The Rise of Compounded GLP-1s

Following the massive success of drugs like Ozempic, Wegovy, and Zepbound, a significant surge in demand led to prolonged shortages starting in 2022. During this period, a new market emerged: telehealth providers offering compounded GLP-1 weight loss medications at a fraction of the cost of brand-name versions. By late 2025, it was estimated that one in eight American adults had utilized these drugs.

Ashwin Chetty, a medical student and researcher, began investigating the accessibility of these medications after noting that some online providers were marketing unapproved oral forms of semaglutide and medications mixed with additives like vitamin B6. His research aimed to answer a critical question: "How easy is too easy when it comes to getting a prescription?"


The Investigation: A Simulated Patient Profile

To evaluate the standards of care, Chetty and his mentors at Yale University School of Medicine created a fictional patient profile—a 27-year-old male with a BMI of 35 and various health conditions like sleep apnea and pre-diabetes. Despite the researcher not meeting these clinical criteria, the results of the experiment were concerning:

  • Rapid Approval: Most providers approved the prescription in under 24 hours; in two instances, the process took less than five minutes.
  • Inadequate Verification: Out of 49 companies tested, only one flagged the discrepancy between the patient's reported weight and the provided photo.
  • Administrative Overrides: In cases where internal databases identified existing prescriptions, some platforms allowed administrators to override clinical denials, suggesting that profit motives might be outweighing medical oversight.

Critical Gaps in Safety and Care

The investigation highlighted several alarming trends in how these platforms operate. Many providers failed to screen for eating disorders, despite the fact that GLP-1s can exacerbate such conditions. Furthermore, there was a frequent lack of guidance regarding diet and lifestyle management—components essential to the effective use of these medications.

Regarding the legality of these compounded versions, Chetty notes that while compounding is permitted during drug shortages, companies are finding loopholes by "customizing" medications. By adding vitamins or minor variations, they claim the drugs are personalized. However, as Chetty argues, "If you're doing the same modification for a million people, are you really personalizing?"


The Ethics of Access vs. Standard of Care

The core issue remains the prohibitive cost of brand-name GLP-1s, which often exceed $1,000 per month. While telehealth platforms have undoubtedly increased patient access to weight loss treatments, the quality of medical supervision is frequently compromised. As noted in the study, there is a clear distinction between access and care.

"We should absolutely be increasing access," Chetty concludes. "Prices should be lowering—and they are lowering—but our standards of care shouldn't be." The findings suggest that as long as financial incentives remain tied to the volume of prescriptions written, the oversight of telehealth platforms will continue to be a subject of intense scrutiny.