Online GLP-1 Sellers Often Skip Clinician Oversight

Nearly all online sellers of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) issued a prescription to a simulated patient with almost no clinician engagement, and some shipped medication within minutes of an application, according to a secret shopper study published today in JAMA.¹

Among the highlights, a researcher posing as a patient who met clinical eligibility criteria for a GLP-1 RA sought prescriptions from 49 websites selling branded (n = 5), compounded (n = 17), or branded and compounded (n = 27) semaglutide or tirzepatide between August and December 2025. Forty-five sites (91.8%) issued a prescription, and 34 (69.4%) mailed the drug; the median time to prescription was 1 day or less, with 2 compounded orders approved in 5 minutes or less.

Why and How Did Clinician Oversight Fall Short?

Every site used an intake questionnaire, and most asked about medical conditions (98.0%) and medications and allergies (93.9%), but only 39 (79.6%) inquired about weight loss goals, 32 (65.3%) asked about nonpharmacological weight-loss attempts, 27 (55.1%) wanted to know about eating disorder history, and 26 (53.1%) included questions on diet and physical activity. Even fewer asked about patient-reported clinical values (n = 18; 36.7%) or personalizing compounded GLP-1 RAs (n = 22; 44.9%), or required a video visit (n = 13; 26.5%) or a call (n = 3; 6.1%).

Screening gaps around eating disorders carry particular weight. A 2026 perspective piece published in The New England Journal of Medicine raised concern that appetite-suppressing drugs could mask or worsen disordered eating in vulnerable patients, especially when prescribers never see a patient in real time.²

Nine sites (20.0%) provided a prescription despite the patient supplying only an upper-body photo when a full-body photo or scale photo was required, and 3 clinicians issued prescriptions to the same patient across 2 or more websites.¹ Also, 2 sites told the researcher they maintained internal databases tracking prescriptions across platforms, yet 1 later reversed a clinician’s denial and issued the drug after the patient requested a refund. In addition, 34 websites (75.6%) automatically charged and shipped medication once a prescription was approved, without requiring the patient to confirm the order.

Compounded sellers were also more likely to ask leading questions about personalizing dosing or adding supplements such as vitamin B12, a pattern the study authors said reflects how sellers have justified continued compounding after the 2022-2025 GLP-1 RA shortage through individualized formulations sold at scale.

These findings add new insight on how compounded GLP-1 RAs reach patients outside traditional pharmacy channels. Compounded semaglutide obtained from unaccredited sources carries documented risks of dosing errors and inconsistent ingredient quality, particularly because the products are typically dispensed in vials rather than the prefilled pens used for FDA-approved versions, according to previous research, with investigators urging pharmacists to steer patients toward pharmacies accredited by the National Association of Boards of Pharmacy when a compounded product is medically necessary.³

How Are Regulators Responding?

The FDA has issued warning letters in multiple rounds since September 2025, including 30 letters in March 2026 alone telling telehealth companies to stop implying that compounded products are equivalent to FDA-approved medications.⁴ Another 25 letters went out in June 2026, and the FDA has logged more than 1700 adverse event reports tied to compounded semaglutide and tirzepatide as of late May 2026.⁵ That enforcement both times has targeted advertising claims. Reporting also shows that many of the telehealth brands receiving warning letters share affiliated medical groups that employ the prescribing clinicians⁶ and that FDA officials view the deeper risk as products sourced from compounders operating outside sterile, inspected supply chains.⁷

For payers and health systems, the study’s findings complicate an already difficult access equation. Limited insurance coverage and high branded prices, cited by the study authors as drivers of telehealth GLP-1 RA demand, are pushing patients toward channels where clinical oversight can be inconsistent or, in some cases, effectively absent.¹

The authors said their findings do not capture what happens after a prescription is filled, and they called for closer scrutiny of how online sellers document medical necessity, particularly for compounded products marketed as personalized. The gap between how quickly these drugs can be obtained online and how thoroughly patients are evaluated is likely to remain a point of scrutiny for regulators, health systems, and managed care organizations alike.

“This study was conducted amid rapid growth in online GLP-1 RA sales and increasing FDA oversight of advertising,” the authors wrote. “Nevertheless, while direct-to-consumer platforms have increased patient access to GLP-1 RAs, these findings suggest that some do so through impersonal care that prioritizes quick prescriptions over comprehensive care.”

References

1. Chetty AK, Chen AS, Ross JR, Ramachandran R. Online prescribing of GLP-1 receptor agonists. JAMA. Published online July 6, 2026. doi:10.1001/jama.2026.9131
2. Banks A. GLP-1 receptor agonists and eating disorders — cause for concern. N Engl J Med. 2026;394(17):1665-1667. doi:10.1056/NEJMp2600300
3. Liu G, Jaerma M, Mo M, Stievater T. Navigating compounded semaglutide: what health care providers need to know. Am J Manag Care. 2025;31(9):480-484. doi:10.37765/ajmc.2025.89787
4. FDA warns 30 telehealth companies against illegal marketing of compounded GLP-1s. News release. FDA. March 3, 2026. Accessed July 6, 2026. https://www.fda.gov/news-events/press-announcements/fda-warns-30-telehealth-companies-against-illegal-marketing-compounded-glp-1s
5. DiSabatino DP, Klein J. FDA’s focus returns to compounding and telehealth: another wave of warning letters. Sheppard. June 18, 2026. Accessed July 6, 2026. https://www.sheppard.com/insights/blogs/fdas-focus-returns-to-compounding-and-telehealth-another-wave-of-warning-letters
6. Palmer K. The virtual Rx boom. STAT News. March 12, 2026. Accessed July 6, 2026. https://www.statnews.com/2026/03/12/fda-telehealth-marketing-glp1-prescribers-behind-warning-letters/
7. Catherman C. Despite FDA crackdown, unapproved GLP-1s still threaten the industry. Healthcare Brew. March 23, 2026. Accessed July 6, 2026. https://www.healthcare-brew.com/stories/2026/03/23/fda-crackdown-unapproved-glp-1s