No appointment. No waiting room. You answer a questionnaire on your phone, take a photo of your face, and a few minutes later a prescription is on its way to the pharmacy.
All for $4.99 a month.
Since 5 October, this has been possible in Utah, in the United States. It is the first time an American state has authorised an artificial intelligence to write a first prescription itself.
How it works
The service is called Nolla Derm. It is offered by Nolla Health, a young New York company. It is aimed at adults in Utah who suffer from mild to moderate acne.
The patient fills in a medical questionnaire, then scans their face. The AI assesses the severity of the acne and, if it considers itself confident enough, chooses a treatment and writes the prescription. Cases that fall outside the framework — severe acne, pregnancy or other at-risk situations — are referred to a doctor.
Human oversight decreases in stages. At first, a healthcare professional validates every prescription before it is sent. In a second phase, the AI will send prescriptions directly, and doctors will review them all after the fact, at least once a week. In the final phase, they will check only one in ten each month.
The AI does not choose freely. It picks from a short list of treatments to be applied to the skin, approved in advance by doctors, some of which are already sold without a prescription. It cannot prescribe any tablets, any hormonal treatment, and above all not isotretinoin, the most powerful drug against acne, whose side effects require strict medical monitoring. According to the company, doctors agreed with the AI's choices in around 96% of the last 1,000 cases, with disagreements mainly concerning dosage.
Why acne, and why Utah
Acne was chosen because it is a very common condition, well known, low-risk, and treated for decades with proven products. For many patients, seeing a dermatologist means weeks of waiting and high costs.
Utah, for its part, has created a "regulatory sandbox": a mechanism that allows certain rules to be temporarily suspended in order to test an AI product under supervision. The state makes clear that taking part in this programme does not mean it approves or recommends the product. It has also added independent auditors tasked with verifying companies' claims.
What is cause for concern
The scheme is highly debated. In the spring, Utah's medical board had requested the suspension of an earlier programme, which allowed an AI to renew existing prescriptions.
There are many questions. Who will be responsible in the event of an error? What happens to the face photos sent to the app? And above all, how far will this go? The company says it wants to extend its service to other conditions, while acknowledging that certain drugs, such as opioids or stimulants, are too risky to be entrusted to an AI.
At the end of September, we reported that doctors were holding back medical AI beyond diagnosis, for lack of sufficient evidence. Utah has just taken that step, on deliberately narrow ground.
What we take away
The headline "an AI prescribes without a doctor" is only half true. For now, doctors approve every prescription, the AI only chooses from eight creams, and serious cases stay out of its reach.
But the direction is clear: simple, repetitive medical tasks could, one day, do without an appointment. In France, that is not possible: a prescription can only be written by an authorised healthcare professional. To find out how to use an AI for your health without taking risks, we are publishing a guide later today.