In light of a recent article focused on Nurx, we wanted to provide an honest perspective on our company and address some of the claims made about our operations.
While the questions raised are not unique for a company like ours that is quickly growing and scaling, we want to be clear that the past business practices featured in the story were in place for a very limited time, impacted a very limited number of patients, and ended nearly a year ago. The story’s depiction of Nurx does not reflect our policies now, but just as importantly, they do not accurately reflect the full picture of how we operated then.
Further, the story failed to accurately portray the high quality of care provided by our medical organization, or the widespread acceptance and positive impact of contraceptive telehealth.
We recognize that as we continue leveraging innovative solutions to address the gaps in our healthcare system, we will continue to make significant investments in our team, our operations and our community. Here’s how we’re doing it.
We’re incredibly proud of the impact we’ve made on the healthcare system over the last few years, particularly in areas of the country where people turn to us because they don’t have any options. There are nearly 20 million women in the U.S. who live in areas without easy access to contraception, which is especially concerning considering nearly half of all pregnancies in the U.S. are unintended.
We believe that everyone should have easy and affordable access to essential and time-sensitive healthcare needs like birth control, regardless of their circumstances. We’re providing a more efficient, patient-centered, and cost-effective way to deliver high-quality clinical care — and our success to date is evidenced by the demand for the way we approach care.
Our patient community now includes more than 200,000 people across the country, 65% of which choose to stay with Nurx year over year. Our Net Promoter Score (NPS) score, which is an industry benchmark for customer satisfaction, is consistently over 90. That kind of score is nearly unheard of in any industry, let alone in healthcare.
While most of our patients choose Nurx for affordable and convenient access to birth control, we’re also now seeing thousands of requests for the HIV-prevention medication PrEP every month, which increased 10x after introducing our PrEP home testing kit last August. By providing convenient and judgement-free care to those who wouldn’t otherwise have access, we can now say that we are the leading telehealth provider of the life-saving medication.
We’re also encouraged by the immediate response to our most recent healthcare service, home HPV testing, which allows women to screen for their risk of cervical cancer from the convenience of their own home.
We’re working hard to introduce more essential healthcare services that will continue to help our patients take control of their own health. We’re looking forward to sharing news on that front in the near future.
Over the last year we have been especially focused on bringing a highly seasoned and experienced leadership team to the table. We recently announced that Varsha Rao is leading the company as our new CEO. As an early investor in Nurx, she has been committed to our mission since the very beginning. Varsha brings decades of experience rapidly scaling startups and established companies like Airbnb and Clover Health.
Aside from Varsha, we’ve also brought on six new leadership team members over the last year including our COO Jon Czaja, VP of Pharmacy Dave Fong, SVP of Legal Lina Brenner, VP of Marketing Katelyn Watson, and VP of Engineering Robert Gash.
We’re also excited to share we have a new Medical Director with extensive medical and operational leadership coming on board very soon.
OUR PHARMACY OPERATIONS
As a company working to safely expand access to healthcare services while making the process as seamless as possible for patients, our supply chain is an area we have invested heavily in over the past year and in which we will continue to invest in this year.
With this in mind, we wanted to set the record straight on an outdated and misguided practice that occurred nearly a year ago. Early on, there was a period of time during which a limited number of undelivered, sealed packages that were originally shipped from a dispensing pharmacy were returned to our former corporate office instead of going back to the originating pharmacy location.
Some of those packages were then re-shipped in an effort to resolve customer service or delivery issues where patients had not received their prescribed and shipped product.
We do want to emphasize this practice was terminated nearly a year ago and impacted a miniscule percentage of the over one million orders we’ve processed at Nurx. We also have no reason to believe this practice impacted patient safety, and any characterization that this misguided practice was part of our normal supply chain operation is simply untrue.
Regardless, this practice does not reflect the high level of standards that we currently hold ourselves accountable to.
We have made significant changes to our leadership team over the last year, including bringing on our VP of Pharmacy Dave Fong, who brings more than thirty years of experience in pharmacy practice, compliance and operations. He formerly served as SVP of Pharmacy at Safeway and Longs Drugs, and is a former member of the California Board of Pharmacy. Dave and his team strive for legal compliance and best practices across all areas of our pharmacy operations, in close alignment with our legal team’s support.
We are confident that today we are following the appropriate processes and are consistently evaluating the integrity of our supply chain practices to make sure nothing like this ever happens again.
OUR COMMITMENT TO CARE
Nurx is one of the many companies that are leveraging telemedicine platforms to achieve public health outcomes that aren’t feasible in the traditional healthcare system. We’re proud of our ability to leverage innovative solutions that help our clinical team provide safe and high-quality care on a wider scale.
Nurx’s platform and clinical protocols are evidence-based, incorporate CDC and governing guidelines, and have been reviewed and approved by leading academic clinicians and medical experts. Treatment provided through robust telemedicine platforms like Nurx often offers more oversight than what is recommended based on the consensus of medical experts.
While one patient example of an adverse event is one too many, and we take any adverse event very seriously, our patient did not experience a Deep Vein Thrombosis (DVT) due to how she accessed care. DVTs and pulmonary embolism are a known risk of combination birth control, which our physician discussed with her patient prior to prescribing. We emphasize that our rates of DVT from birth control among our patient community of over 200,000 people is 0.023%, which is significantly lower than the national average, which ranges between 0.1–0.3%.
In fact the existing breadth of research — combined with the low-risk associated with birth control pills — is why some of the leading medical groups have advocated to allow women to access oral contraceptives without any doctor consult and to remove the prescription requirement altogether. This includes the leading organization representing OB-GYNS, American Congress of Obstetricians and Gynecologists, which stated, “ACOG has long supported over-the-counter access to oral contraceptives. Birth control is an essential part of women’s health care, and over-the-counter status would help more women benefit from the ability to control their own reproductive health. Of course, decades of use have proven that oral contraceptives are safe for the vast majority of women, and that they are safer than many other medications that are already available over-the-counter.”
Our providers are highly confident in their ability to deliver care that meets or even exceeds the quality of care provided in a traditional setting, and we thought it would be helpful for you to hear directly from them on this matter:
“I’ve been practicing medicine since the 1980’s and involved in telemedicine since the early 2000’s. My colleagues and I at Nurx recognize that taking care to provide health care that is appropriate, and only to patients for whom it is appropriate, is critical. Practicing with Nurx has been wonderful — we have a team of strong, compassionate clinicians, and we follow professional guidelines. We communicate with and educate our patients, and are clear that we expect honesty and truthful information from them, and that we exercise our professional judgement in the interest of their safety. We focus on preventive care — preventing unwanted pregnancy, preventing HIV infection, and screening for cervical cancer. These are appropriate for telemedicine, for many patients. The complaints I have gotten from patients reflect their disappointment when we recommend that they work with their personal physician instead of with us, because we don’t think their medical conditions make telemedicine safe for them. We’re so happy to provide preventive care for those for whom it is appropriate — and also happy to refer people to their physician for in-person care when it’s needed.” — Dr. Julie Graves, MD, MPH, PhD
“I was honestly afraid that communication would be compromised without face-to-face patient contact, but it turns out that messaging patients through the platform often removes the inhibitions that some patients feel talking in person. I spent a number of years working in an outpatient internal medicine practice, and rarely did patients ask many questions about potentially embarrassing topics. People feel much freer when sending an essentially anonymous text. I love the convenience this platform provides to both the patients and the providers. Using an asynchronous model, we can message back and forth throughout the day and night. I can take as much time as I need to respond thoughtfully and can look up medical articles and consult with colleagues if I don’t immediately know the answer. I don’t have to worry about patients getting backed up in the waiting room. It’s easy for both the patients and the providers to ask another question or add something they may have forgotten to say earlier…For as long as I’ve been with the company — and I was one of the first doctors hired on — we have consistently erred on the side of practicing conservative medicine.” — Dr. Nancy Shannon, MD, PhD
OUR CLINICAL PROTOCOLS
As mentioned earlier, Nurx’s clinical protocols are evidence-based, incorporate CDC and governing guidelines, and have been reviewed and approved by leading academic clinicians and medical experts. We want to set the record straight on a reported discussion regarding prescribing policies for women 35 and older who smoke less than 15 cigarettes a day.
The implied debate was regarding whether we should implement an informed consent model, where we would inform these women about the risks of estrogen containing birth control so they can share decision making with their provider to make an informed decision.
To be clear, the CDC’s US Medical Eligibility Criteria for Contraceptive Use guidelines themselves categorize the use of combination birth control for women age 35 and older who smoke less than 15 cigarettes a day as a category 3 “Theoretical or proven risks usually outweigh the advantages” vs a category 4 “Unacceptable health risk. Method not be used”. The CDC guidelines themselves recognize the clinical decision making required to determine the appropriate birth control method for a given patient.
However our former medical director’s clinical judgement — that the clinical protocols should reflect a more conservative approach which does not offer combination birth control for women who are 35 and older who smoke under any circumstances — was upheld and is still upheld to this day. Our clinical leadership always has and always will have the final say over clinical decisions.
We shared earlier that the response to how we deliver care has been overwhelming since Nurx first launched. While benchmarks like our off-the-charts NPS score are a great way to measure how the business is doing, what really motivates us is when our patients proactively share with us how much Nurx has made an impact on how they approach their healthcare decisions. As with our providers, we thought you’d want to hear from them directly:
“Before Nurx, getting birth control was such a pain — I have two toddlers and a full-time job, and my doctor is an hour and a half away. Missing work to carry two toddlers to a doctors appointment is a nightmare, not even to mention the copays. Having two kids and PCOS has made hormonal birth control so difficult for me. I’ve never had a birth control that didn’t have horrible side effects, until I found Nurx. Once I signed up, a doctor talked to me right away and explained what my options were. She worked with me to find something that was right for me. And I did it all from the computer so I didn’t have to drive anywhere or pay any co-pays! To be able to get birth control online instead of having to drive all the way to the doctor and miss work is so much easier. Nurx has been awesome. I think it’s so awesome that there’s finally a company that is convenient to get birth control easily — especially for working moms.” — Lezlee, Nurx Patient
“I was in the middle of changing my medical insurance and was without a doctor or coverage right when my birth control pill was running out. If I hadn’t found Nurx I would have missed my pill and risked the chance of pregnancy. So grateful you exist!” — Jilian, Nurx Patient
“I’m from a small conservative town, so before Nurx I didn’t look forward to talking to my doctor about birth control. They would always ask me if I was sexually active, which is a big thing in a conservative town. You can’t just get on birth control because you want to control your acne, or hormones, or god forbid you want to have a normal, regular period. It comes with a lot of stigma and it’s uncomfortable. I also kept getting prescribed the same kind that didn’t work well for me. I’m super busy. I work full time and I’m also involved in politics, so getting birth control was taking a lot of time and energy I didn’t have. It just wasn’t a positive experience at all. Now with Nurx it’s seamless and so much easier.” — Nurx Patient
“When I heard that PrEP was 99% effective at preventing HIV, I knew I wanted to get on it for extra protection — not that my lifestyle is crazy, I just want to have extra security. But I grew up in a very conservative area. Trying to find a doctor where I’d be accepted was hard. If I asked for PrEP, they’d say “I don’t prescribe that. I don’t believe in that lifestyle”…It was a sigh of relief when I moved to Orlando, Florida — a more accepting community — and finally found a doctor that was helpful. Even then, it wasn’t easy…I would have to take the day off work to sit in a lobby for two hours before I was even seen by my doctor. Then she’d send me to go get my blood work done. After that, I’d have to go back so she could write the prescription…sometimes my doctor would forget to send the paperwork to the lab, so I’d have to wait another week before I was prescribed again…Now with Nurx, I can do it all at my leisure — I don’t have to worry about missing a week. The home test kit is amazing. It’s delivered while I’m at work, I complete it when I get home, and send it right back in the mail. The customer service is amazing too. They message me 15–20 days before my prescription runs out, so I’m not left without PrEP. I love that I can open the app and just message a doctor. I’ve never waited more than an hour for a response. The doctors are on top of me too. Sometimes I’ll get a test kit and forget to send it back in, so they’ll send me a friendly little text to remind me. Now I know that every 90 days I’ll get a kit in the mail and every 30 days I’ll get my prescription. It’s made being on PrEP so easy and convenient!” — Ryan, Nurx Patient
“I also used the HPV home test, which was awesome! There’s a history of cervical cancer in my family, so I wanted to do one to have peace of mind. It’s uncomfortable to go to a doctor to get a pap smear and I’d also have to pay a copay that was more expensive than doing it through Nurx. The instructions were super easy and I had no issues at all!” — Megyn, Nurx Patient
“I was having a lot of problems getting a birth control prescription prior to Nurx. Turns out I have a plan under the Affordable Care Act that isn’t required to cover birth control for religious reasons. The nurse was shocked. I was shocked. My insurance had covered everything before this. I didn’t know how I was going to get birth control after that…. Nurx was exactly what I needed. Now my birth control comes right to my door every three months. It’s so reliable. I’ve never had to worry about it not showing up on time or getting sent to the wrong address. I don’t have to worry about finances either. There are so many options, so you’re going to find one that works for you. It makes everything so easy. Especially if someone doesn’t have a doctor. I just moved so I don’t have a primary care provider yet, so being able to talk to a doctor through Nurx is a great option. When I moved, all I did was message Nurx to let them know and they updated everything. It was so simple. I can’t imagine going back” — Elizabeth, Nurx Patient
We have never been more confident in the state of our business, the integrity of our supply chain and decision making, and most importantly the high quality care that our providers deliver to the Nurx community every day.
Our focus has and always will remain on the Nurx community and how we can best meet them on their terms, safely and appropriately.
While we’ve addressed many of the claims made about how we run our business, we recognize there may be a few outstanding questions that you’d like more clarity on.
We’d be happy to address these with you, please get in touch with us at firstname.lastname@example.org