Lack of clinical oversight raises red flags in virtual GLP-1 prescribing

New research is highlighting the lack of clinical oversight in the virtual prescribing of GLP-1s, calling into question the safety of the booming digital GLP-1 gold rush.

The 'secret shopper' study revealed that telehealth-based GLP-1 prescribers often did not require clinician interaction, indicating that clinician engagement in online GLP-1 prescribing may be far lower than expected. The study, conducted by Yale University researchers and published in JAMA, aimed to evaluate the prescription process and clinical engagement in virtual GLP-1 prescribing.

The researchers used a simulated patient profile that met the eligibility criteria for GLP-1 receptor agonists to obtain prescriptions from telehealth websites between August and December 2025. The 'patient' selected the lowest-cost prescription and followed the process until the prescription was approved or blood work was requested.

Through the profile, the researchers solicited GLP-1 prescriptions from 49 websites, of which 17 sold compounded GLP-1s only, 5 sold branded GLP-1s only and 27 sold both. A majority of the telehealth websites prescribed the drug (91.8%), and two-thirds mailed the medication (69.4%).

All websites used a questionnaire to determine prescription approval. Most (79.6%) asked about weight-loss goals in their questionnaire, while 65.3% asked about prior non-pharmacological weight-loss attempts and 53.1% about diet and physical activity. Nearly all (98%) asked about medical conditions and medications and allergies 93.9%), while a little over half (55.1%) asked about eating disorders.

However, only 36.7% asked for patient-reported clinical values, such as blood pressure, blood glucose and cholesterol, and about half (44.9%) asked questions related to personalizing compounded GLP-1. Just over a quarter (26.5%) required a video visit, and 6.1% required a call. Fewer than half of the websites provided opportunities to ask questions asynchronously (46.9%) or synchronously (44.9%).

Further, most of the websites (75.6%) automatically charged and shipped the GLP-1 RA after the prescription was approved, without requiring patient confirmation.

The researchers highlighted several findings indicating limited clinician oversight, including prescriptions issued without the required photos and those issued within five minutes or less. 

For instance, the median time for a patient to have a prescription approved was one day. However, two compounded prescriptions were issued in five minutes or less. In addition, nine websites prescribed the drugs with only an upper-body photo despite saying they required a full-body photo or a photo standing on a scale.

The study also revealed that, in some cases, multiple GLP-1 prescriptions were issued by the same clinicians. Three clinicians prescribed GLP-1s to the patient via two or more websites.

"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 researchers wrote.

The research comes amid ongoing efforts to curb direct-to-consumer advertising of compounded GLP-1 medications online. Last September, the FDA sent 50 warning letters to wellness clinics and telehealth platforms for advertising unapproved compounded GLP-1 drugs. Earlier this year, the agency sent another 30 telehealth companies warning letters for making deceptive claims in advertisements for compounded GLP-1 medications.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers healthcare IT and innovation, including artificial intelligence, digital healthcare, EHRs and interoperability.