Key takeaways:

• Most websites provide GLP-1 prescriptions based solely off questionnaire responses.
• Of 49 websites offering GLP-1s to patients, 26.5% required a video visit and 6.1% required a phone call with a clinician.

PHILADELPHIA — Most websites selling GLP-1 receptor agonists prescribe medications without any direct interaction with a health care professional, according to data from a “secret shopper” study.

Researchers attempted to obtain GLP-1 prescriptions from 49 websites selling the class of medication from August to December 2025. A researcher created a simulated patient profile designed to meet eligibility for a GLP-1 prescription. The researcher received a prescription from 45 of the 49 websites, despite 26.5% of websites requiring a video visit and 6.1% requiring a phone call. Findings from the study were published in JAMA and presented at the Heart in Diabetes CME Conference.

Data were derived from Chetty AK, et al. Abstract 0057. Presented at: Heart in Diabetes CME Conference; June 19-21, 2026; Philadelphia.

“The findings are very concerning,” Ashwin K. Chetty, a fourth-year medical student at Yale University School of Medicine, who served as the secret shopper, and Reshma Ramachandran, MD, MPP, MHS, assistant professor of medicine at Yale University School of Medicine, told Healio. “One would hope that, as there is a clinician ultimately making a decision to prescribe a medication through these platforms, that this would serve as a protective factor for patients in providing evidence-based, high-quality care. However, our findings suggest that clinicians are only present on these platforms in name, not in practice. The prescription-centric approach of these platforms that sidelines clinicians increases the risk of clinical and financial harm for patients.”

Of the websites visited, 27 sold branded and compounded GLP-1s, 17 only sold compounded GLP-1s and five only sold branded medications.

Prescriptions were obtained from 91.8% of websites, and 69.4% of the websites mailed medication. Of the four websites that did not prescribe a drug, two asked for blood work, one said it found an existing prescription on another website and the fourth withdrew an initial prescription due to a discrepancy between the patient photo and reported weight.

Questionnaire data

All websites provided the researcher with a questionnaire. Of the websites, 79.6% asked about weight-loss goals, 65.3% inquired about previous weight-loss attempts and 53.1% asked about diet and physical activity. Regarding personal health information, 98% of questionnaires asked about medical conditions, 93.9% asked about other medications and allergies, 55.1% included questions about eating disorders and 36.7% asked for clinical values. In addition, 44.9% of websites asked about personalizing compounded GLP-1s.

Chetty and Ramachandran said they were surprised to see how many websites were neglecting to ask patients important questions related to GLP-1 therapy.

“Half of websites did not ask about eating disorders, which is particularly concerning given that GLP-1s may induce or worsen eating disorders,” Chetty and Ramachandran said. “This is not only a missed opportunity to screen for eating disorders but also risks starting a medication that may have more risks than benefits, especially given that most people with eating disorders are undiagnosed.

“Only half of websites asked about diet and physical activity, which should be a foundational part of any weight management plan,” Chetty and Ramachandran told Healio. “Additionally, only some websites asked if patients had recently received a medical examination or have a primary care doctor. As patients increasingly utilize telehealth as a substitute for traditional clinical care due to loss of coverage or ease of access, it is concerning that these sites are centered around prescribing instead of ensuring quality care.”

More oversight needed

Of the websites that prescribed GLP-1s, 20% did so with only an upper-body photo submitted despite requiring a full-body photo, and 75.6% charged the patient and shipped the medication without asking for confirmation. There were four websites that issued a branded prescription through the respective manufacturer’s direct-to-consumer website.

Chetty and Ramachandran said the findings reveal the need for the FDA to more thoroughly monitor websites that are issuing prescriptions for incretin-based drugs.

“The FDA should collect data on the amount and types of drugs compounded, along with their prescribers, to enable further research on this market, flag concerning prescribing practices and inform regulatory oversight,” Chetty and Ramachandran said.

For more information:

Ashwin K. Chetty can be reached at ashwin.chetty@yale.edu.

Reshma Ramachandran, MD, MPP, MHS, is an assistant professor of medicine and health services researcher at Yale School of Medicine. Ramachandran can be reached at reshma.ramachandran@yale.edu.