GLP-1 telehealth sites prescribe fast, skip screening

Clinical takeaway: Patients on a GLP-1 may have started it with little or no clinical evaluation. Ask where the prescription came from and whether it's compounded, then backfill the history the intake missed.

Nearly one in five adults on a GLP-1 got the prescription online. A secret shopper study now shows what stands behind many of those scripts: a questionnaire, sometimes reviewed in 5 minutes or less, that often never asked about diet, disordered eating, or basic labs.

Online GLP-1 sales for weight loss took off during shortages from 2022 to 2025, driven by high demand and with little insurance coverage. Most of what sellers ship from online encounters is not the branded drug but compounded versions with the same active ingredients but different inactive ingredients that don't have FDA approval.

FDA intends to act against compounded GLP-1s and is moving on two fronts. In April, it proposed excluding semaglutide, tirzepatide, and liraglutide from the 503B bulks list now that the official shortage has passed. This would end the regulatory pathway outsourcing facilities use to compound them at scale. A final determination is pending. Then in June, the agency sent 25 warning letters to telehealth companies over false or misleading claims about compounded semaglutide and tirzepatide, following more than 40 similar letters to compounding pharmacies in late 2025.

Another issue is that obesity care standards call for a fuller workup before starting therapy, from taking weight and medication history through a physical exam. This study documented how much of that recommended process actually happens when the prescription is obtained online.

Every website assessed patients with a questionnaire, and for most that was the entire evaluation. Only 13 sites (26.5%) required a video visit and an additional three (6.1%) required a call. About half asked about diet and physical activity (53.1%) or eating disorders (55.1%), roughly one-third (36.7%) requested any clinical values such as blood pressure or glucose, and fewer than one in five (18.4%) even asked whether the patient had a primary care clinician.

Oversight lapses went beyond thin intake. Nine sites (20%) prescribed despite receiving only an upper-body photo when their own rules required a full-body or scale photo. Three clinicians prescribed to the same patient through two or more websites, and 34 sites (75.6%) automatically charged and shipped after approval without the patient's confirmation.

Customization was a sales lever too: nearly half the sites (44.9%) asked questions that could justify modified formulations or dosing, and 60% of products that arrived contained added supplements, most often vitamin B12. Median cost ran $217 per month with appointment and membership fees folded in.

Researchers built a simulated patient profile meeting GLP-1 eligibility criteria and sought prescriptions from 49 previously identified websites between August and December 2025, following each process until a prescription decision or a blood work request. The study captured a single patient profile at one point in time, and no data covered what follow-up, if any, came after the prescription.

Whether the pending 503B determination shrinks the compounded supply remains to be seen. Until it does, prescriptions from these platforms keep arriving, and the screening they skip becomes downstream work. Watch for the final bulks-list ruling and for whether warning letters shift what telehealth sites claim, if not what they sell.

"Limited clinician engagement, especially when prescribing compounded GLP-1 RAs with uncertain safety, efficacy, and quality, may increase risks of medical and financial harm," the authors note.

Source: Chetty AK, et al. (2026 Jul 6) JAMA. Online prescribing of GLP-1 receptor agonists