Is there any way Dr. Ackerley can prescribe the VIP for you since you have consulted with her online (before, I gather, she stopped doing this). Maybe there are regulations that prevent that since you're in different states. Just wondering. I sympathize with the unbelievably high expenses of trying to restore our bodies integrity.
My understanding as of July 2018 is that Dr Ackerley does still work with patients via telemedicine, but she does not establish a doctor patient relationship (ie ordering tests, writing rx) without a visit to her office, and then requires an in person office visit once a year. I think her fees are less than Dr Rapaport's, but the travel expenses may eat up the difference. It's possible that things might have changed since July!