Utah just opened the door to something no other state has tried: letting artificial intelligence write brand-new prescriptions.
On Monday, New York startup Nolla Health flipped the switch on its Nolla Derm app for adults in Utah. Users snap a few photos of their face, answer a short medical questionnaire, and the AI decides whether they qualify for topical acne treatment. If the system is confident, it generates a prescription and sends it to a pharmacy or ships the medication straight to the door. No waiting room. No appointment. No human doctor reviewing every single case from the jump.
The program is limited on purpose. Only Utah residents 18 and older with mild-to-moderate acne can enroll. The AI sticks to a short list of topical creams and gels — tretinoin, adapalene, clindamycin with benzoyl peroxide, benzoyl peroxide, azelaic acid, and a few compounded options that include niacinamide or topical spironolactone. Pills, Accutane, hormone treatments, and severe acne are off-limits. If the system spots pregnancy, breastfeeding, a weak immune system, a past reaction to one of the meds, or anything else outside its narrow rules, it stops and hands the case to a real physician.
The app runs $4.99 a month during the pilot. Medication is extra — roughly $50 for home-delivered compounded formulas or $10 to $40 for generics at a local pharmacy.
Oversight starts strict and loosens only if the data looks clean. For the first 100 patients, two Utah-licensed doctors must approve every AI-written prescription before it goes out. Once that phase clears, the AI can issue prescriptions on its own while doctors review them after the fact. Later, the doctors sample about 10 percent of cases each month and look at every escalation or side-effect report. The state has to sign off before each stage advances, and any serious problem can hit the pause button.
Nolla says its model was trained on more than 100,000 labeled acne cases and that doctors agreed with its treatment picks about 96 percent of the time in recent real-world tests. Patients can still message a human doctor through the app anytime — those replies come from actual clinicians, not the AI.
The company and state officials point to a clear problem they’re trying to fix. Roughly 100,000 people in Utah have active acne at any moment, but only about 10 percent ever see a dermatologist. Average wait times stretch to 61 days — nearly double the national median — and 11 counties have no dermatologist at all. A single visit can run $300. Untreated acne can leave permanent scars and drive costs higher later.
“The pilot is designed to complement, not replace, physicians,” Nolla said in its announcement. “By handling routine, low-acuity cases, Nolla Derm frees dermatologists to focus on complex, high-risk patients.”
Dr. Zaid Fadul, the company’s chief medical adviser, put it more bluntly: “The AI can’t improvise. It can only choose from a short list of physician-approved topical treatments. The moment a patient falls outside those limits, it stops and hands them to a doctor.”
Zach Boyd, who runs Utah’s Office of Artificial Intelligence Policy, called the launch “a significant step forward in leveraging AI to improve healthcare access for Utahns, while maintaining rigorous oversight and safety.”
The whole thing sits inside Utah’s experimental AI sandbox, the same program that earlier allowed AI systems to handle certain prescription renewals. Those earlier pilots drew pushback from the state medical board. This time Nolla worked more closely with the board and outside physicians before launch. The company has to report adverse events within 24 hours, file detailed monthly numbers, and share de-identified data with independent auditors. Quarterly reports will be made public.
The pilot is set for one year, with possible extensions. Whether it expands beyond acne or beyond Utah will depend on what the safety numbers look like when the first results come in. For now, Utah is the only place in the country where an AI can write your first acne prescription — and the rest of the industry is watching.
