Only Hair Loss and Acne Medications Surge... How to Prevent 'Prescription Vending Machines' [The Future of Telemedicine ④]

Consultations Completed in 30 Seconds... The Reality of Telemedicine
Concerns Over Drug Misuse, Including Non-Reimbursable Medications

Editor's NoteWe are now living in an era where, instead of waiting in long lines at hospital waiting rooms, patients can meet doctors on their smartphone screens. After being temporarily allowed during the COVID-19 pandemic and during periods of conflict between the government and medical associations, as well as through pilot programs, telemedicine is set to be fully implemented by the end of this year. While telemedicine provides convenience by filling medical gaps for remote areas and vulnerable groups, there are also limitations due to the ban on medication delivery and concerns about drug misuse. The perspectives of the medical community, platform industry, and patient organizations remain sharply divided. Facing a major transformation that could disrupt the paradigm of the healthcare industry, this article examines the current state of Korea's medical field as it is being changed by telemedicine, and provides an in-depth analysis of the challenges that must be addressed to achieve genuine innovation.

There is growing criticism that telemedicine platforms are excessively commercializing medical services by exposing hospitals based on star ratings, number of reviews, and price order. This is because doctors are reluctant to refuse unreasonable prescription requests from patients in order to manage their reputations on the platform, and in some cases, there is an overuse of non-reimbursable prescriptions for certain conditions.

On January 26, a reporter personally obtained a prescription for acne medication through a telemedicine app. After accessing the app and sorting doctors by "most reviews," a doctor with an overwhelming number of more than 30,000 reviews appeared at the top. When the reporter requested a consultation with this doctor, a phone call came shortly afterward. Even though no separate photos of the condition were uploaded when filling out the consultation request, the doctor only asked a single question-"Is it pustular acne?"-and did not attempt to visually confirm the affected area. Soon after, a two-week prescription for the acne medication "Minocin" was issued. The initial consultation fee posted on the app was 4,900 won, but due to a non-reimbursable prescription, the final fee charged was 15,000 won.

A doctor profile that appeared at the top when searching by "most reviews" to get a prescription for acne treatment on a certain telemedicine app. It has nearly 30,000 reviews.

There was also no verification at the pharmacy stage. After sending the prescription to a nearby pharmacy and visiting in person, the pharmacist handed over the medication without any identity verification process.

On the same day, at another orthopedic clinic where a patient received a telemedicine consultation to get painkillers for a herniated disc, there was also no procedure to verify whether the patient actually had the condition. When the patient requested a digestive medicine that was not on the prescription list, the doctor added it without any further checks or guidance.

The problem is that such lax consultations are leading to serious drug misuse. According to data submitted to the National Assembly Health and Welfare Committee by Myungok Seo, a member of the People Power Party, from the Health Insurance Review and Assessment Service on February 3, the number of non-reimbursable drug prescriptions through telemedicine has surged as pilot projects have expanded.

Looking at the monthly figures, the number of remote checks for the acne medication "Isotinon" in August 2023 was only 41 cases, accounting for about 0.03% of the total 136,601 cases. However, by November of last year, this had soared to 4,556 cases, making up 3.78% of the 120,535 total cases. Prescriptions via telemedicine alone increased 126-fold. According to the Drug Information Center, Isotinon is a medication used to treat severe acne that does not respond well to other treatments.

The increase for the hair loss treatment "Finasteride" is even steeper. In August 2023, there were only 6 remote checks (0.007%), but by November of last year, this had skyrocketed to 7,664 cases, accounting for 6.53% of the total 117,394 cases.

DUR is a system that checks through a computerized network whether newly prescribed drugs overlap with those already being taken. However, since the check is not mandatory, it is impossible to know the exact volume of non-reimbursable drug prescriptions. As a result, non-reimbursable drugs, whose distribution status is difficult to track, are being indiscriminately dispensed through telemedicine channels.

A medical industry insider pointed out, "Currently, the telemedicine fee is set at 130% of the in-person consultation fee, and an additional 30% is added to the pharmacy's dispensing and medication guidance fees. If telemedicine continues to expand with a focus only on convenience, it could lead to moral hazard for both patients and doctors, encouraging unnecessary medical services."

There are also concerns about the system that allows telemedicine platforms to sort hospitals by "star ratings" and "price." Evaluating the quality of medical services based on patients' subjective experiences may prompt doctors to provide prescriptions that cater to patient preferences rather than practicing sound medical judgment. Advertising specific hospitals or attracting patients by emphasizing price could also violate the Medical Service Act's prohibition on "inducement and brokerage."

Moreover, even on the ground, doctors are being deployed for telemedicine consultations without systematic training or guidelines tailored to remote care. Currently, there are no safeguards in place to prevent higher risks than in-person care, such as fraudulent prescriptions through voice alteration or identity theft.

Jae Yong Shin, Professor of Preventive Medicine at Yonsei University College of Medicine, said, "The current telemedicine system lacks clear direction and objectives, resulting in an absence of detailed safety plans. If the full-scale project is implemented without specific regulatory measures for platforms and stronger patient identity verification procedures, there is a risk that medical consultations themselves will become meaningless or be misused."