Inside 24 hours of injecting the primary dose of a weight reduction treatment she acquired following a go to with a telehealth physician, Karleigh McClain was admitted to the hospital, she stated.
The 31-year-old compliance marketing consultant from Hendersonville, Tennessee, stated she couldn’t cease vomiting.
“Sunday morning, all of it hits,” McClain recalled, as she described what occurred that weekend in January. “I can’t preserve something down.”
McClain stated she thought the dosage the telehealth firm had prescribed appeared too excessive. She tried to contact her physician, however when she didn’t get an instantaneous response, she stated she referred to as the corporate and a “care workforce” consultant confirmed the directions — which stated to inject 2.21 milligrams of the semaglutide treatment as soon as every week — have been appropriate.
It turned out, nevertheless, that was almost 9 instances the quantity sufferers are sometimes advised to take for his or her first dose.
Practically a month after she was recognized with an overdose, McClain stated she was “nonetheless coping with the residual uncomfortable side effects,” together with an elevated coronary heart charge and imaginative and prescient issues she felt have been tied to the treatment.
Most sufferers who’ve taken a GLP-1 acquired their prescription by way of a main care physician or a specialist, KFF polling information exhibits. However because the uptake of telehealth has grown considerably because the begin of the covid pandemic, McClain is one in all thousands and thousands of Individuals who’ve used on-line firms to fulfill a wide range of their medical wants.
Lots of the firms have began providing GLP-1 drugs for weight reduction as demand for these medicine has exploded. However sure treatment errors tied to GLP-1s have exploded too, in keeping with a KFF Well being Information evaluate of Meals and Drug Administration information, and physicians and telemedicine researchers fear that antagonistic experiences tied to telehealth firms have gotten extra frequent.
Dangerous outcomes aren’t distinctive to telehealth suppliers or to the compounded weight reduction medicine a lot of them supply. In actual fact, product legal responsibility lawsuits alleging affected person accidents have been filed overwhelmingly towards pharmaceutical giants Eli Lilly and Novo Nordisk, which manufacture name-brand weight reduction medicine, courtroom information exhibits. The drugmakers have defended their merchandise.
Nonetheless, some critics are additionally involved that getting a weight reduction prescription on-line is often a lot simpler than getting one by way of an in-person appointment. Not solely do many telehealth firms write fast prescriptions for GLP-1s, however they typically promote the drugs, too, permitting sufferers to bypass in-person pharmacy visits. This one-stop procuring isn’t essentially a superb factor, in keeping with critics who say some telehealth suppliers are writing prescriptions for individuals who shouldn’t be taking GLP-1s after which offering little or no follow-up care.
“It offers a black eye to telemedicine,” stated Elizabeth Krupinski, an experimental psychologist at Emory College who has carried out analysis on the effectiveness of telehealth.
Telemedicine stands to profit “so many individuals,” Krupinski stated, significantly when the expertise is built-in inside a bigger healthcare system. That method, sufferers profit from the comfort of telehealth whereas sustaining a reference to their in-person suppliers.
However some telehealth firms are advertising and marketing GLP-1s as a simple approach to reduce weight — generally with the assistance of paid celeb endorsements — with out emphasizing the significance of wholesome consuming and train, she stated.
They could be following the letter of the regulation, Krupinski stated. However writing prescriptions whereas skimping on care “isn’t within the Hippocratic oath.”
The Excellent Storm
Beginning round 2020, many states loosened restrictions on telehealth, which allowed on-line firms to proliferate. This helped accommodate sufferers who couldn’t, or selected to not, be seen in particular person on the peak of covid transmission.
Expanded telehealth entry was additionally meant to decrease obstacles in rural communities, in addition to mitigate physician and nurse shortages. In lots of locations, telehealth docs and nurses are legally allowed to deal with sufferers throughout state strains. However the best way telemedicine is practiced varies broadly, and state legal guidelines largely dictate guidelines that telehealth suppliers should comply with.
Some firms, similar to Mochi Well being, require sufferers to fulfill just about with a supplier, similar to a physician, nurse practitioner, or doctor assistant, earlier than they will get a GLP-1 prescription.
However others, together with Ro, generally require nothing extra of sufferers than an “asynchronous” analysis, which doesn’t embrace a dwell dialog with a healthcare supplier. Throughout this sort of analysis, clients are sometimes requested to fill out an consumption kind and reply a medical historical past questionnaire earlier than they’re evaluated for a prescription. Ro requires a dialog in actual time when required by state regulation, or when requested by a affected person or clinician, stated Nicholas Samonas, a spokesperson for the corporate.
“Each affected person is recommended by their supplier on the potential advantages and dangers of remedy primarily based on their particular person medical historical past,” Samonas stated. Ro’s clinicians can order lab work when vital and, when applicable, could suggest sufferers search in-person care, he stated.
However some medical specialists are involved that digital care could also be inadequate for prescribing weight reduction medicine.
Sufferers with a historical past of pancreatitis, for instance, needs to be recommended about potential problems, medical research present. The identical goes for individuals with a situation referred to as gastroparesis, which impacts abdomen nerves and muscular tissues, and people vulnerable to medullary thyroid most cancers.
Some sufferers might also profit from blood work or muscle mass screening earlier than beginning a GLP-1.
However not all telehealth firms are adequately evaluating sufferers earlier than writing prescriptions, stated Marc-Andre Cornier, an endocrinologist on the Medical College of South Carolina and the rapid previous president of The Weight problems Society.
Relating to parsing the great from the unhealthy, “whose job is it to police that?” he requested. The issue, he stated, is there aren’t standards written by a authorities company or a medical society to find out which suppliers are treating sufferers appropriately and which aren’t.
Whereas the primary GLP-1 was authorised by the FDA greater than 20 years in the past, to deal with Kind 2 diabetes, using these medicine took off in 2021 when Novo Nordisk acquired approval for a semaglutide drug to deal with weight problems, with the model title Wegovy. In a 2025 KFF ballot, almost 1 in 5 adults stated they’d taken a GLP-1.
In a current paper in The New England Journal of Medication, doctor Amanda Banks famous that the proportion of GLP-1 prescriptions written for individuals who weren’t diabetic, overweight, or obese elevated from 4.5% in 2018 to 17% in 2023.
Within the paper, Banks referred to as it “troubling” how straightforward it’s to acquire a prescription for weight reduction medicine and anxious they may exacerbate present consuming issues or trigger new instances, together with of anorexia.
Cornier, who has acquired compensation from Novo Nordisk for serving as a marketing consultant, echoed a few of Banks’ issues. “It’s not simply filling out a kind on-line after which having some random healthcare supplier log off on it,” he stated. “There are issues with a few of these on-line applications that there’s not a correct analysis, there’s not a baseline, and there’s not correct supervision.”
The American Telemedicine Affiliation, which advocates for the enlargement of “digitally enabled care,” has not addressed how telehealth suppliers prescribe GLP-1s, spokesperson Gina Cella stated.
“It is a bit out of our scope,” Cella stated, when requested if the affiliation had addressed the subject of telehealth suppliers and GLP-1 prescriptions.
The shortage of readability makes selecting an organization probably complicated for sufferers, and the medical occupation is partly accountable, stated Jamy Ard, an weight problems physician and researcher at Wake Forest College Faculty of Medication in Winston-Salem, North Carolina.
Medical doctors have traditionally performed a nasty job counseling sufferers about weight reduction, and many individuals aren’t comfy speaking to their main care physician about it, Ard stated. Sufferers suppose, “Why would I am going to my physician and have them say, ‘Eat much less and transfer extra,’ when I’ve heard that 1,000,000 instances and I don’t need to have that lecture once more?” Ard stated.
This downside, mixed with previous shortages of name-brand variations of GLP-1s, similar to Ozempic, Mounjaro, and Trulicity, has created a “good storm” for telehealth firms to flourish, stated Ard, who has acquired help from pharmaceutical and telehealth firms.
Whereas some telehealth firms prescribe solely name-brand weight reduction medicine, many additionally supply cheaper, compounded variations. They act as intermediaries between clients and mail-order compounding pharmacies, which create GLP-1s by mixing lively elements, similar to semaglutide, with components. The elements for compounded medicine are generally sourced from abroad suppliers, and the formulations are usually not reviewed by the FDA for security.
The atmosphere is “very a lot uncontrolled and poorly, if in any respect, regulated,” Ard stated. “There’s simply no customary of care.”
Emily Hilliard, a spokesperson for the Division of Well being and Human Providers, advised KFF Well being Information that compounded medicine “ought to solely be utilized in sufferers whose medical wants can’t be met by an FDA-approved drug.”
Hilliard stated the company urges “customers to be vigilant and know the supply of their drugs.”
Understanding the Dangers
Whereas weight reduction medicine have helped thousands and thousands of individuals reduce weight, they’re not with out threat, the info exhibits.
A KFF Well being Information information evaluation of the FDA’s Antagonistic Occasion Monitoring System discovered that treatment errors made by suppliers or sufferers with fashionable weight reduction medicine exploded from simply over 2,000 experiences in 2020 to over 25,000 in 2025. These self-reported occasions concerned semaglutide, tirzepatide, dulaglutide, and liraglutide, the generic names for main GLP-1s.
Amongst frequent points cited within the antagonistic occasion experiences have been administration of an additional or incorrect dose, points with communication a few product, and prescribing errors.
Since 2019, the Nationwide Poison Information System has fielded a virtually 1,500% improve in calls associated to overdoses or uncomfortable side effects from injectable weight reduction medicine. The info doesn’t distinguish between overdoses tied to a telehealth prescription and people stemming from an in-person medical appointment, however it’s a reflection of how prevalent these medicine have change into.
But information on potential treatment errors and antagonistic reactions to GLP-1 drugs is incomplete, as a result of many points are by no means reported to federal officers.
For instance, in a March 5 warning letter, the FDA accused drugmaker Novo Nordisk, the maker of Wegovy and Ozempic, of failing to report some antagonistic occasions to the federal authorities, together with suicidal ideation and loss of life.
No person is aware of how typically antagonistic occasions happen, stated Kristen Nixon, a Johns Hopkins College researcher who has studied posts about weight reduction medicine on Reddit, a well-liked on-line discussion board.
Her workforce analyzed a whole bunch of Reddit posts from 2020 by way of final August and recognized frequent mentions of drug reactions and consumer errors, similar to sufferers’ not figuring out learn how to appropriately dose and inject the treatment.
However one other discovering additionally stood out to her.
“Wow, there are lots of people speaking about telehealth,” Nixon recalled pondering. Reddit commenters stated they acquired GLP-1 prescriptions from scores of telehealth platforms, Nixon discovered. Commenters additionally talked about a number of dozen compounding pharmacies — typically in the identical posts about telehealth.
Pharmacies are sometimes required to counsel sufferers on drugs they obtain. However Nixon’s analysis discovered that telehealth firms typically mail the drugs immediately, that means sufferers don’t have to go to a pharmacy.
“Anecdotally, it looks as if the telehealth firms are actually facilitating entry to compounded drugs,” Nixon stated.
Leslie Gammon, 54, an workplace supervisor from Wendell, North Carolina, stated she turned to a telehealth firm referred to as Amble Well being for a weight reduction drug prescription. She was given a GLP-1 after filling out a web-based kind, she stated.
Like McClain, when she acquired her mail-order compounded treatment in late October, she thought the dosage that accompanied it appeared too excessive. She’d acquired a field of semaglutide earlier within the month with a a lot decrease dose. However the refill she acquired was a stronger formulation, and the directions advised Gammon to inject thrice the amount she had been taking in earlier weeks.
Despite the fact that she injected barely lower than that advisable quantity earlier than mattress on a Sunday night, she awakened in the midst of the night time “throwing up each 20 to 25 minutes,” she stated. And it didn’t cease till Tuesday. She was finally admitted to a hospital in Raleigh and now owes the hospital over $9,000, a medical invoice exhibits.
Amble Well being didn’t reply to questions for this text.
The supply system for injectable variations of weight reduction medicine is extra sophisticated than for a tablet. In its Nationwide Poison Information System alert, America’s Poison Facilities famous that some individuals reported “by chance taking 10-times the advisable dose as a result of complicated measurement models whereas utilizing a syringe.”
And people who find themselves wanting to lose further weight — earlier than a marriage or a trip, for instance — could select to self-administer a higher-than-recommended dose, stated Arthur Caplan, a bioethics professor at New York College’s Grossman Faculty of Medication.
Some telehealth firms aren’t doing sufficient, he stated, to verify sufferers perceive the dangers or the complicated supply system related to the injectable medicine.
“The consent isn’t enough,” Caplan stated. “There’s no probing to see when you understood something.”
Cella, with the American Telemedicine Affiliation, stated the group has not addressed the problem of teaching sufferers in regards to the dangers of injecting weight reduction medicine. However she pointed to the affiliation’s “Rules of Follow,” which states that telehealth enterprise fashions “should put the affected person first.”
Proceed With Warning
Pharmaceutical firms should listing probably dangerous uncomfortable side effects once they promote the name-brand variations of their FDA-approved drugs. Potential uncomfortable side effects of GLP-1s embrace nausea, vomiting, adjustments in imaginative and prescient, low blood sugar, and, in uncommon instances, thyroid most cancers. In the meantime, telehealth firms haven’t traditionally adopted the identical guidelines that drugmakers have in disclosing treatment dangers in ads. However the FDA has began cracking down on deceptive drug adverts.
A nationwide scarcity of weight reduction drugs in 2022 opened the door for compounding pharmacies to fabricate these medicine. However because the FDA declared the scarcity over final 12 months, firms that supply compounded medicine are more and more going through authorized and regulatory challenges associated to their advertising and marketing techniques.
Mounjaro producer Eli Lilly and different drugmakers are suing a number of telehealth firms for selling compounded variations of their medicine. In a single authorized grievance, Eli Lilly alleged Mochi Well being had engaged in “misleading” enterprise techniques. In a movement to dismiss the lawsuit final 12 months, legal professionals for Mochi Well being referred to as the grievance a part of a “nationwide marketing campaign to bolster Lilly’s income by dictating affected person care by way of the elimination of compounded medicine as a remedy possibility for weight administration.” The lawsuit is ongoing.
Eli Lilly spokesperson Michael Jamison stated in a written remark that telehealth firms sued by the drug producer threaten “affected person security by falsely selling supposedly ‘personalised’ compounded tirzepatide” and mislead “customers in regards to the security, scientific testing, and effectiveness of their compounded knockoffs.”
In the meantime, Novo Nordisk has filed 130 lawsuits towards “entities engaged in illegal advertising and marketing and sale of knockoff semaglutide medicine,” stated Liz Skrbkova, a spokesperson for the drugmaker.
She stated the corporate is dedicated to “defending sufferers from unapproved knockoff medicine made with overseas, inauthentic lively pharmaceutical elements that pose important security and efficacy dangers.”
The Trump administration despatched a flurry of warning letters in September and February to on-line firms similar to Hims & Hers, SkinnyRx, Be a part of Josie, and Genesis Well being Worldwide. The FDA stated these and different firms had made false or deceptive claims associated to compounded variations of weight reduction medicine.
“Your claims suggest that your merchandise are the identical as an FDA-approved product when they don’t seem to be,” the company’s Middle for Drug Analysis and Analysis wrote to Hims & Hers on Sept. 9. HHS later referred the corporate to the Division of Justice after it introduced the launch of a $49 model of Novo Nordisk’s Wegovy tablet.
When requested in regards to the FDA warning, Abby Reisinger-Moley, a spokesperson for Hims & Hers, pointed to a March assertion from the corporate saying a shift away from compounded weight reduction medicine. The corporate stated within the press launch that it had entered into an settlement with Novo Nordisk to promote name-brand variations.
Alex Smith, CEO of Be a part of Josie, a web-based platform that helps ladies in menopause reduce weight by prescribing GLP-1s, stated his firm additionally made adjustments in response to an FDA letter, to incorporate eradicating Be a part of Josie’s title from treatment vials. “Which I agree with,” Smith stated, “since you don’t need sufferers pondering you’re the compounding pharmacy.”
SkinnyRx and Genesis Well being Worldwide didn’t reply to requests for remark.
However these warnings aren’t the primary time the federal authorities has stepped in to make sure that telemedicine is getting used appropriately, stated Mei Wa Kwong, government director of the Middle for Linked Well being Coverage.
Prior instances concerned attention-deficit/hyperactivity dysfunction drugs and different managed substances prescribed by telehealth suppliers, she stated. Whereas these medicine pose extra threat to sufferers than GLP-1s, the businesses have been additionally accused of improperly screening potential clients.
The onus nonetheless falls on customers to analysis firms earlier than signing up for his or her companies, Kwong stated.
“All the time strategy something on the web with a touch of skepticism,” Kwong stated.
‘Retains Getting Worse’
McClain, the Tennessee lady hospitalized this 12 months after a GLP-1 overdose, stated she misplaced 50 kilos a number of years in the past by taking a name-brand GLP-1 prescribed by her physician.
On the time, the treatment was coated by her medical insurance. This 12 months, when she was able to take a GLP-1 once more following a being pregnant, the drug was now not coated for weight reduction.
To save cash by acquiring a less expensive, compounded GLP-1, McClain signed up for Mochi Well being after doing her personal analysis. “That was simply essentially the most inexpensive possibility,” she stated.
However inside hours of her first dose, she stated, she discovered herself on the cellphone with poison management.
After her overdose, McClain stated, she spoke to a scientific director at Mochi Well being, as soon as by cellphone however principally through electronic mail, about her lingering signs earlier than communication paused.
David Pilip, a spokesperson for Mochi Well being, stated in a press release that the corporate wouldn’t focus on particular person sufferers as a result of privateness obligations. However he stated antagonistic occasions are “instantly flagged” and “investigated with excessive precision.”
“Mochi Well being takes affected person security extraordinarily severely,” Pilip wrote in an electronic mail. “We promptly initiated a evaluate and have been in direct and ongoing communication with the affected person to achieve a decision. We stay dedicated to doing so.”
McClain anticipates her healthcare payments associated to the hospital keep will complete at the very least $900. She stated that to get the $159 refund for her three-month membership and reimbursement for the hospital bills, she has been requested to signal a doc saying she gained’t take authorized motion towards the corporate. Her expertise, she stated, “simply retains getting worse.”
NBC Information producer Jessica Herzberg and KFF Well being Information senior correspondent Fred Schulte contributed to this report.
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