A landmark secret-shopper study published in JAMA reveals how dangerously easy it has become to obtain GLP-1 weight-loss prescriptions online.
Researchers found that some telehealth websites issued prescriptions for semaglutide and tirzepatide in as little as five minutes, with minimal clinical oversight.
The study examined 49 websites selling branded or compounded versions of semaglutide or tirzepatide between August and December 2025.
A researcher posing as an eligible patient found that 45 of the 49 sites, or 91.8%, issued a prescription, and 34 of them actually mailed the drug.
The median time to receive a prescription was one day or less, with two compounded orders approved in under five minutes.
While nearly all sites used intake questionnaires, screening for critical health factors remained inconsistent and dangerously incomplete across platforms.
Only 27 of the 49 sites asked about eating disorder history, and just 26 included questions about diet and physical activity levels.
A mere 13 sites required a video visit with a clinician, and only three required any form of phone call before issuing a prescription.
GLP-1 medications carry an FDA black box warning for thyroid cancer risk and require pancreatitis screening, neither of which can be assessed through a self-reported questionnaire.
“Limited clinician engagement, especially when prescribing compounded GLP-1 RAs with uncertain safety, efficacy, and quality, may increase risks of medical and financial harm,” the study authors noted.
The compounding problem adds another layer of danger, as products dispensed in vials rather than FDA-approved prefilled pens carry documented risks of dosing errors.
The FDA has issued more than 30 warning letters in March 2026 alone, telling telehealth companies to stop implying compounded products are equivalent to FDA-approved medications.
The agency has also logged more than 1,700 adverse event reports tied to compounded semaglutide and tirzepatide as of late May 2026.
An additional 25 warning letters went out in June 2026, signaling that regulators are intensifying their scrutiny of the online prescribing marketplace.
“It’s a clinician waving people through, not patient care,” said Dr. James J. Chao, who prescribes GLP-1 medications as part of a weight-loss program.
Dr. Chao added that “state medical boards need to start auditing doctors who are writing hundreds or thousands of telehealth prescriptions each month.”
He also called on online platforms to “verify identity and at least basic baseline health data before releasing any prescriptions to pharmacies.”
The study authors concluded that while direct-to-consumer platforms have increased patient access to GLP-1 receptor agonists, some do so by prioritizing quick prescriptions over comprehensive care.
