too thin to qualify per U.S. Food and Drug Administration (FDA) guidelines. Sometimes, patients will have side effects from medications, but when they follow up with the virtual doctor who prescribed them, they don’t get a helpful response.
Sites like these fall under the large umbrella of telehealth, which has unquestionably improved access to medical care, getting services to people who may not be able to easily or quickly find a doctor. It’s also made people much more comfortable seeking treatment for conditions that they might be embarrassed to bring up with their regular doctor, such as erectile dysfunction or hair loss. But telehealth has changed a lot since it started, when it usually referred to a video call with your doctor. Now, it includes hundreds of websites and the pharmacies they partner with—many of which are under-regulated.
“There’s no accountability, no follow-up if they do have a problem. Trying to get back with their provider is impossible, and then it becomes my problem,” Wittekind says. “There’s no oversight with most of these places. Yes, you’re improving access, but at what cost?”
Why telehealth sites are exploding
Elliot Tabibian started his first telehealth site when he was just 18 years old. You don’t need to be a doctor to do so; all you have to do is figure out a condition that people are seeking treatment for and market your website. Outside companies have popped up to help with the infrastructure side—connecting patients with doctors and pharmacies, for example, and ensuring that the website complies with various state and federal laws.
Tabibian says he got into telehealth after hearing about a friend who paid a website $200, had a 30-second doctor’s appointment by phone, and got a medical marijuana card. “I thought, ‘that seems pretty profitable, I should get in there,’ says Tabibian, who is now 22.
His first site prescribed medical marijuana; he also tried out sites that sold erectile dysfunction medicines and ones that allowed people to get doctor’s notes stating that they needed service animals. (He shut these sites down after competition got too tight, he says.) He now operates two telehealth sites, one of which helps people get medical exemptions so that they can tint their car windows. “Tired of Cops Taking Your Tint? See if you Qualify for a Medical Tint Exemption in Less than 10 Minutes!” the site reads. It claims to give customers a full refund if they do not get approved for an exemption.
Tabibian’s is one of hundreds, if not thousands, of telehealth sites that have proliferated in recent years. Though some of the first direct-to-consumer telehealth sites started operating before the pandemic, consumers really started embracing telehealth during it, when many insurers loosened restrictions to ensure more patients had access to care. This allowed medical care to be delivered at home to people who might not be able to travel to receive it elsewhere, expanding access. But what was meant to be a temporary measure became permanent as people grew accustomed to the convenience.
As more people sought out telehealth, entrepreneurs like Tabibian stepped in. They were enabled by companies forming networks of doctors that telehealth companies could contract with to provide services to patients, says Rebecca Gwilt, managing partner of Elevare Law, which consults with digital health care companies. An entrepreneur only has to create a website and market its services to get a telehealth company off the ground.
These sites became extremely popular once the first GLP-1s debuted in 2021 and immediately went into shortage. People wanted GLP-1s, and many either couldn’t get them or couldn’t afford them. Telehealth entrepreneurs saw an opportunity, Gwilt says. They partnered with a special type of pharmacy, called a compounding pharmacy, that mixed the active ingredients in GLP-1s and sold them for much less than the pharmaceutical companies.
These sites take advantage of several weaknesses in the American medical system. It is expensive and inconvenient to go to the doctor, and patients often need to wait more than a month for an appointment. Insurance is also dismal to deal with, and deductibles and pre-approvals can make getting medications a costly headache.
Those issues “created a gap that the compounding pharmacies and telehealth facilities were able to step into,” says Dr. Anjali Deshmukh, a pediatrician who is also a professor of health law at Seton Hall University. “They did not create the problem, but they are unquestionably profiting.”
One of the companies that helps entrepreneurs start their own telehealth sites is CareValidate. Co-founder Dr. Jiten Chhabra says he has seen a huge surge of people getting into telehealth—even those “who have no business in telehealth.” CareValidate is growing 20% month over month, he says, buoyed by investors and doctors interested in the idea of cash pay for medical care and specific medications.
“We’re about to see a telehealth site for everything—it’s going to be very niche,” he says. “It’s going to show up in your social media, and it’s going to be the easiest way to get your hyper-personalized health condition taken care of.”
There are now virtual companies where customers can get diagnoses and prescriptions for things like low testosterone, toenail fungus, and even fear of public speaking. Often, the medicines are prescribed on a recurring basis, creating a long-term demand for the services of the telehealth doctor—and revenue streams for investors. These sites have essentially changed the power dynamic between doctors and patients; now, it’s the patients demanding medications they’ve decided they need from online health care providers, rather than patients asking doctors about what’s best for them.
Investors see a huge upside because the sites are relatively cheap to launch and because they can turn a profit quickly—either by charging people for visits, selling medications at a markup, or both. Venture capitalists and private equity groups have put millions into telehealth startups, some of which have only a few employees. The size of the U.S. telehealth market was an estimated $28.3 billion in 2025, according to Grand View Research, and is projected to grow to $60.4 billion by 2033. The telehealth boom is concentrated in the U.S., where the high cost of medications and medical care has driven many consumers to telehealth sites; the market is not as strong in other countries.
The telehealth space is expected to further explode because of interest in peptides, the injectable compounds that wellness influencers have popularized. (Very few clinical studies prove that peptides are effective, aside from those for GLP-1s, one example of a peptide.) In a two-day July hearing, a FDA committee recommended that the agency allow specialty pharmacies to dispense six peptides; if approval is finalized, many patients are expected to get their prescriptions from telehealth sites.
Telehealth can be appealing to doctors who are burned out from long hours and negotiating with insurance companies. With telehealth, they can work from home and often avoid insurance altogether.
“The economics are good, the lifestyle is good,” says Chhabra.
The problems with this type of telehealth
The downsides of this direct-to-patient model are starting to become evident. Patients who claim they were prescribed medicines after a cursory online evaluation are filing lawsuits about unanticipated side effects. Several lawsuits allege problems with telehealth companies prescribing at-home ketamine, Adderall, and hair-loss drugs.
In a few cases, patients have died after receiving what their families allege were inadequate telehealth services. Some lawsuits are also accusing telehealth sites of pressuring doctors to act in ways that maximize profit, rather than patient health.
Research suggests that the level of care provided by some of these sites is sometimes poor. In one July 2026 study published in JAMA, a researcher attempted to obtain prescriptions from 49 telehealth websites and found that there was “limited clinician engagement” and that the sites sometimes issued prescriptions, often in as little as five minutes, despite patients not uploading required photos or following other rules of the sites. In some cases, the same clinician provided several different prescriptions for the same patient across multiple sites.
“What we found is really there’s not any sort of true engagement with a clinician,” says Dr. Reshma Ramachandran, a Yale professor and clinician and one of the authors of the study. “The motivation from these websites is just to prescribe and not necessarily provide health care in the sense of someone actually conveying to that patient the risks and benefits we need to be considering.”
Because so many sites compete to attract customers, experts say that some doctors are unlikely to turn down requests. Doctors sometimes have quotas of prescriptions they need to meet from the sites or get bonuses for meeting certain goals, says Ramachandran, who has friends who work for telehealth sites. A recent Senate investigation into a handful of telehealth sites found that 85%-100% of patients who interacted with a provider received prescriptions.
Many patients report that there’s little follow-up from the sites or the doctors they employ, making it difficult for people to know what to do if they develop side effects. Ramachandran, who works at a federally qualified health center for low-income patients, says she has patients coming in who turned to telehealth because insurance got too expensive and were seeking medication, got confused about the dosage they received, and had bad side effects from the medications they took.
“I think we’re undermining trust in the physician-patient relationship,” says Erin Fuse Brown, a professor of health services, policy and practice at the Brown University School of Public Health. She argues that telehealth sites are similar to “pill mills,” where the prescribers generate prescriptions if there is any conceivable reason to do so. “If you can just go to a website and get the drug you’re seeking after a cursory asynchronous questionnaire, it commercializes medicine in a way that’s a little bit dangerous.”
Few laws exist to regulate these sites, which have the ability to claim to just be platforms connecting patients and providers.
“There’s so much money to be made, and so many recent business school graduates running a start-up to get to the next big thing, that this aspect of telemedicine is getting way ahead of regulation, the law, and ethics,” says Arthur Caplan, a professor of bioethics at the NYU Grossman School of Medicine. “It’s like a gold rush.”
Ramachandran says that while telehealth sites may have started as efforts to increase access to care, many have since incorporated incentives for doctors who get patients to try additional medications or take specific costly tests. Her study found that some sites didn’t disclose that the GLP-1s they sold were compounded and made unsubstantiated efficacy claims.
“There are definitely digital health companies out there that you get concerned are worried about revenue rather than patient care,” says Dr. Suneer Chander, a co-founder of Air Physician Academy, which works to educate doctors about how to ethically enter telehealth. “That’s the sort of stuff we want doctors to understand before they get into digital health so that they can lead the industry, rather than be told what to do.”
Tabibian, for instance, says one of the doctors who works for his company has done 300 asynchronous visits a day, reviewing patients’ requests for medication. The doctor gets paid $20 per review and has made as much as $6,000 a day.
Asked if he was worried that 300 prescriptions per day was too many, Tabibian says that it’s up to the doctors to do their due diligence on what’s right for the patients. The way his company is set up, he says, he has no say in any medical decisions. “I’m a technology company. My job is just to connect the patient and physician,” he says. “Anything medical that goes on between the patient and the doctor is 100% the doctor’s responsibility.”
He does see other sites bend the rules, he says—prescribing testosterone for men whose levels don’t medically support a prescription, for instance. He got ketamine prescribed for himself online because he was interested in starting a ketamine site, and says that he only took half of what the doctor ordered and was so high he couldn’t get out of bed. “That’s just a huge liability,” he says.
Succeeding at telehealth is really about being good at marketing, he says, and people—especially young people—who know how to promote sites through social media can cash in. “It’s really been smooth sailing,” he says. “From what I’ve seen, there’s little to no enforcement in the field.”
Murky regulations
Few regulations guide what doctors can and can’t do via telehealth. Doctors, for instance, must meet what’s called the “standard of care,” meaning that they are expected to diagnose and treat the patient in the same way other qualified doctors would. But standard-of-care obligations are enforced by medical societies and professional associations, and few have taken steps to punish doctors for not meeting the standard of care through telehealth, says Caplan, the bioethics professor.
“I’ve tested the sites, and the longest it took me to get whatever pill was about 35 seconds,” he says. “There doesn’t seem to be a thorough medical exam happening.”
Instead, he says, doctors are prescribing medicine like antidepressants without talking to people to figure out why they might be depressed, or prescribing medications with serious side effects without much warning. Litigation often only comes after something bad has happened, like a death or other adverse event.
“I do worry about the fracturing of the medical system more broadly,” says Deshmukh, the Seton Hall professor. “I think having a relationship with a physician who understands you and knows your medical history and can make these decisions together is important.”
State medical boards could step in and discipline doctors who are providing substandard care through telehealth. But “the investigation capacity is really, really limited, and often they just don’t have the resources,” says Ramachandran, the Yale physician and professor.
There are not many existing federal laws that could effectively regulate telehealth, says Fuse Brown, the professor from Brown. A law called the anti-kickback statute makes it illegal to compensate someone to make referrals for something (for example, medications) paid for by a federal health care program. That would presumably prohibit telehealth sites who make money off of prescriptions from paying doctors to make those prescriptions. But the anti-kickback statute only applies to drugs prescribed through federal programs like Medicare and Medicaid, and many of these sites are cash pay, so the statute wouldn’t apply.
States could also investigate whether providers who work for these sites are being pressured or incentivized to prescribe more medicines, Fuse Brown, who adds that such pressure could potentially violate state laws.
Even without explicit pressure, telehealth providers know what patients expect of them. Wittekind, the geriatrics provider in Columbus, says he tried out working at a telehealth site after a company pitched him on setting his own hours and making some extra money. But one of his first patients was a man who wanted an oral hair-loss medication that can come with serious side effects, Wittekind says.
The patient already had hypertension, and Wittekind didn’t think the drug would be a good solution for him, so he turned down the patient’s request. Wittekind realized that his principles probably led to bad reviews for the telehealth site—the patient seemed “perplexed” by the denial—but he didn’t like the idea of prescribing powerful medications without much opportunity for follow-up. He ultimately decided telehealth wasn’t a good fit for him because of that pressure to give the patients what they want.
It wasn’t worth the extra money,” he says. But to many other clinicians, it is.
