Utah lets AI refill chronic prescriptions in state-backed pilot program

Utah has launched a first-of-its-kind trial that lets an artificial intelligence (AI) system approve some prescription renewals without a physician signing off, putting one of medicine’s most routine tasks at the center of the debate over how long of a leash algorithms should be allowed in clinical care.

Under a yearlong agreement with New York-based health-tech startup Doctronic, the Utah Department of Commerce’s Office of Artificial Intelligence Policy is allowing an autonomous AI platform to renew certain maintenance medications for patients with chronic conditions including hypertension, diabetes and thyroid disease.

State officials describe the partnership as the first program in the country in which an AI system is legally allowed to participate in medical decision-making for prescription renewals.

The pilot is intended to shorten wait times for routine refills, reduce gaps in treatment and free physicians to spend more time on complex visits. Physician groups, including the American Medical Association (AMA), have urged caution and stressed that clinicians should remain central to prescribing decisions.

How Doctronic works

Patients in Utah can access the program through a prescription renewal link on Doctronic’s website. The system verifies that users are physically located in Utah and confirms their identify, typically by checking a government-issued ID and a selfie against existing records.

Doctronic then pulls a patient’s existing prescriptions and highlights medications that appear to qualify for automated renewal. The service is limited to refills of drugs that were initially prescribed by a human clinician and that fall within a formulary of roughly 190 commonly used, noncontrolled medications for chronic conditions, including blood pressure medicines, cardiometabolic drugs, birth control and selective serotonin reuptake inhibitors (SSRIs).

Controlled substances, pain medications, attention-deficit/hyperactivity disorder (ADHD) drugs, injectables and drugs that require regular laboratory monitoring are excluded.

A chatbot walks patients through a structured questionnaire about symptoms, side effects, adherence, changes in health status and other medications they are taking. The AI system scans for new red flags, potential drug interactions or contraindications and decides whether renewing the existing prescription appears appropriate.

If the case passes those checks, the system sends the refill order directly to a pharmacy, typically for a 30-, 60- or 90-day supply, according to state officials.

When the AI detects something unusual or is uncertain, it is programmed to defer to a human clinician.

Doctronic requires physicians to review its first 250 renewal decisions in each drug class before the system is allowed to handle subsequent refills autonomously in that class. Patients whose requests are not cleared by the AI can be routed to a free video visit with a physician.

The company currently charges patients a $4 fee per renewal in Utah, which it says covers the cost of identity verification and retrieving medical records while the program ramps up.

Doctronic executives have said they expect the cost to fall over time, potentially being covered by insurance or bundled into a low annual membership.

What Utah hopes to learn

Utah regulators describe the initiative as a controlled experiment. The pilot operates inside the state’s AI regulatory “sandbox,” which allows certain rules to be relaxed temporarily while officials watch closely for potential problems.

The Department of Commerce notes that prescription renewals account for roughly 80% of all medication activity and that delays are a major driver of missed doses and avoidable medical spending.

“Medication non-compliance is one of the largest drivers of poor health outcomes and preventable healthcare costs, responsible for over $100 billion in avoidable medical expenses annually,” said physician and Doctronic co-founder Adam Oskowitz, M.D., Ph.D., in the state’s news release. “Improving access to medication renewals will directly impact this by improving medication compliance and reducing unnecessary emergency room visits.”

State officials say they will track refill timeliness and medication adherence, patient access and satisfaction, safety outcomes, workflow efficiency and cost impacts.

The Office of Artificial Intelligence Policy plans to publish results so other states and federal regulators can use the data as they consider how to govern high-stakes uses of AI in health care.

The move comes against a backdrop of mounting workforce pressure — the Association of American Medical Colleges (AAMC) projects a national shortage of up to 86,000 physicians by 2036. Doctronic’s blog post on the Utah pilot cites national survey data showing that new-patient physician appointments can take an average of about 26 days in major U.S. cities, and longer than 45 days in some markets.

The company argues that if AI can reliably manage “low-risk, high-volume” tasks like refills, physicians can devote more time to complex care and conversations that require clinical judgment and long-term relationships with patients.

“If you’ve been taking the same blood pressure medication for two years and nothing has changed, renewing that prescription doesn’t require much clinical judgement. But it still requires review and approval,” the company wrote. “When people can't get timely refills, they go without their medications. Someone who runs out of blood pressure pills and can't get an appointment for three weeks might be forced to skip doses, raising their risk of stroke or heart attack.”

Guardrails and liability

Utah officials say the agreement with Doctronic is the first state-approved program to let an AI system legally take part in medical decision-making for prescription renewals.

The pilot is confined to patients with chronic conditions who are already on stable therapies. It excludes new diagnoses, higher-risk medications and drugs that require regular lab monitoring. The AI is required to escalate cases to a human physician when patients report concerning symptoms, when potential drug–drug interactions are detected or when any other safety flag is triggered.

“Utah’s approach to regulatory mitigation strikes a vital balance between fostering innovation and ensuring consumer safety,” said Margaret Woolley Busse, executive director of the Utah Department of Commerce, in the state’s announcement.

Doctronic has also obtained a malpractice insurance policy that explicitly covers its AI system, intended to hold the technology to a standard comparable to a human clinician if an error occurs, according to company officials.

Company data shared with regulators compares the AI’s treatment plans with those of physicians in 500 urgent care cases and reports a 99.2% match rate; Utah officials say that analysis helped inform their decision to proceed with the pilot.

Oskowitz has argued that, within narrow boundaries, the automated system can be more thorough than a rushed visit. “The AI is actually better than doctors at doing this,” he said, according to Politico’s reporting. “When you go see a doctor, it’s not going to do all the checks that the AI is doing.”

For now, the Utah program remains limited: only residents using eligible chronic medications can participate, and early refills are still subject to physician review as the system is validated. But with Arizona, Texas and other states exploring their own AI “sandboxes,” Utah’s results could help determine whether AI-driven refill services stay a niche experiment or become a more common feature of how prescriptions are managed nationwide.