On January 1, 2020, dermatologists on Apostrophe will start offering only Apostrophe medications (here’s a list). Most of these Apostrophe medications are proprietary mixes and customized creams so they are only available through the Apostrophe Pharmacy Network, requiring home delivery. This is a significant departure from our previous model of all prescriptions being sent to one’s local pharmacy for pickup. Why have we evolved to this new care model?

When we started the company our vision was always to deliver more accessible and affordable dermatological care. What we didn’t expect was that physically delivering medications to our patients was the only way to guarantee they’d actually obtain it.

As we saw the volume of online visits increase over the years, we saw a strange pattern: despite industry-high patient satisfaction scores, only about half of patients were following up for a second visit with their dermatologist. This got us curious as to what was keeping patients from coming back. Unwanted/ineffective treatments? The price?

The primary culprit was none of these. We were asking patients for their satisfaction after their online visit but before their experience at the pharmacy. Here is where we found the tension.

We found that over one third of patients treated on the platform were unable to pick up the medications prescribed to them. These patients had paid for and completed an online visit. A personalized treatment plan had been made for them. And yet their prescriptions remained unfilled at their local CVS, Walgreens, etc.

Upon further investigation, there were a number of reasons why patients weren’t getting their medication. For one, we offered a convenient online solution and the trip to the pharmacy remained the epitome of inconvenience. Another reason was that the medications being prescribed weren’t covered by most patients’ insurance – this led to high out of pocket costs that made treatment prohibitively expensive. Finally, different pharmacies offered the same medications for different prices. If a patient was prescribed multiple medications (over 80% of patients are), many times they had to drive to pick up different meds at different pharmacies. This problem only compounded the price and convenience issue.

We did our best to help these patients. We partnered with prescription benefit coupon companies and individually sent discount coupons to reduce the out-of-pocket price. We facilitated prior authorizations whenever it was appropriate (this is a form justifying why insurance should cover a medication when it’s not typically covered). We transferred thousands of prescriptions to the pharmacies with the lowest possible prices on behalf of patients. Most of the above is performed via phone call or fax, so this was taking a lot of resources.

In the end, we saw some improvement but not enough. Our costs associated with all of this administrative work skyrocketed while over time coverage for acne/rosacea related issues only worsened. Patients loved online dermatology visits - but they couldn’t physically get their medications.

Pharm to Table

We knew we had to completely change our approach if we were going to make the impact we wanted. Visits weren’t enough, we had to be able to guarantee reasonably priced medication and deliver it to patients’ homes.

Now after their online visits, patients return to Apostrophe to see their personalized treatment plan. Instead of having to go to the pharmacy to find out the cost, the price for each medication is immediately available and no insurance is necessary. Patients can then checkout and have their medications delivered to their home for free.

The first Apostrophe medications were sent in July and the results have been inspiring: over 85% of patients are physically obtaining their prescribed Apostrophe medications. That’s a 40% increase to the old way.

We still have a lot of work to do. We’re continuing to grow the medications and ingredients offered on Apostrophe. We’re pouring tons of energy into outlining all of the ingredients used in our products to justify how they’re amazing. We’re expanding into some new conditions and some new states soon. More to come.