How Plans, Clinicians Should Handle Gray-Market Retatrutide

Patients who turned to gray-market retatrutide before its approval should be screened without judgment and brought back into supervised care rather than penalized, said Rob Stransky, founder of NiceRx, in a Q&A with The American Journal of Managed Care^® (AJMC^®).

Retatrutide, Eli Lilly's investigational agonist of the glucose-dependent insulinotropic polypeptide, glucagon-like peptide-1 (GLP-1), and glucagon receptors, has fueled an online gray market of unregulated vials sold as research chemicals.¹ In October, a research letter in JAMA Network Open that analyzed Reddit posts from 13,589 users reporting current retatrutide use called for nonjudgmental screening for nonapproved peptide use.² Meanwhile, 14% of employers surveyed by the Business Group on Health have already dropped coverage of GLP-1s for weight loss or plan to do so in 2027.³

Stransky, whose telehealth company currently offers compounded GLP-1 therapies, discussed what routine peptide screening should look like at intake, the dosing and purity risks of gray-market products, and how health plans should handle members who used unapproved versions once retatrutide reaches the market.

AJMC: How often are NiceRx patients asking about retatrutide or disclosing that they've already used it or other gray-market peptides? How do your clinicians respond when they do?

Stransky: It's not something we hear often. Most of our patients come to us specifically because they want medically supervised care, so unapproved or gray-market use isn't a common disclosure for us. When it does come up, the approach is the same regardless of frequency: the clinicians never penalize disclosure. The goal in that conversation is to find out what was actually taken, counsel honestly on the risks of an unregulated product, and work with the patient on a supervised path forward.

AJMC: What should a nonjudgmental screening for nonapproved peptides look like in a telehealth or primary care intake?

Stransky: Practically, it means asking about peptide and GLP-1 use the same routine way you'd ask about supplements or alcohol as a standard question for every patient, not a flag that only comes up if something looks off. It means the question is framed without judgment, so a patient has no reason to hide the answer.

AJMC: Beyond the drug itself, what risks come from gray-market products, such as dosing, purity, and contamination, and what have you seen in practice?

Stransky: The drug risk is only part of it. These products typically come from unregulated or overseas labs with no sterility assurance, no verified concentration, and no consistent quality control from batch to batch, so a patient can't actually know what dose they're injecting or what else might be in the vial.

In practice, that may result in symptoms that don't track cleanly with the drug's expected profile, which is a hard thing for a clinician to manage safely when there's no reliable information about what was actually administered.

AJMC: Many employers are narrowing GLP-1 coverage for 2027. How much do cost and coverage gaps push patients toward unapproved products, and what would reduce that?

Stransky: Cost is the single biggest driver of this market. When a patient loses coverage or faces a few hundred dollars a month out of pocket, a $100 unregulated product online may become tempting, even though patients have no way to verify what they're actually buying. The fix isn't just coverage; it's affordable, clinically supervised options that keep a prescriber and a licensed pharmacy in the loop, so cost pressure doesn't force patients to choose between paying and having any medical oversight at all.

AJMC: Once retatrutide is approved, how should health plans handle members who used gray-market versions beforehand?

Stransky: Approval should be treated as an opportunity to bring these patients back into supervised care, not a compliance problem to penalize them for. That means plans and clinicians should expect disclosure to increase once there's an approved, legitimate option to transition to and should make that transition easy: a clinical check-in to confirm what was used and reassess the patient's status, rather than requiring them to disclose at risk of being dropped or denied care. The goal is getting people onto a monitored, safe product, not relitigating how they got there.

AJMC: Does NiceRx currently prescribe GLP-1 therapies, and does it plan to offer retatrutide if approved?

Stransky: Yes, NiceRx currently offers compounded GLP-1 therapies, prescribed by licensed providers as part of a supervised treatment plan. If retatrutide is approved, any future offering would follow the same path as any other approved medication, through normal prescribing and pharmacy channels, not as a compounded product.

References

1. Steinzor P. 5 things to know about retatrutide, the “Trillion-Dollar” drug. AJMC. August 14, 2026. Accessed November 10, 2026. https://www.ajmc.com/view/5-things-to-know-about-retatrutide-the-trillion-dollar-drug
2. Sehgal NKR, Tronieri JS, Rader B, Ungar L, Guntuku SC. Self-reported adverse effects among social media users taking nonapproved retatrutide. JAMA Netw Open. 2026;9(10):e2638929. doi:10.1001/jamanetworkopen.2026.38929
3. How are employers managing GLP-1 coverage amid rising demand and costs? Business Group on Health. Accessed November 10, 2026. https://www.businessgrouphealth.org/topics/blog/how-are-employers-managing-glp-1-coverage-amid-rising-demand-and-costs