ADHD Startup’s Business Surged, Followed by Complaints and Concerns
(Bloomberg) — Mental-health startup Done grew quickly by offering online prescriptions for ADHD, touting “worry free” refills and “next day” appointments. But in recent months, an influx of patients and a focus on growth has overwhelmed the company’s clinicians and exacerbated their concerns about Done’s ability to properly look after patients.
It’s also led to a wave of customer complaints about missed refills and confusing communication. In some cases, patients have taken to airing their grievances as comments on the company’s feel-good Instagram posts – only to find their comments vanished days later.
The complaints and internal concerns, described to Bloomberg by about a dozen patients and staff, are the latest chapter in the tumultuous world of startups that arose during the pandemic to provide treatment for mental-health conditions. They promised to solve a real problem: Despite high US rates of mental illness, it remains bafflingly difficult to find health professionals to help. But as Bloomberg has previously reported, a handful have pushed boundaries in ways that have courted controversy and even legal scrutiny.
Done offered ADHD patients an appealing proposition: For a monthly fee, they could book online appointments with health professionals who could evaluate them and write prescriptions, including for tightly regulated medicines such as Adderall and Ritalin.
Jennifer Bauer, a 36-year-old in Austin, Texas, signed up for Done’s services in March because she thought she might have attention-deficit/hyperactivity disorder, known as ADHD. At first, it went smoothly – she received a diagnosis and a prescription for Adderall – but recently she said she’s been frustrated.
Bauer says she requested a refill of her Adderall prescription at the beginning of July. On July 12, one day before she was set to run out of medication, she emailed Done to check on her prescription. The company responded that her provider wanted to schedule a telehealth appointment “before prescribing more medication,” according to an email from Done that Bauer shared with Bloomberg.
The earliest available appointment was in October. Bauer ran out of pills on July 13.
That was “absolutely horrible,” Bauer said. The medication enabled her to concentrate, and without it, she had difficulty completing basic tasks, like cooking or doing laundry.
Struggling Patients
Bloomberg spoke to six Done customers, including Bauer, who described similar frustrations – ranging from issues with refills to a non-responsive customer service department to difficulties canceling their accounts. Replies to the company’s social media posts are filled with angry comments. Others have posted scathing reviews at the Better Business Bureau.
Done acknowledged that some clinicians might have backlogs and said the issues were also caused by outside pharmacies and technical challenges. The company said it was committed to “high-quality psychiatric chronic care management.”
Done saw explosive growth during 2021. Its monthly revenues quickly eclipsed the $3 million it raised from investors, and profits peaked last summer, three people familiar with the private company said. Much of that growth was helped by a pandemic-era change in online health rules that let doctors and nurses working with companies like Done write prescriptions for controlled substances, including stimulants used to treat ADHD.
But Done struggled to handle the surge in demand. High turnover among its independent-contractor clinicians caused a backlog of hundreds of messages from patients, four current and former clinicians said. On top of that, Done saw a surge of new patients after it’s competitor, Ahead, shut down in April.
Done also faced turnover among key staff, which may have to do with the company’s compensation structure that incentivizes prioritizing new patients, clinicians said. Nurse practitioners are paid about $100 per hour, on average, for new patient appointments, which typically last half an hour. However, their earnings are much lower for follow-up sessions which can pay as low as $7 per appointment, said clinicians who spoke to Bloomberg on condition of anonymity.
Done’s focus on growth sometimes collided with quality-of-care concerns, former executives told Bloomberg in May.
Terry Plumlee, 62, in Houston, Texas, faced her own challenges with the company. She signed up for Done in April and received a 30-day Adderall prescription after an initial video consultation. The prescription wasn’t refilled in May, and after weeks of trying to contact the company, she was asked to pay $47 to have the medication mailed to her. She paid the funds but didn’t receive the package.
Since April, Plumlee has paid at least $509 to the company, with the most recent charge on July 12, according to bank statements and credit card records she provided. She hasn’t had any video visits since April or received any pills beyond the initial 30-day supply.
“I’ve never been so incensed with any company in the history of my life,” Plumlee said.
Done declined to comment on Bauer or Plumlee’s experiences, or on any other patient. But just one day after Bloomberg asked the company about Plumlee’s complaints, she received an email from Done saying she would receive $205 in refunds, according to a copy of the message shared with Bloomberg.
Some Done patients said the company was able to help address their problems. A 36-year-old in Reno, Nevada, who didn’t want to be named for privacy reasons, said that when their pharmacy refused to fill the prescription, Done helped find an alternative. A woman in Oregon said that Done refunded her more than $500 after trouble filling her prescription.
Other companies have faced more than just complaints. Cerebral Inc., another mental telehealth company, is being investigated by federal law enforcement for possible violations of the Controlled Substances Act, but has not been charged. The increased scrutiny has resulted in CVS Health Corp. and Walmart Inc. refusing to fill prescriptions for controlled substances from Cerebral and Done.
“We strive to provide all of our members with excellent service,” a Done spokesperson who declined to provide their name said in an email. “Due to some pharmacies making decisions to illegitimize patient’s needs for treatment via telehealth, many patients experienced delays receiving their prescriptions, particularly for controlled substance medications.”
The spokesperson also cited technical problems, saying the company’s electronic systems were down over the July 4 weekend, but back online July 5. Affected patients received some free membership, the spokesperson wrote. But three patients told Bloomberg News they experienced issues well before the July 4 outage, and three said they had trouble after Done said the issue was resolved.
Bauer was one of the patients who took her complaints online, to Done’s Instagram posts.
Bauer commented on one of Done’s posts on July 15: “It’s been 12 days since my refill request and no one has been able to tell me When or if I’ll receive it.”
Bloomberg News saw Bauer’s online reply on June 15. By June 20, it had vanished.
In an Instagram conversation between Bauer and an unnamed Done representative, Bauer asked why the company was deleting negative comments.
“Public comments will be deleted as required since they are relatively irrelevant with social marketing comms,” the representative wrote, according to a screenshot provided by Bauer. Done declined to comment further.
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