An Online Secret Shopping Study Reveals Easy Access to GLP-1 Prescriptions with Limited Clinician Oversight

If you live in the United States, you have likely seen advertisements for GLP medications on social media, while watching television, or listening to the radio. Numerous companies are selling prescriptions to millions of consumers on the internet—all without requiring individuals to step inside a clinician’s office.

A Yale research team was interested in finding out how difficult it would be to obtain a prescription online. They created a patient profile of a 27-year-old male who qualified for a GLP-1 and attempted to obtain a prescription through 49 different websites. Overall, 92% prescribed the GLP medication and 69% mailed it. The researchers' findings were published in JAMA on July 6.

“We knew many people were accessing these drugs outside of insurance coverage, but we were surprised that the vast majority of these websites did not require communication with a clinician,” says first-author Ashwin Chetty, who is a fourth-year medical student at Yale School of Medicine. “In some cases, the request was put in on a Monday evening, approved shortly after, and the prescription was delivered by Tuesday or Wednesday.”

The study shows that if an eligible patient is able to pay for the medication, they will receive it quickly and with very little oversight, says senior author Reshma Ramachandran, MD, MHS.

Most of the companies in the secret shopper study sold compounded versions of GLP medications, which are not regulated by the U.S. Food and Drug Administration (FDA) and are therefore more affordable.

“These compounded products have never reached a clinical trial, and they’ve had no FDA review. The companies are creating new drugs and selling them across state lines. It’s alarming that these medications—which have not been tested on patients—are being mass-produced and mass-marketed for profit,” says Ramachandran, assistant professor of medicine (general medicine).

Consumers may not be aware of the possible safety risks associated with obtaining these medications through an insecure supply chain.

The researchers also found that in most cases, the secret shopper was able to access a prescription without talking to a clinician to verify the provided information.

Since even FDA-approved medications carry risks, when clinicians prescribe medications for patients, there is a discussion about such risks and benefits, including contraindications, like other diseases or drugs that may interact adversely.

“There are certain medical conditions that are important to discuss when deciding whether or not a patient should be on a GLP-1,” says Chetty. “And so I would have expected that, in light of this, there would be a more thorough medical history where more questions were asked to ensure all bases are covered, which wasn't the case for many of these websites.”

“Every drug that we prescribe for our patients has some sort of risk-benefit that's personalized to each person,” Ramachandran adds.

The researchers want to raise awareness of the websites and online pharmacies selling unregulated medications, and the need for safeguards.

Various medical professional societies have issued clear guidelines and best practices for prescribing GLP-1s.

“The websites need to have protections in place that are more robust than simply a clinician who's just willing to prescribe. Companies and organizations need to follow the guidelines by asking the correct questions and ensuring they’re prescribing medications appropriately,” Ramachandran says.

The researchers call for greater levels of patient protection through increased regulation and requirements that websites disclose the risks of taking compounded drugs.

“As we're seeing telehealth platforms grow across the country, and replacing in-person healthcare access, telehealth needs to replicate the patient-clinician experience that happens in the real-world. It can't just be a pay-to-prescribe sort of platform. It needs to be a pay-for-appropriate-treatment platform,” says Ramachandran.

Other authors of the study include: Alissa Chen, MD, MPH, and Joseph Ross, MD, MHS.