Utah just crossed a line most states won’t touch: allowing an AI system to prescribe psychiatric medications without a doctor in the loop. The state quietly greenlit Legion Health, a San Francisco startup, to renew prescriptions for mental health drugs through a $19-a-month chatbot. It’s only the second time any U.S. state has handed this kind of clinical authority to artificial intelligence, and physicians are already sounding alarms about the opacity, risk, and questionable promise of expanding care to underserved communities.

Legion Health just got permission to do something that would have seemed unthinkable a few years ago. The startup’s AI chatbot can now prescribe psychiatric medications in Utah without a human doctor signing off. State regulators announced the one-year pilot program last week, framing it as an innovative solution to mental health care shortages and runaway costs.

But this isn’t some limited trial tucked away in a research lab. Utah residents can now pay Legion Health $19 a month for an AI to handle prescription renewals for medications that treat conditions like depression, anxiety, and ADHD. The chatbot evaluates patients, decides whether to renew their meds, and sends the prescription to a pharmacy, all without a physician reviewing the decision.

Utah is only the second state to take this leap. Earlier this year, regulators gave similar authority to Doctronic, another AI system, though details about that program remain scarce. The rest of the country is watching closely, and the medical community isn’t exactly thrilled about what they’re seeing.

“This is fundamentally about whether we trust algorithms to make life-altering clinical decisions,” one psychiatrist told The Verge. The concerns go beyond abstract ethical debates. Psychiatric medications can have serious side effects, require careful dosing adjustments, and often need monitoring for drug interactions or changing symptoms. Critics argue that an AI chatbot, no matter how sophisticated, can’t replicate the nuanced judgment of a trained physician.