Secret Shopper Study Reveals GLP-1 Telehealth Gaps

Direct-to-consumer telehealth platforms have become a major access point for GLP-1 receptor agonists, and a new secret-shopper study finds that clinician oversight at many sites is minimal at best. The findings raise questions about whether online prescribing pathways adequately screen patients before dispensing a drug class with known contraindications.¹

On a recent episode of Diabetes Dialogue, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discussed the study, published in JAMA and led by Ashwin K. Chetty, a fourth-year medical student at Yale School of Medicine, with Reshma Ramachandran, MD, MPP, MHS, of Yale, as corresponding author.

Investigators built a simulated patient profile meeting GLP-1 eligibility criteria and solicited prescriptions from 49 websites between August and December 2025. Seventeen sites sold compounded formulations only, five sold branded medication only, and 27 sold both. Forty-five sites, or 91.8%, issued a prescription, and 34 sites, or 69.4%, mailed the medication directly to the patient.

Among the four sites declining to prescribe, two required blood work, one flagged an existing prescription through an internal cross-site database, and one withdrew after a mismatch between the submitted photo and reported weight. Notably, a separate site overturned its own clinician's denial and issued the prescription despite a similar database flag. Several prescriptions were approved in five minutes or less, some despite missing required photos, and only a minority of sites required a video visit or phone call.

Compounded GLP-1 sellers raised a distinct concern. Compounding is intended only for documented medical need or drug shortage, and no shortage currently exists for GLP-1 RAs. Even so, several sites used leading questionnaire items, such as prompts about vitamin B12 deficiency, to justify added supplements and modified dosing, pointing to limited clinician engagement where compounded product safety and quality remain uncertain.

The findings highlight a gap between the convenience driving patients toward online GLP-1 access, often a response to cost and insurance barriers, and the safeguards needed to screen for contraindications such as prior pancreatitis. Isaacs and Bellini emphasized clinicians should ask patients directly and without judgment about online GLP-1 use, since many remain reluctant to disclose it. The study adds pressure for stronger regulatory oversight of online prescribing as demand for compounded and branded GLP-1s continues to grow.

Editors’ Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others.

References

1. Chetty AK, Chen AS, Ross JS, Ramachandran R. Online prescribing of GLP-1 receptor agonists. JAMA. 2026;336(5):428. doi:10.1001/jama.2026.9131