Online GLP-1 Sellers Often Skip Clinician Oversight, Secret Shopper Study Finds

Online sellers of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) frequently prescribe these medications with little to no direct clinician engagement, according to findings of a new secret shopper study published in JAMA. The findings raise questions about the adequacy of screening for patients obtaining GLP-1 RAs, including compounded versions, through direct-to-consumer telehealth platforms.¹

Nearly 1 in 5 adults taking a GLP-1 RA report obtaining their prescription online, a trend driven largely by compounded formulations sold through telehealth platforms partnered with compounding pharmacies. These compounded products contain the same active ingredients as their branded counterparts but different inactive ingredients, and they are not approved by the FDA.¹

“When taking a medical history of a patient, I think pharmacists and other clinicians need to become more comfortable in asking patients if they are obtaining medications from non-traditional sources,” Reshma Ramachandran, MD, MPP, MHS, assistant professor of medicine at Yale School of Medicine and author of the study, told Pharmacy Times. “If we don’t ask, we won’t know and won’t be able to provide our patients with information that could prevent them from being harmed.”

Study Design and Key Findings

Researchers from Yale University used a simulated patient profile that met standard GLP-1 RA eligibility criteria to attempt to obtain prescriptions from 49 websites identified in prior research between August and December 2025. Of those, 45 sites (91.8%) issued a prescription and 34 (69.4%) mailed the medication to the simulated patient.¹

Every website relied on a questionnaire, but the depth of clinical screening varied widely. While nearly all sites asked about medical conditions (98.0%) and medications or allergies (93.9%), fewer asked about eating disorders (55.1%), diet and physical activity (53.1%), or patient-reported clinical values such as blood pressure or glucose (36.7%). Only about a quarter of sites required a video visit with a clinician, and just 6.1% required a phone call.¹

Gaps in Clinical Vetting

The study also identified specific lapses suggesting limited oversight. Nine websites (20.0%) prescribed a GLP-1 RA despite the patient providing only an upper-body photo when a full-body photo or scale photo was required. Two prescriptions were issued in 5 minutes or less, and 3 clinicians across different websites prescribed to the same simulated patient more than once. Some sites also maintained internal databases that flagged existing prescriptions from other platforms, yet 1 site reversed an initial denial and issued a prescription after the patient requested a refund.¹

Notably, 60.0% of prescribed compounded GLP-1 RAs included an added supplement, such as vitamin B12 or glycine, and 44.9% of sites asked questions related to "personalizing" a compounded formulation or dose, a pattern the study authors say reflects how sellers have used individualization to justify continued compounding beyond the FDA-recognized GLP-1 RA shortages in recent years.¹

“We should be asking if patients use telehealth or other non-traditional facilities like IV hydration spas where medications are often dispensed and administered to patients without clinical oversight,” Ramachandran continued.

Implications for Pharmacists

For pharmacists, these findings underscore the importance of medication reconciliation and patient counseling around GLP-1 RAs obtained outside conventional care pathways. Compounded products carry uncertain safety, efficacy, and quality profiles compared with FDA-approved formulations, and patients may not disclose online purchases unless directly asked. The FDA has separately intensified enforcement against telehealth companies for misleading marketing of compounded GLP-1 products, issuing warning letters to 30 companies in March 2026 for claims suggesting compounded versions are equivalent to FDA-approved drugs.²

Pharmacists are also well positioned to screen for disordered eating and inadequate psychosocial assessment, concerns that have drawn separate scrutiny in the literature given the potential for undetected eating disorders among patients seeking rapid weight-loss prescriptions online. With automatic charging and shipping occurring in 75.6% of prescribing websites without a confirmation step, pharmacists may increasingly encounter patients who obtained GLP-1 RAs with little clinical context, making thorough intake conversations at the pharmacy counter an important safeguard.^1,3

“Pharmacists play a critical role in safeguarding patients from potentially harmful or ineffective drugs obtained online,” Ramachandran explained. “For compounded products, pharmacists could ensure that patients are aware that these are not FDA-regulated products and that it is unclear whether the compounded drug is actually the same as the branded version despite advertising otherwise and that there have been no clinical studies conducted to establish quality, safety, or efficacy of the compounded product.”

REFERENCES

1. Chetty AK, Chen AS, Ross JS, Ramachandran R. Online prescribing of GLP-1 receptor agonists. JAMA. Published online July 6, 2026. doi:10.1001/jama.2026.9131

2. FDA warns 30 telehealth companies against illegal marketing of compounded GLP-1s. News release. FDA. Released March 3, 2026. Accessed July 16, 2026. https://www.fda.gov/news-events/press-announcements/fda-warns-30-telehealth-companies-against-illegal-marketing-compounded-glp-1s

3. 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