A secret shopper study published in JAMA on July 6 found that many telehealth vendors prescribing GLP-1 drugs do not require a conversation with a clinician before issuing a prescription. Of 49 sampled websites, 45 prescribed to a fictional patient, yet only about 1 in 4 required a video visit and…
The study examined 49 websites that sell GLP-1 drugs. Among those, 45 issued a prescription for a fictional patient who met the basic eligibility criteria. According to the findings, only about 1 in 4 of the sampled websites required a video consultation with a clinician, and 6% required a phone call with a clinician. All 49 websites did ask patients to complete a questionnaire, but that level of screening alone was often the only step before a prescription was issued.
Claudia Lewis, a partner and cochair of the FDA group at the law firm Venable, told Healthcare Brew, “I’m not surprised to hear that people are getting prescriptions without having met with a true healthcare provider.”
Of the websites that issued a prescription, 39 prescribed compounded versions of GLP-1 drugs. Compounded drugs are unofficial versions of brand-name medications. Unlike their branded counterparts, they are not independently reviewed by the FDA for safety, efficacy, or quality. While compounding is legal, it is only permitted under specific conditions, such as when a patient has an allergy to an inactive ingredient in the branded drug or when the branded drug is in shortage.
The study authors wrote, “Limited clinician engagement, especially when prescribing compounded GLP-1 receptor agonists with uncertain safety, efficacy, and quality, may increase risks of medical and financial harm.”
The two most commonly prescribed GLP-1 drugs, tirzepatide and semaglutide, were in shortage from 2022 until October 2024 and February 2025, respectively. When those shortages ended, many expected that telehealth compounding operations would wind down. Instead, according to an October 2025 analysis from the life sciences research firm Iqvia, prescription volumes for compounded GLP-1s actually increased.
Recent polling from Gallup, conducted in May and June of 2026, shows that about 1 in 10 US adults currently report taking a GLP-1 medication for weight loss. Among those users, roughly 1 in 5 say they take a compounded version.
Lewis emphasized that some compounded drug sellers are likely operating properly. She said she cannot definitively say whether prescriptions are being issued without adequate clinician oversight across the board.
Kyle Zebley, CEO of the American Telemedicine Association ATA and executive director of its advocacy arm ATA Action, said in an email to Healthcare Brew that the “vast majority” of telehealth providers “meet or exceed” clinical standards. He added, “We don’t believe this study reflects a widespread or systemic problem in telehealth.”
The FDA has also encountered telehealth compounders that attempted to evade restrictions by labeling their products as intended for “research” rather than for human consumption, according to a June 2026 notice from the agency.
FDA rules prohibit compounders from making exact copies of commercially available drugs except during a shortage. Some telehealth companies have added inactive ingredients such as vitamins, arguing that their drug is no longer an exact copy of a patented drug. In an April 2026 notice, the FDA clarified that these compounded drugs can still be considered copies and are therefore illegal.
Novo Nordisk, the maker of Ozempic and Wegovy, has filed lawsuits against more than 100 compounders. Eli Lilly, which manufactures Mounjaro and Zepbound, has also taken legal action against compounding pharmacies, accusing them of violating FDA regulations.
Between September 2025 and March 2026, the FDA reported sending “thousands” of warning letters to pharmaceutical and telehealth companies for misleading advertising practices, such as implying their drugs are FDA-approved when they are not.
In February 2026, roughly one year after the most recent GLP-1 shortage ended, the FDA issued a notice vowing to “take action” against mass-marketed compounded GLP-1s. That notice mentioned possible legal actions, including seizure and injunction of non-FDA-approved drugs.
On April 30, 2026, the FDA proposed removing three GLP-1 active pharmaceutical ingredients from the 503B bulks list of active ingredients. If finalized, that proposal would halt mass compounding at outsourcing facilities. The proposal has not yet been finalized.
Lewis expressed concern that the FDA’s actions may be coming too late for those compounders that are skirting the rules. She said, “The minute that the FDA decided that the shortage on these products had passed…that was the time for the FDA to be like, ‘Look, unless you fit into one of these exceptions clearly, we’re going to be sending you warning letters, and then we’re going to be seizing your product.’ And that didn’t happen.”
The FDA declined to comment specifically on the secret shopper study but pointed to two notices dated June 15 that warn telehealth compounders and patients about the risks associated with illegal manufacturing and promotion of compounded drugs.
Peptides referenced: Semaglutide, Tirzepatide, GLP-1.
Related reading: Study Links Paternal Stress Before Conception to Offspring Growth, How Semaglutide Protects the Heart: Wegovy and Cardiovascular Health, APhA Urges FDA to Prioritize Patient Safety in Peptide Reviews, No Statistical Link Found Between GLP-1 Drugs and Eye Disease in Type 2 Diabetes.