Vertically integrated telehealth models are driving conflicts of interest and prescribing safety risks, says paediatric neurologist turned MP Dr Monique Ryan.
Independent MP Dr Monique Ryan has called for an inquiry into Australia’s telehealth services, warning that patients priced out of specialist care or seeking medicines with high misuse potential are turning to online clinics operating vertically integrated telehealth models.
She told The Medical Republic that AHPRA, the TGA, and ACCC lacked sufficient oversight of the growing number of vertically integrated telehealth companies which have commercial relationships with medication wholesalers.
In 2024, AHPRA established a rapid regulatory response unit to tackle unethical business practices and high-volume prescribing of medicines, including weight loss drugs and medicinal cannabis.
The number of medicinal cannabis units prescribed fell by almost 30% following the AHPRA and the TGA’s crackdown, according to data from the Department of Health, Disability and Ageing.
However, Dr Ryan said AHPRA’s attempts fell “well short of addressing the problem” – namely, the commercial structures behind telehealth companies.
“There’s a regulatory desert in terms of monitoring what’s going on with these [telehealth] companies and ensuring patient safety is monitored appropriately through the patient interactions with doctors employed by them,” Dr Ryan said.
While she said telehealth was a significant part of the healthcare system, particularly for patients in rural and remote communities who often have difficulty accessing a GP and other specialist medical care, it needed to be held to the same regulatory standards as other practices.
“When vertically integrated companies with in-house pharmacists have existing commercial relationships with pharmaceutical companies, it’s in their best interests to prescribe and dispense drugs to patients,” Dr Ryan said.
“It’s a conflict of interest that’s potentially relevant with pharmacist prescribing,” she said.
Dr Ryan told TMR patients who couldn’t afford or access specialist psychological or psychiatric care, for instance, were often turning to online clinics that prescribed stimulants – medication she stressed was not entirely “benign”.
However, these vertically integrated telehealth prescriptions often fall outside MBS billing, she said, leaving patients to pay out of pocket.
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In her letter to health minister Mark Butler, she cited an instance where a patient with an eating disorder had been prescribed weight loss drugs as just one example of the “high potential for misuse or harm” from insufficient telehealth prescribing oversight.
As reported in the ABC, a woman with a history of anorexia nervosa was prescribed GLP-1 receptor agonists by an online clinic after receiving targeted ads on Instagram.
The telehealth practitioner never screened the patient for an eating disorder, and the patient admitted to falsifying her health information, according to the ABC.
“Nationally consistent regulation is certainly what we should be aspiring to, so that the rules that apply to other forms of medical care also apply to telehealth care,” Dr Ryan said.
“The gap can only be closed by government action,” her letter to Mr Butler read.
“I’ve always been in favour of expanding general practice to include multidisciplinary care. If we could have community centres where, as well as a GP, you could talk to a community pharmacist and get advice about medications, that would be fantastic,” she told TMR.
In July, the supermarket chain Woolworths began offering 1000 Everyday Rewards points, equivalent to $5 in grocery savings, to consumers who booked a telehealth consultation with its digital health subsidiary Healthylife, using the platform Hola.
Hola Health secured a $10 million investment from Woolworths’ subsidiary.
