The tangled web of online providers, compounded GLP-1s, and care continuity

As patient interest in glucagon-like peptide-1 receptor agonists grows, lifestyle management vendors and employer-sponsored wellness programs are revamping their approach to long-term weight loss to accommodate GLP-1 use. This approach leaves a key group of patients unaccounted for – and puts them at risk.  

A 2024 Kaiser Family Foundation survey found 21% of patients don’t get GLP-1s from a prescription from a weight specialist or primary care physician. These patients obtain the drugs from medical spas, aesthetic medical centers, or online providers. While this increases the availability of weight-loss treatment options – particularly for patients with limited access to clinical care options otherwise – it’s contrary to the Food and Drug Administration’s recommendation that patients get a prescription directly from a physician and fill it at a state-licensed pharmacy.  

In particular, getting GLP-1s from a telehealth provider concerns two-thirds of PCPs, according to Omada Health. Top worries include inappropriate use, compromised continuity of care, poor medication reconciliation, limited side effects management, and the prevalence of compounded GLP-1s, which haven’t been approved by the FDA.  

Compounded medications have been linked to adverse events, dosing concerns, and illegal online sales, the FDA notes in its recommendations. (The agency isn’t entirely innocent; compounded GLP-1s were only phased out in May 2025 once shortages of semaglutide and tirzepatide had been resolved.) 

They’ve also caused rifts between manufacturers and care providers – most notably Novo Nordisk and Hims & Hers Health. Last month, the Danish drugmaker terminated its recently minted collaboration with the telehealth company over allegations it was exposing patients to “knock-off drugs made with unsafe and illicit foreign ingredients” by marketing compounded versions of semaglutide made in Chinese factories that hadn’t been inspected by the FDA. (Semaglutide is the active ingredient in Novo Nordisk’s Wegovy.) 

Electronic prescriptions of GLP-1s can present clear risks to patients and providers. However, it’s worth noting traditional prescribing and treatment workflows aren’t without their flaws. 

• Just because a licensed practitioner can prescribe GLP-1s during an in-person appointment doesn’t mean they should. Verywell Health noted psychiatrists, dermatologists, and plastic surgeons have added them to their practices. This hints at a quick-fix approach to weight loss, not a long-term commitment to weight management. 

• The uptick in prescriptions has led to a corresponding uptick in denials, according to Medical Economics. Some insurers are only approving GLP-1s with prior authorization. Others require additional documentation. Others may drop coverage if a patient succeeds in reducing their body mass index (BMI) below a certain level. That can close the door to patients otherwise ready for the medication. 

• Regular check-ins are vital to support long-term weight and lifestyle management, noted Medscape. That means open communication, patient education support, and above all trust, noted FPM Journal. That’s easier said than done. There are less than 10,000 physicians certified in obesity medicine in the United States and Canada, according to the American Board of Obesity Medicine. Meanwhile, shortages of PCPs, internists, and preventive medicine professionals are well documented, especially beyond major urban areas. 

Here, telehealth is poised to increase access to the coordinated care necessary for long-term weight management. Engagements with patients should encompass side effects, comorbidities such as diabetes or hypertension, and diet and lifestyle changes, in addition to monitoring and adjusting GLP-1 use, as necessary. Verywell Health noted an important distinction among online providers is a commitment to weight-loss health and education, not just a perceived pipeline to medications. 

In addition, RubiconMD noted telehealth consults between PCPs and endocrinologists or cardiologists can support informed decision-making. These specialists can help PCPs navigate the administrative complexities of GLP-1 prescribing, for example, or create personalized treatment plans that account for medical history, comorbidities, and weight-loss goals.  

Brian Eastwood is a Boston-based writer with more than 10 years of experience covering healthcare IT and healthcare delivery. He also writes about enterprise IT, consumer technology, and corporate leadership.