Utah lets an AI write first-time acne prescriptions, a US first

The process takes about 10 to 15 minutes, according to Nolla.

1. Sign up: eligible Utah adults download the Nolla Derm app and opt into the pilot.
2. Verify and consent: you confirm your identity and complete an informed-consent process.
3. Answer questions: a short intake questionnaire.
4. Scan your face: a five-angle face scan, Unite.AI reports. The AI scores acne severity from the images, not from what you report.
5. Get a plan: if appropriate, you receive a personalized treatment plan and prescription in the app.

Prescriptions arrive by home delivery or pharmacy pickup. Daily skin scans track progress, and treatment plans are updated monthly, Nolla says.

If the AI isn't sure: the patient is sent to a licensed physician rather than getting an uncertain recommendation, according to Nolla.

Not much, by design. The AI can only choose from pre-approved treatment pathways, and can't improvise, Nolla says.

The state agreement lists a set of topical creams and gels, Unite.AI reports:

• Tretinoin
• Adapalene
• Clindamycin with benzoyl peroxide
• Benzoyl peroxide
• Azelaic acid
• Some compounded versions with niacinamide and, in two formulations, topical spironolactone

Off the table: pills, hormone therapies, isotretinoin and severe acne are all outside the pilot.

Hard stops: pregnancy, plans to become pregnant, breastfeeding, immunosuppression, severe kidney or liver disease, a prior reaction to a listed drug, being under 18 or a non-Utah address all end the process. Higher severity scores are sent to a physician or to in-person care, according to Unite.AI.

Physicians do, but less over time.

Nolla's description of its three stages:

• Stage one, first 100 patients: a licensed physician reviews and approves every AI prescription before it goes to the patient.
• Stage two, first 500 patients: the AI issues prescriptions on its own, and a physician reviews them daily after the fact.
• Stage three: a physician reviews a sample of prescriptions once a week.

The signed agreement is somewhat different, Unite.AI reports. It requires two Utah-licensed physicians to approve each prescription in stage one, weekly retrospective review in stage two, and from 750 patients on, a monthly review of at least 10% of prescriptions plus every case involving an escalation or side effect. The Verge also describes two physicians approving each early prescription.

Labeled as AI: every prescription goes out under the overseeing physician's provider number, is marked as AI-initiated, and pharmacies are told an AI generated it, Unite.AI reports.

Human support: patients can message a licensed physician at any time, and Nolla says they're never talking to AI when they do.

According to Nolla, licensed clinicians agree with its AI's treatment recommendations in over 96% of real-world cases. The rest reflected minor adjustments, like changing a cream's strength, not fundamental disagreements, the company says. That figure comes from Nolla and hasn't been independently verified.

"People are right to worry about AI in medicine that nobody can control. This program was built to be the opposite," said Dr. Zaid Fadul, Nolla Health's chief medical adviser. "The real test for AI in healthcare isn't how smart it is. It's whether someone other than the company can shut it off," he added. "In Utah, the state can, and physicians can."

The model behind it: in its proposal to the state, Nolla said its severity-scoring model was trained on more than 100,000 labeled acne cases, Unite.AI reports.

The agreement sets clear tripwires, according to Unite.AI.

• To move up a stage: Nolla needs written approval from the state, at least 95% agreement between the AI and reviewing physicians, zero missed hard stops and zero serious adverse events.
• If something goes wrong: any serious adverse event triggers an immediate review and pause.
• Reporting: Nolla must report adverse events within 24 hours and file monthly reports on case counts, prescriptions by drug, clinician agreement rates and escalation reasons. The state publishes quarterly reports.

The access problem: about 100,000 people in Utah have active acne at any given time, but only 10% ever see a dermatologist, Nolla says. The average wait in Utah is 61 days, nearly double the national median, and 11 counties have no dermatologists at all. A visit can cost up to $300.

A low-risk start: acne is a well-understood condition with decades of clinical evidence, and the treatments in the pilot mainly risk localized skin irritation or dryness, Nolla and Unite.AI note.

Utah's sandbox: Utah already lets AI systems renew certain medications, a program that started earlier this year, The Verge reports. Several other healthcare companies are experimenting with AI prescriptions there. Utah's earlier prescribing pilots only allowed renewals. One, run by Doctronic since October 2025, still has a licensed practitioner authorize every request, Unite.AI reports.

Who is Nolla? The New York-based company launched its app in the US in summer 2025. It says the app has been downloaded by more than 175,000 people across 44 states, and its state proposal discloses seed funding from General Catalyst, according to Unite.AI.

"Our Office facilitates innovative AI solutions while ensuring that public health and patient safety remain paramount," said Zach Boyd, director of Utah's Office of Artificial Intelligence Policy.

The pilot runs under an agreement between Utah's Office of Artificial Intelligence Policy, its Division of Professional Licensing and Nolla's operating companies, Unite.AI reports.

• What it does: the licensing division agreed not to take enforcement action for unlicensed practice or under telehealth rules when Nolla's AI issues these prescriptions.
• What it isn't: the agreement says it's regulatory mitigation only, not an endorsement or approval by the state.
• How long: 12 months, with at most two 12-month extensions under state law. The office can end it at any time.
• Checks: participants report monthly, and the state has hired independent evaluators to audit health AI pilots by stress-testing guardrails, checking decision logs and evaluating patient outcomes.

• The app: $4.99 a month during the pilot, down from the standard $9.99, according to Unite.AI.
• The medicine: home-delivered compounded treatment costs $49.99, or generic equivalents typically run $10 to $40 at a local pharmacy.

• In Utah with acne: you can get a prescription in minutes without a dermatologist visit, if you qualify.
• Everywhere else: this is a test case. How it goes could shape whether other states let AI make first-time prescribing decisions.
• Know the limits: severe acne, pills and many health conditions still need a human doctor.