Inside 24 hours of injecting the primary dose of a weight reduction medicine she acquired following a go to with a telehealth physician, Karleigh McClain was admitted to the hospital, she mentioned.
The 31-year-old compliance guide from Hendersonville, Tennessee, mentioned she couldn’t cease vomiting.
“Sunday morning, it all hits,” McClain recalled, as she described what occurred that weekend in January. “I can’t keep anything down.”
McClain mentioned 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 mentioned she known as the corporate and a “care team” consultant confirmed the directions — which mentioned to inject 2.21 milligrams of the semaglutide medicine as soon as every week — had been right.
It turned out, nevertheless, that was practically 9 instances the quantity sufferers are sometimes advised to take for his or her first dose.
Almost a month after she was recognized with an overdose, McClain mentioned she was “still dealing with the residual side effects,” together with an elevated coronary heart fee and imaginative and prescient issues she felt had been tied to the medicine.
Most sufferers who’ve taken a GLP-1 acquired their prescription via a main care physician or a specialist, KFF polling knowledge exhibits. However because the uptake of telehealth has grown considerably because the begin of the covid pandemic, McClain is one among tens of millions of People who’ve used on-line corporations to satisfy quite a lot of their medical wants.
Lots of the corporations have began providing GLP-1 drugs for weight reduction as demand for these medication has exploded. However sure medicine errors tied to GLP-1s have exploded too, based on a KFF Well being Information overview of Meals and Drug Administration knowledge, and physicians and telemedicine researchers fear that opposed experiences tied to telehealth corporations have gotten extra widespread.
Unhealthy outcomes aren’t distinctive to telehealth suppliers or to the compounded weight reduction medication lots of them supply. In truth, product legal responsibility lawsuits alleging affected person accidents have been filed overwhelmingly in opposition to pharmaceutical giants Eli Lilly and Novo Nordisk, which manufacture name-brand weight reduction medication, court docket knowledge exhibits. The drugmakers have defended their merchandise.
Nonetheless, some critics are additionally involved that getting a weight reduction prescription on-line is normally a lot simpler than getting one via an in-person appointment. Not solely do many telehealth corporations write fast prescriptions for GLP-1s, however they usually promote the drugs, too, permitting sufferers to bypass in-person pharmacy visits. This one-stop purchasing isn’t essentially a great factor, based on 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 gives a black eye to telemedicine,” mentioned Elizabeth Krupinski, an experimental psychologist at Emory College who has carried out analysis on the effectiveness of telehealth.
Telemedicine stands to learn “so many people,” Krupinski mentioned, notably when the expertise is built-in inside a bigger healthcare system. That approach, sufferers profit from the comfort of telehealth whereas sustaining a reference to their in-person suppliers.
However some telehealth corporations are advertising and marketing GLP-1s as a straightforward solution to shed pounds — generally with the assistance of paid superstar endorsements — with out emphasizing the significance of wholesome consuming and train, she mentioned.
They could be following the letter of the legislation, Krupinski mentioned. However writing prescriptions whereas skimping on care “is not in the Hippocratic oath.”
The Excellent Storm
Beginning round 2020, many states loosened restrictions on telehealth, which allowed on-line corporations to proliferate. This helped accommodate sufferers who couldn’t, or selected to not, be seen in individual at the peak of covid transmission.
Expanded telehealth entry was additionally supposed to decrease limitations 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 traces. However the best way telemedicine is practiced varies extensively, and state legal guidelines largely dictate guidelines that telehealth suppliers should comply with.
Some corporations, corresponding to Mochi Well being, require sufferers to satisfy just about with a supplier, corresponding 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 embody a dwell dialog with a healthcare supplier. Throughout this sort of analysis, prospects 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 legislation, or when requested by a affected person or clinician, mentioned Nicholas Samonas, a spokesperson for the corporate.
“Every patient is counseled by their provider on the potential benefits and risks of treatment based on their individual medical history,” Samonas mentioned. Ro’s clinicians can order lab work when vital and, when applicable, might advocate sufferers search in-person care, he mentioned.
However some medical specialists are involved that digital care could also be inadequate for prescribing weight reduction medication.
Sufferers with a historical past of pancreatitis, for instance, must be recommended about potential issues, medical research present. The identical goes for folks with a situation known as gastroparesis, which impacts abdomen nerves and muscle tissue, and people inclined to medullary thyroid most cancers.
Some sufferers may profit from blood work or muscle mass screening earlier than beginning a GLP-1.
However not all telehealth corporations are adequately evaluating sufferers earlier than writing prescriptions, mentioned Marc-Andre Cornier, an endocrinologist on the Medical College of South Carolina and the rapid previous president of The Weight problems Society.
In terms of parsing the great from the dangerous, “whose job is it to police that?” he requested. The issue, he mentioned, 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 accredited by the FDA greater than 20 years in the past, to deal with Kind 2 diabetes, using these medication took off in 2021 when Novo Nordisk acquired approval for a semaglutide drug to deal with weight problems, with the model identify Wegovy. In a 2025 KFF ballot, practically 1 in 5 adults mentioned 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 chubby elevated from 4.5% in 2018 to 17% in 2023.
Within the paper, Banks known as it “troubling” how straightforward it’s to acquire a prescription for weight reduction medication and nervous they may exacerbate present consuming issues or trigger new circumstances, together with of anorexia.
Cornier, who has acquired compensation from Novo Nordisk for serving as a guide, echoed a few of Banks’ considerations. “It’s not just filling out a form online and then having some random healthcare provider sign off on it,” he mentioned. “There are concerns with some of these online programs that there’s not a proper evaluation, there’s not a baseline, and there’s not proper supervision.”
The American Telemedicine Affiliation, which advocates for the growth of “digitally enabled care,” has not addressed how telehealth suppliers prescribe GLP-1s, spokesperson Gina Cella mentioned.
“This is a bit out of our scope,” Cella mentioned, when requested if the affiliation had addressed the subject of telehealth suppliers and GLP-1 prescriptions.
The dearth of readability makes selecting an organization doubtlessly complicated for sufferers, and the medical occupation is partly in charge, mentioned Jamy Ard, an weight problems physician and researcher at Wake Forest College Faculty of Medication in Winston-Salem, North Carolina.
Docs have traditionally achieved a foul job counseling sufferers about weight reduction, and many individuals aren’t snug speaking to their main care physician about it, Ard mentioned. Sufferers assume, “Why would I go to my doctor and have them say, ‘Eat less and move more,’ when I have heard that a million times and I don’t want to have that lecture again?” Ard mentioned.
This drawback, mixed with previous shortages of name-brand variations of GLP-1s, corresponding to Ozempic, Mounjaro, and Trulicity, has created a “perfect storm” for telehealth corporations to flourish, mentioned Ard, who has acquired assist from pharmaceutical and telehealth corporations.
Whereas some telehealth corporations prescribe solely name-brand weight reduction medication, many additionally supply cheaper, compounded variations. They act as intermediaries between prospects and mail-order compounding pharmacies, which create GLP-1s by mixing energetic components, corresponding to semaglutide, with components. The components for compounded medication are generally sourced from abroad suppliers, and the formulations usually are not reviewed by the FDA for security.
The atmosphere is “very much uncontrolled and poorly, if at all, regulated,” Ard mentioned. “There is just no standard of care.”
Emily Hilliard, a spokesperson for the Division of Well being and Human Companies, advised KFF Well being Information that compounded medication “should only be used in patients whose medical needs cannot be met by an FDA-approved drug.”
Hilliard mentioned the company urges “consumers to be vigilant and know the source of their medicine.”
Understanding the Dangers
Whereas weight reduction medication have helped tens of millions of individuals shed pounds, they’re not with out danger, the information exhibits.
A KFF Well being Information knowledge evaluation of the FDA’s Adversarial Occasion Monitoring System discovered that medicine errors made by suppliers or sufferers with standard weight reduction medication exploded from simply over 2,000 studies 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 opposed occasion studies had been administration of an additional or incorrect dose, points with communication a few product, and prescribing errors.
Since 2019, the Nationwide Poison Knowledge System has fielded a practically 1,500% improve in calls associated to overdoses or unwanted effects from injectable weight reduction medication. The information 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 medication have turn out to be.
But knowledge on potential medicine errors and opposed 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 opposed occasions to the federal authorities, together with suicidal ideation and demise.
No one is aware of how usually opposed occasions happen, mentioned Kristen Nixon, a Johns Hopkins College researcher who has studied posts about weight reduction medication on Reddit, a well-liked on-line discussion board.
Her crew analyzed a whole bunch of Reddit posts from 2020 via final August and recognized frequent mentions of drug reactions and person errors, corresponding to sufferers’ not figuring out the way to accurately dose and inject the medicine.
However one other discovering additionally stood out to her.
“Wow, there are a lot of people talking about telehealth,” Nixon recalled pondering. Reddit commenters mentioned they acquired GLP-1 prescriptions from scores of telehealth platforms, Nixon discovered. Commenters additionally talked about a number of dozen compounding pharmacies — usually in the identical posts about telehealth.
Pharmacies are sometimes required to counsel sufferers on drugs they obtain. However Nixon’s analysis discovered that telehealth corporations usually mail the drugs immediately, that means sufferers don’t must go to a pharmacy.
“Anecdotally, it seems like the telehealth companies are really facilitating access to compounded medications,” Nixon mentioned.
Leslie Gammon, 54, an workplace supervisor from Wendell, North Carolina, mentioned she turned to a telehealth firm known as Amble Well being for a weight reduction drug prescription. She was given a GLP-1 after filling out a web based kind, she mentioned.
Like McClain, when she acquired her mail-order compounded medicine 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 quantity she had been taking in earlier weeks.
Although she injected barely lower than that beneficial quantity earlier than mattress on a Sunday night, she awoke in the midst of the night time “throwing up every 20 to 25 minutes,” she mentioned. 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 medication is extra sophisticated than for a tablet. In its Nationwide Poison Knowledge System alert, America’s Poison Facilities famous that some folks reported “accidentally taking 10-times the recommended dose due to confusing measurement units while using a syringe.”
And people who find themselves desperate to lose further weight — earlier than a marriage or a trip, for instance — might select to self-administer a higher-than-recommended dose, mentioned Arthur Caplan, a bioethics professor at New York College’s Grossman Faculty of Medication.
Some telehealth corporations aren’t doing sufficient, he mentioned, to verify sufferers perceive the dangers or the advanced supply system related to the injectable medication.
“The consent is not adequate,” Caplan mentioned. “There’s no probing to see if you understood anything.”
Cella, with the American Telemedicine Affiliation, mentioned the group has not addressed the issue of training sufferers in regards to the dangers of injecting weight reduction medication. However she pointed to the affiliation’s “Principles of Practice,” which states that telehealth enterprise fashions “must put the patient first.”
Proceed With Warning
Pharmaceutical corporations should checklist doubtlessly dangerous unwanted effects after they promote the name-brand variations of their FDA-approved drugs. Potential unwanted effects of GLP-1s embody nausea, vomiting, modifications in imaginative and prescient, low blood sugar, and, in uncommon circumstances, thyroid most cancers. In the meantime, telehealth corporations haven’t traditionally adopted the identical guidelines that drugmakers have in disclosing medicine dangers in commercials. However the FDA has began cracking down on deceptive drug advertisements.
A nationwide scarcity of weight reduction drugs in 2022 opened the door for compounding pharmacies to fabricate these medication. However because the FDA declared the scarcity over final yr, corporations that provide compounded medication are more and more dealing with authorized and regulatory challenges associated to their advertising and marketing ways.
Mounjaro producer Eli Lilly and different drugmakers are suing a number of telehealth corporations for selling compounded variations of their medication. In a single authorized criticism, Eli Lilly alleged Mochi Well being had engaged in “deceptive” enterprise ways. In a movement to dismiss the lawsuit final yr, legal professionals for Mochi Well being known as the criticism a part of a “nationwide campaign to bolster Lilly’s profits by dictating patient care through the elimination of compounded drugs as a treatment option for weight management.” The lawsuit is ongoing.
Eli Lilly spokesperson Michael Jamison mentioned in a written remark that telehealth corporations sued by the drug producer threaten “patient safety by falsely promoting supposedly ‘personalized’ compounded tirzepatide” and mislead “consumers about the safety, clinical testing, and effectiveness of their compounded knockoffs.”
In the meantime, Novo Nordisk has filed 130 lawsuits in opposition to “entities engaged in unlawful marketing and sale of knockoff semaglutide drugs,” mentioned Liz Skrbkova, a spokesperson for the drugmaker.
She mentioned the corporate is dedicated to “protecting patients from unapproved knockoff drugs made with foreign, inauthentic active pharmaceutical ingredients that pose significant safety and efficacy risks.”
The Trump administration despatched a flurry of warning letters in September and February to on-line corporations corresponding to Hims & Hers, SkinnyRx, Be part of Josie, and Genesis Well being Worldwide. The FDA mentioned these and different corporations had made false or deceptive claims associated to compounded variations of weight reduction medication.
“Your claims imply that your products are the same as an FDA-approved product when they are not,” 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 medication. The corporate mentioned within the press launch that it had entered into an settlement with Novo Nordisk to promote name-brand variations.
Alex Smith, CEO of Be part of Josie, a web based platform that helps girls in menopause shed pounds by prescribing GLP-1s, mentioned his firm additionally made modifications in response to an FDA letter, to incorporate eradicating Be part of Josie’s identify from medicine vials. “Which I agree with,” Smith mentioned, “because you don’t want patients thinking 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, mentioned Mei Wa Kwong, government director of the Middle for Linked Well being Coverage.
Prior circumstances concerned attention-deficit/hyperactivity dysfunction drugs and different managed substances prescribed by telehealth suppliers, she mentioned. Whereas these medication pose extra danger to sufferers than GLP-1s, the businesses had been additionally accused of improperly screening potential prospects.
The onus nonetheless falls on customers to analysis corporations earlier than signing up for his or her providers, Kwong mentioned.
“Always approach anything on the internet with a hint of skepticism,” Kwong mentioned.
‘Keeps Getting Worse’
McClain, the Tennessee girl hospitalized this yr after a GLP-1 overdose, mentioned she misplaced 50 kilos a couple of years in the past by taking a name-brand GLP-1 prescribed by her physician.
On the time, the medicine was lined by her medical health insurance. This yr, when she was able to take a GLP-1 once more following a being pregnant, the drug was now not lined 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 just the most affordable option,” she mentioned.
However inside hours of her first dose, she mentioned, she discovered herself on the telephone with poison management.
After her overdose, McClain mentioned, she spoke to a scientific director at Mochi Well being, as soon as by telephone however largely by way of e mail, about her lingering signs earlier than communication paused.
David Pilip, a spokesperson for Mochi Well being, mentioned in a press release that the corporate wouldn’t talk about particular person sufferers attributable to privateness obligations. However he mentioned opposed occasions are “immediately flagged” and “investigated with extreme precision.”
“Mochi Health takes patient safety extremely seriously,” Pilip wrote in an e mail. “We promptly initiated a review and have been in direct and ongoing communication with the patient to reach a resolution. We remain committed to doing so.”
McClain anticipates her healthcare payments associated to the hospital keep will complete no less than $900. She mentioned 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 received’t take authorized motion in opposition to the corporate. Her expertise, she mentioned, “just keeps getting worse.”
NBC Information producer Jessica Herzberg and KFF Well being Information senior correspondent Fred Schulte contributed to this report.
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