Online GLP-1 Prescribing Lacks Adequate Safety, Oversight

A new secret shopper study reveals that online glucagon-like peptide-1 receptor agonist (GLP-1 RA) prescribing platforms are prioritizing speed over safety, with some issuing prescriptions in under 5 minutes with little to no meaningful clinician involvement, according to a research letter in JAMA.¹

“Accelerated by the COVID-19 pandemic and the resulting lockdown measures, patients are now increasingly using online services for medical consultations and access to prescription and over-the-counter medications,” according to a study in the Elsevier journal EClinicalMedicine.² “The digital pharmacy market is estimated to be growing at a rate of about 14% year on year and telehealth uptake has risen sharply, with consumer adoption reported to have increased from 11% in 2019 to 46% in 2021 in the USA. Although these platforms can offer clear benefits to patients, they also present some substantial public health risks.”

The JAMA study researchers explored GLP-1 RA prescriptions from 49 different websites, finding that nearly 92% of these platforms issued a prescription. Alarmingly, 2 of these compounded prescriptions were issued in 5 minutes or less, and 75.6% of the websites automatically charged and shipped the medication following approval without requiring any further confirmation from the patient.¹

READ MORE: How GLP-1 Therapies Could Impact Bone Density, Muscle Loss

Although nearly all websites utilized some form of questionnaire, significant clinical gaps remained. Only 53.1% asked about diet and physical activity, and just over half inquired about the history of eating disorders. Furthermore, clinician interaction was often nonexistent or superficial, with a median video or call duration of only 9 minutes when such interaction was required at all.

An Unregulated Online Market

This lack of oversight is particularly concerning given the rise of compounded GLP-1 RAs, which are not FDA-approved and do not undergo the same rigorous review for safety, effectiveness, or quality. The high demand and resulting brand name shortages have created a “wild west” where sellers justify mass compounding through claims of personalization, often adding understudied supplements like vitamin B12 or NAD+.^1,3

The real-world consequences of this unregulated market were further highlighted by an NPR investigation into Zappy Health and its partner, Ousia Pharmacy. Customers found that Ousia lacked the necessary sterile compounding license to produce injectable medications. State inspectors later discovered the pharmacy was improperly storing drugs and failing to keep adequate records.⁴

Pharmacists must also contend with the risk of substandard or counterfeit products. The CDC warns that nearly 95% of websites selling prescription drugs online operate illegally, with some distributing counterfeit pills containing dangerous substances like fentanyl or methamphetamine.⁵

Even when the active ingredient is correct, the FDA has identified salt forms, such as semaglutide sodium and acetate, being used in compounding despite having no lawful basis for human use or safety evidence. Quality issues extend to shipping as well. Because GLP-1s require strict refrigeration, injectable versions that arrive warm or with inadequate ice packs are considered potentially unsafe for use.^3,6

Online GLP-1 Prescribing Risks

The clinical risks of fragmented care are equally severe. Without the involvement of a primary care physician, patients may receive ineffective doses or suffer from serious adverse effects like pancreatitis and severe dehydration.^2,3

As of May 2026, the FDA has received over 1700 adverse event reports related to compounded semaglutide and tirzepatide, including hospitalizations caused by dosing errors.³

To protect patients, pharmacists should emphasize the importance of using licensed telehealth platforms that require thorough medical evaluations and partner with state-licensed pharmacies. Resources like the FDA’s BeSafeRx campaign can help consumers verify the legitimacy of an online pharmacy.^3,5,6

Despite digital platforms offering convenience and privacy, they cannot replace the safety afforded by a legitimate prescriber-patient relationship and the oversight of a regulated pharmacy environment.^5,6

“This study was conducted amid rapid growth in online GLP-1 RA sales and increasing FDA oversight of advertising,” concluded the authors of the current study.¹ “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.”

READ MORE: Obesity Management Resource Center

REFERENCES

1. Chetty AK, Chen AS, Ross JS, Ramachandran R. Online Prescribing of GLP-1 Receptor Agonists. JAMA. July 6, 2026. doi:10.1001/jama.2026.9131

2. Online pharmacies: a double-edged sword. EClinicalMedicine. 2025 Feb 24;80:103133. doi: 10.1016/j.eclinm.2025.103133.

3. FDA’s concerns with unapproved GLP-1 drugs used for weight loss. FDA. June 15, 2026. Accessed July 7, 2026. https://www.fda.gov/drugs/drug-alerts-and-statements/fdas-concerns-unapproved-glp-1-drugs-used-weight-loss

4. Lupkin S. Thinking of buying obesity drugs online? Read this first. NPR. February 17, 2025. Accessed July 7, 2026. https://www.npr.org/sections/shots-health-news/2025/02/17/nx-s1-5299288/semaglutide-wegovy-zepbound-compounding-pharmacy

5. Potential public health risk among individuals ordering counterfeit prescription medications from online pharmacies. News Release. CDC. October 2, 2024. Accessed July 7, 2026. https://www.cdc.gov/media/releases/2024/s1002-counterfit-prescription-online-pharmacies.html

6. Billingsley A. Can you get GLP-1s online for weight loss? GoodRx. April 9, 2026. Accessed July 7, 2026. https://www.goodrx.com/classes/glp-1-agonists/glp-1-online