Utah lets an AI write acne prescriptions with no doctor signing off first

Starting Monday, Oct. 5, 2026, Utah residents 18 and older can get an acne prescription written by Nolla Health's AI after a face scan and a medical questionnaire, with no doctor approving it beforehand once the early phase ends. Bloomberg reports it is the first time a US state has let AI take over a doctor's role in prescribing.

This is the first time a US state has let software write a brand-new prescription, not just refill one a doctor already wrote. Acne creams are about as low-risk as prescriptions get, which is exactly why Utah started here. But the oversight shrinks fast: after the first 500 patients, a doctor only spot-checks one in ten. Nolla says it wants to become an AI family doctor, so watch whether the next pilot reaches past skin cream.

On Monday, 5 October 2026, Nolla Health opened a Utah pilot that lets its Nolla Derm app write an acne prescription. Nolla is a New York City startup. Bloomberg’s Annika Inampudi reports this is the first time a US state has let software take a doctor’s role in prescribing. Nolla’s page says Nolla Derm is the first AI to issue an initial acne prescription, not a refill of one a doctor already wrote, and that no existing prescription is required. The pilot is for Utah residents 18 and older. Those lines are Nolla’s and Bloomberg’s.

How a person gets the prescription. Nolla says you download the app, check your identity with a photo ID, complete a consent form and a short health questionnaire, and take a face scan from five angles. The AI scores the acne from that scan and picks a treatment. Nolla says the whole path takes about 10 to 15 minutes. Bloomberg adds that the software rates how oily the skin is and produces an “acne severity score,” from clear skin to severe acne, then recommends a drug. The prescription can go to a pharmacy. Nolla says you can choose home delivery of a compounded cream, or pickup of a generic version at a local pharmacy. Compounded means a pharmacy mixes that cream for you, instead of handing you a standard tube. Nolla says the AI does not pick which of those two ways you get the medicine.

What the app is allowed to prescribe. Nolla’s page names a restricted list of topical acne drugs: tretinoin, adapalene, clindamycin with benzoyl peroxide, benzoyl peroxide, and azelaic acid. Some of those are combined with niacinamide, a form of vitamin B3, or with topical spironolactone, a hormone-related drug put on the skin rather than swallowed. Each plan has a morning treatment and an evening treatment. Topical means you put it on the skin. Nolla says the pilot does not include pills, other drugs that act through the whole body, hormone therapies, or isotretinoin, the strong acne pill. Bloomberg describes the same limit as eight approved treatments, some of them already sold over the counter, and not pills or hormone therapies. Eight is Bloomberg’s count. The drug names are Nolla’s.

Who can use it. Nolla says the pilot is for Utah residents 18 and older with mild or moderate acne. People who are pregnant, trying to become pregnant, or breastfeeding are not eligible for an AI prescription, and neither are people with certain conditions Nolla names, including a suppressed immune system, severe kidney or liver disease, or a past reaction to one of the pilot’s drugs. Those people are sent to a physician. Severe acne, including nodulocystic acne, the deep painful kind, is sent to an in-person dermatologist. If a scan shows more significant acne, Nolla says a physician reviews the case before any prescription, at no charge, usually within 48 hours. Side effects, or skin that does not improve, are also sent to a physician.

How much a doctor looks at the prescription, and when. Nolla’s page describes three stages. For the first 100 patients, two physicians each approve the prescription before it goes out, which can add up to 24 hours. Up through 500 patients, the AI sends the prescription itself, and a physician reviews every case afterward, at least once a week. After that, physicians review a sample of at least 10 percent of prescriptions every month, plus every case with a side effect or an escalation. Nolla says the pilot cannot move to the next stage unless it meets safety targets and the state gives written approval. Bloomberg describes the same staircase with one difference in the first stage: a physician reviews the first 100 prescriptions before they go to a pharmacy; the next 400 are sent by the AI and reviewed weekly afterward; after that, a physician reviews at least 10 percent once a month. Bloomberg’s next 400, added to the first 100, is the 500-patient line Nolla prints. The two-physician check, the extra review of side effects, and the written state approval to change stages are Nolla’s.

What Utah changed in the law. Prescribing has usually been limited to physicians and to some nurse practitioners and physician assistants. Zachary Boyd, director of the Office of Artificial Intelligence Policy, told Bloomberg the state waived its rule that a prescriber be a licensed professional and gave Nolla a “narrow exception.” The office requires malpractice insurance that covers prescriptions the AI writes. Malpractice insurance is the coverage that pays if a patient is harmed. Boyd also said the office wrote “duty of care” terms into Nolla’s contract. A duty of care is the legal job of looking after the patient, and those terms are meant to help a court decide a case if the AI wrote the prescription. Those lines are Bloomberg’s, from Boyd.

What the medical board changed, and whose name is on the prescription. Bloomberg reports that Nolla talked to the Utah Medical Licensing Board before the pilot was approved. After those talks, the pilot was amended so an outside physician appointed by the board oversees the prescription reviews. Nolla is the first company in this program to have that conversation before approval, Bloomberg says. Chief executive Luis Wenus told Bloomberg the prescription still carries a clinician’s name, even though no person writes it. Separately, Nolla’s page says you can message a licensed physician in the app at any time, at no extra cost, and ask for a full review of your case. That message line is Nolla’s. It is not the same thing as a doctor approving the prescription before the pharmacy receives it.

What it costs. Nolla lists the app at $4.99 a month, discounted from $9.99. That price includes daily AI skin scans, educational material, telehealth, and sending the prescription. The medicine is separate. Nolla says compounded morning and evening treatments cost $49.99 with home delivery. A generic filled at a local pharmacy is often $10 to $40, or covered by insurance, Nolla says. Home delivery usually ships within 3 days and arrives 3 to 7 days later. Pharmacy pickup can be the same day or the next day. Bloomberg, citing the company, puts the app at about $5 a month and the compounded medicine at about $50 a month, against $150 to $300 for a typical dermatology visit. The $4.99, the $9.99, the $49.99, and the $10 to $40 range are Nolla’s. The visit comparison is the company’s figure as Bloomberg reports it.

How long the pilot lasts. Nolla says it runs under a 12-month agreement with Utah’s Office of Artificial Intelligence Policy. Bloomberg says the program operates for one year and can be renewed for up to two more years, at that office’s discretion. A renewal is a choice the office can make. It is not an automatic extension.

The earlier fight, over refills. Bloomberg reports that the same office previously approved a pilot by Doctronic, a startup whose AI approves refills of medicines a doctor had already prescribed, from painkillers to depression drugs. The Utah Medical Licensing Board then wrote an open letter saying it had not been consulted and that the program “places Utah citizens at risk.” The office did not stop Doctronic. It removed two medicines from Doctronic’s list after talking with the board. Boyd told Bloomberg he does not expect the same controversy for Nolla, because this pilot is limited to acne medicine and the risks are narrower. Those lines are Bloomberg’s account of the earlier refill pilot. The acne program is a separate agreement.

What the state office says on its own page. The Office of Artificial Intelligence Policy sits inside the Utah Department of Commerce. Its page says it has signed three new pilot agreements: Expect Fitness for pelvic-floor physical therapy, August AI for routine prescription refills, and Nolla Health for acne treatment. It has also signed master agreements with University of Utah Health and Intermountain Health for future pilots inside those health systems. Utah’s AI sandbox lets a company test a product under a written agreement that can adjust one rule for a limited time. The company stays under every other law. The office says being accepted is not an endorsement or an approval of the product by the State of Utah. The same page says the office has hired independent evaluators to audit healthcare AI sandbox pilots, to stress-test the guardrails, inspect decision logs, and look at patient outcomes with state regulators. The page names Nolla for acne treatment. It does not say those evaluators are already assigned to Nolla.

What a doctors’ group, and Nolla’s chief executive, said about the stakes. American Medical Association chief executive John Whyte told Bloomberg that these tools “shouldn’t autonomously be trying to practice medicine,” and that if they do, they need to be held to the same high standards as humans. He added that he does not think they can meet that burden. Wenus told Bloomberg the downside of these skin creams is that skin can get red or start peeling, and that the possible reactions are much lower risk than many other drugs. Nolla’s team told Bloomberg the adverse effects of the eight drugs are limited to local irritation or dryness. Wenus also said the longer goal is an “all-in personal doctor in your family, driven by AI,” and that acne in Utah is the first step. Those quotations are Bloomberg’s.

The picture is Nolla Health’s launch graphic for the pilot. A dark blue field carries the words The First AI-Powered Prescriptions, then Now piloting in Utah with Nolla Derm. On the left, a phone shows a face covered by a scan mesh. On the right, a second phone reads NO PRESCRIPTION NEEDED and Your prescription is ready, with a small skin photo. The Nolla Health logo sits at the bottom. The frame does not print a calendar date. It is the company’s own graphic for this program.

In plain terms, Utah is letting Nolla Health’s app write a first acne prescription for adults in the state, from a face scan and a questionnaire, and send it to a pharmacy. Nolla says two physicians approve each of the first 100 prescriptions before they go out. After that, the review moves to after the fact, and once the pilot passes 500 patients a doctor looks at a sample of at least one prescription in ten, plus side effects. The state waived the usual rule that a licensed person has to be the prescriber, required insurance that covers an AI-written prescription, and put a board-appointed doctor over the reviews. The drugs are skin creams, not pills. The app is listed at $4.99 a month. The agreement lasts a year.