While acne care may seem like a leap coming from a company that's built its reputation (and base of over one million patients) mainly on reproductive health care, Nurx clinical team lead Nancy Shannon MD, PhD, says the company added acne to its portfolio of concerns as a response to existing patient demand. According to a survey from Nurx, a whopping 85 percent of its patients reported experiencing acne issues, but just 7 percent of them reported being under a dermatologist's care.
Dr. Shannon says because the company works with 350,000 birth control patients, it has unique expertise around the hormonal issues which cause a significant amount of acne seen in the age group it treats. "Over half of patients that are coming to see us for birth control have concerns about acne—we see that on their medical charts [or] they're asking us to provide that service," Dr. Shannon says. "And while we've not advertised it as acne care, certainly many of the women that see us for birth control are coming either because they realize that oral contraceptives can help with acne or because their dermatologist has referred them over to Nurx to get help with birth control."
For these reasons, acne care was on the company's radar long before the COVID-19 pandemic took hold, but the circumstances of this year have amplified the need for this type of care, says Dr. Shannon. After all, it's been challenging to visit doctors in person, and no matter how bad the acne, some people would prefer to stay safely at home than to risk a technically non-essential appointment. At the same time, Dr. Shannon adds, "maskne," aka acne caused by wearing COVID-protective masks, has caused or intensified breakouts for 66 percent of existing Nurx patients surveyed.
But it's difficult to get onto a dermatologist's schedule even in the best of times, Dr. Shannon points out. "We don't want a patient to have to wait," she says. "We want them to be able to pick up their phone, open the app, have someone hop on to help them, and get their medication, if indicated, within a week. That's what our dream is."
In-person dermatology can also be expensive. While medication costs are not included in Nurx's $35 price tag, the company's consultations are still just a fraction of what the in-person equivalent care would likely cost, especially for those who are uninsured. "What we're trying to do with this acne-care line—just as we have with our migraine, birth control, HIV PrEP, and STI testing care—is democratize medicine and health care and make it more accessible to everyone," says Dr. Shannon. The Nurx team has "worked really hard" to make their acne prescriptions affordable for those who are uninsured, she adds, and has partnered with pharmacies that take insurance for those who are. (Prescriptions can be sent to a patient's preferred pharmacy, too.)
Which isn't to imply that the company will be defaulting to medication in every scenario; Nurx providers will offer an integrative approach to care. "What we want people to do is to think about how they care for themselves and how that impacts whether they're having a breakout or whether they're not," Dr. Shannon says, noting that sun protection, the use of appropriate skin care products, diet, and more can all influence acne issues. "And there are some really good over-the-counter medications that can be used in conjunction with prescription medications as well, and we'll certainly steer people toward those as appropriate," she adds.
Of course, Nurx isn't first-to-market on dermatological (and specifically, acne-related) telehealth. Hims & Hers also offer acne care; however, they use a free survey form to customize prescription creams that the patient then purchases as a subscription, rather than prescribing existing medications purchased through pharmacies. (Hers does separately offer birth control prescriptions, though.) Rory, Apostrophe, and Dermatica utilize similar models. This approach allows for free consultations but requires payment for treatment (e.g. custom creams). Nurx's approach, on the other hand, requires an out-of-pocket expense for the consultation but may allow for lower customer costs on prescriptions for covered patients. Many regular dermatologists have been offering telehealth visits to patients during the pandemic, too, but in most cases, regular visit fees apply.
With respect to dermatological services, Nurx doesn't plan to stop at acne care, either. While she's elusive on what exactly is in the pipeline, Dr. Shannon says Nurx hopes to expand into customers outside of their current age demographic, which skews younger. "Even as they get into older age, people have skin conditions and skin concerns that affect how they feel about themselves and how they interact with others," she says. "We'd like to help them out and not just confine ourselves to the younger age group with acne."
It should be noted that many telehealth services—including Nurx's acne care—aren't yet available in every state due to varied laws. But Dr. Shannon says this is slowly changing as a result of the pandemic, and she expects expansion. And there are compelling arguments for telehealth beyond this crisis—the cost and convenience issues of in-person care existed long before COVID-19, and Nurx aims to eliminate much of the burden our current health-care system places on patients. "We hope that contacting us is the same as picking up your phone and sending a text message to a friend," Dr. Shannon says. "You don't have to take a day off work, you don't have to try to find someone to care for your kid or any of that—you just do it when it's convenient for you."
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