Some telehealth GLP-1 prescriptions have little clinician oversight, little regulation

Amid limited insurance coverage for pricey GLP-1s, some patients are turning to the internet.

But a secret shopper study published in JAMA on July 6 found that telehealth GLP-1 vendors often don’t require a patient to talk with a clinician before getting a prescription, raising concerns about safety and oversight.

Of 49 sampled websites, 45 issued a prescription for a fictional patient who met eligibility criteria, according to the study. Only about 1 in 4 required a video visit with a clinician, and 6% required a clinician call, though all 49 required the patient to fill out a questionnaire.

“I’m not surprised to hear that people are getting prescriptions without having met with a true healthcare provider,” Claudia Lewis, partner and cochair of the FDA group at law firm Venable, told Healthcare Brew.

How did we get here? Of the studied websites that issued prescriptions, 39 prescribed compounded GLP-1s.

Compounded drugs are unofficial versions of brand-name drugs. Unlike their brand-name counterparts, they are not independently checked by the FDA for safety or quality. They are legal but allowed only in certain circumstances, like if a patient has an allergy to an inactive ingredient in a branded drug or if a drug is in shortage.

“Limited clinician engagement, especially when prescribing compounded GLP-1 [receptor agonists] with uncertain safety, efficacy, and quality, may increase risks of medical and financial harm,” the study reads.

Looking for loopholes. The GLP-1s tirzepatide and semaglutide were in shortage from 2022 until October 2024 and until February 2025, respectively. After those shortages ended, telehealth compound sellers were expected to start closing up shop. Instead, prescription volumes grew, according to an October 2025 analysis from life sciences research firm Iqvia.

Now, about 1 in 10 US adults say they’re taking a GLP-1 medication for weight loss, and 1 in 5 of those adults say they’re taking a compounded version, according to May and June Gallup polling.

Lewis stressed some of these compounders are certainly doing things by the book, and said she can’t definitively speak to whether prescriptions are being given without adequate clinician oversight.

Kyle Zebley, CEO of the American Telemedicine Association (ATA) , a trade organization, and executive director of advocacy arm ATA Action, told Healthcare Brew over email that the “vast majority” of telehealth providers “meet or exceed” clinical standards.

“We don’t believe this [study] reflects a widespread or systemic problem in telehealth,” he said.

The FDA has also identified telehealth compounders that seemingly tried to bypass restrictions by labeling their drugs as intended for “research” rather than human consumption, according to a June 2026 notice from the agency.

The FDA bars compounders from producing exact copies of a commercial drug, except in a shortage. Some telehealth companies have added inactive ingredients like vitamins with the rationale that their drug is no longer an exact copy of a patented drug. The FDA clarified in an April 2026 notice that these compound drugs can still be considered copies, and are thus illegal.

What’s being done? Novo Nordisk, which makes Ozempic and Wegovy, has sued over 100 compounders. Eli Lilly, maker of Mounjaro and Zepbound, has also filed suits against compounding pharmacies, accusing them of skirting FDA rules.

For its part, from September 2025 to March 2026, the FDA said it has sent “thousands” of warning letters to pharmaceutical and telehealth firms accusing them of misleading advertising tactics, such as implying their drugs are FDA-approved.

In February 2026, about a year after the most recent GLP-1 shortage ended, the FDA issued a notice vowing to “take action” against mass-marketed compounded GLP-1s, including legal action and the seizure and injunction of non FDA-approved drugs.

On April 30, the FDA proposed excluding three GLP-1 active pharmaceutical ingredients from the 503B bulks list of active ingredients, which would stop mass compounding at outsourcing facilities. That proposal has not yet been finalized.

But for those compounders that may be skirting the rules, Lewis worries that the FDA’s actions come too late.

“The minute that [the FDA] decided that the shortage on these products had passed…that was the time for the FDA to be like, ‘Look, unless you fit into one of these exceptions clearly, we’re going to be sending you warning letters, and then we’re going to be seizing your product.’ And that didn’t happen,” she said.

The FDA told Healthcare Brew it doesn’t generally comment on specific studies but pointed to two June 15 notices warning telehealth compounders and patients about the risks of illegal manufacturing and promotion of compounded drugs.