Within 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, it all hits,” McClain recalled, as she described what occurred that weekend in January. “I can’t keep anything 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 team” consultant confirmed the directions — which stated to inject 2.21 milligrams of the semaglutide treatment as soon as per week — have been right.
It turned out, nonetheless, that was practically 9 instances the quantity sufferers are usually instructed to take for his or her first dose.
Nearly a month after she was recognized with an overdose, McClain stated she was “still dealing with the residual side effects,” together with an elevated coronary heart price and imaginative and prescient issues she felt have been tied to the treatment.
Most sufferers who’ve taken a GLP-1 acquired their prescription via a main care physician or a specialist, KFF polling data reveals. But because the uptake of telehealth has grown considerably for the reason that begin of the covid pandemic, McClain is one among thousands and thousands of Americans who’ve used on-line firms to satisfy quite a lot of their medical wants.
Many of the businesses have began providing GLP-1 drugs for weight reduction as demand for these medication has exploded. But sure treatment errors tied to GLP-1s have exploded too, based on a KFF Health News assessment of Food and Drug Administration knowledge, and physicians and telemedicine researchers fear that adversarial experiences tied to telehealth firms have gotten extra frequent.
Bad outcomes aren’t distinctive to telehealth suppliers or to the compounded weight reduction medication a lot of them supply. In reality, 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 reveals. The drugmakers have defended their merchandise.
However, some critics are additionally involved that getting a weight reduction prescription on-line is often a lot simpler than getting one via 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 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,” stated Elizabeth Krupinski, an experimental psychologist at Emory University who has carried out analysis on the effectiveness of telehealth.
Telemedicine stands to learn “so many people,” Krupinski stated, significantly when the know-how 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.
But some telehealth firms are advertising GLP-1s as a straightforward strategy to shed some pounds — typically with the assistance of paid movie star endorsements — with out emphasizing the significance of wholesome consuming and train, she stated.
They could also be following the letter of the regulation, Krupinski stated. But writing prescriptions whereas skimping on care “is not in the Hippocratic oath.”
McClain says she overdosed on an injectable weight reduction treatment in January after following dosing directions from a telehealth supplier. (Arielle Weenonia Gray for KFF Health News)
The Perfect Storm
Starting 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 individual at the height of covid transmission.
Expanded telehealth entry was additionally supposed to decrease barriers in rural communities, in addition to mitigate physician and nurse shortages. In many locations, telehealth medical doctors and nurses are legally allowed to deal with sufferers throughout state traces. But the best way telemedicine is practiced varies widely, and state legal guidelines largely dictate guidelines that telehealth suppliers should observe.
Some firms, similar to Mochi Health, require sufferers to satisfy nearly with a supplier, similar to a physician, nurse practitioner, or doctor assistant, earlier than they will get a GLP-1 prescription.
But others, together with Ro, typically require nothing extra of sufferers than an “asynchronous” analysis, which doesn’t embrace a dwell dialog with a healthcare supplier. During one of these analysis, clients are usually 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.
“Every patient is counseled by their provider on the potential benefits and risks of treatment based on their individual medical history,” Samonas stated. Ro’s clinicians can order lab work when mandatory and, when applicable, could advocate sufferers search in-person care, he stated.
But some medical consultants are involved that digital care could also be inadequate for prescribing weight reduction medication.
Patients with a historical past of pancreatitis, for instance, must be recommended about potential problems, medical research present. The identical goes for folks with a situation referred to as gastroparesis, which impacts abdomen nerves and muscle tissue, and people prone to medullary thyroid most cancers.
Some sufferers may additionally profit from blood work or muscle mass screening earlier than beginning a GLP-1.
But not all telehealth firms are adequately evaluating sufferers earlier than writing prescriptions, stated Marc-Andre Cornier, an endocrinologist on the Medical University of South Carolina and the fast previous president of The Obesity Society.
When it involves parsing the nice from the dangerous, “whose job is it to police that?” he requested. The downside, 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.
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While the primary GLP-1 was accepted by the FDA greater than 20 years in the past, to deal with Type 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, nearly 1 in 5 adults stated that they had taken a GLP-1.
In a recent paper in The New England Journal of Medicine, 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.
In the paper, Banks referred to as it “troubling” how simple it’s to acquire a prescription for weight reduction medication and apprehensive they could exacerbate current consuming issues or trigger new circumstances, 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 just filling out a form online and then having some random healthcare provider sign off on it,” he stated. “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 Association, which advocates for the enlargement of “digitally enabled care,” has not addressed how telehealth suppliers prescribe GLP-1s, spokesperson Gina Cella stated.
“This 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 lack of readability makes selecting an organization doubtlessly complicated for sufferers, and the medical career is partly responsible, stated Jamy Ard, an weight problems physician and researcher at Wake Forest University School of Medicine in Winston-Salem, North Carolina.
Doctors have traditionally accomplished a foul job counseling sufferers about weight reduction, and many individuals aren’t snug speaking to their main care physician about it, Ard stated. Patients suppose, “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 stated.
This downside, mixed with previous shortages of name-brand variations of GLP-1s, similar to Ozempic, Mounjaro, and Trulicity, has created a “perfect storm” for telehealth firms to flourish, stated Ard, who has acquired assist from pharmaceutical and telehealth firms.
While some telehealth firms prescribe solely name-brand weight reduction medication, 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 medication are generally sourced from abroad suppliers, and the formulations should not reviewed by the FDA for security.
The surroundings is “very much uncontrolled and poorly, if at all, regulated,” Ard stated. “There is just no standard of care.”
Emily Hilliard, a spokesperson for the Department of Health and Human Services, instructed KFF Health News that compounded medication “should only be used in patients whose medical needs cannot be met by an FDA-approved drug.”
Hilliard stated the company urges “consumers to be vigilant and know the source of their medicine.”
Understanding the Risks
While weight reduction medication have helped thousands and thousands of individuals shed some pounds, they’re not with out danger, the info reveals.
A KFF Health News knowledge evaluation of the FDA’s Adverse Event Monitoring System discovered that treatment errors made by suppliers or sufferers with common weight reduction medication exploded from simply over 2,000 experiences in 2020 to over 25,000 in 2025. Those self-reported occasions concerned semaglutide, tirzepatide, dulaglutide, and liraglutide, the generic names for main GLP-1s.
Among frequent points cited within the adversarial occasion experiences have been administration of an additional or incorrect dose, points with communication a couple of product, and prescribing errors.
Since 2019, the National Poison Data System has fielded a nearly 1,500% increase in calls associated to overdoses or negative effects from injectable weight reduction medication. The knowledge 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 into.
Yet knowledge on potential treatment errors and adversarial 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 adversarial occasions to the federal authorities, together with suicidal ideation and loss of life.
Nobody is aware of how typically adversarial occasions happen, stated Kristen Nixon, a Johns Hopkins University researcher who has studied posts about weight reduction medication on Reddit, a preferred on-line discussion board.
Her crew analyzed tons of of Reddit posts from 2020 via final August and recognized frequent mentions of drug reactions and consumer errors, similar to sufferers’ not figuring out the right way to appropriately dose and inject the treatment.
But one other discovering additionally stood out to her.
“Wow, there are a lot of people talking about telehealth,” Nixon recalled pondering. Reddit commenters stated they obtained 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 usually required to counsel sufferers on drugs they obtain. But Nixon’s analysis discovered that telehealth firms typically mail the drugs immediately, which means sufferers don’t have to go to a pharmacy.
“Anecdotally, it seems like the telehealth companies are really facilitating access to compounded medications,” Nixon stated.
A collage of weight reduction drug ads on social media from telehealth firms. In latest months, the Trump administration has despatched warning letters to on-line firms for false or deceptive claims associated to compounded variations of GLP-1 drugs. (Collage by KFF Health News)
Leslie Gammon, 54, an workplace supervisor from Wendell, North Carolina, stated she turned to a telehealth firm referred to as Amble Health 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. But the refill she acquired was a stronger formulation, and the directions instructed Gammon to inject thrice the amount she had been taking in earlier weeks.
Even although she injected barely lower than that really useful quantity earlier than mattress on a Sunday night, she awakened in the midst of the evening “throwing up every 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 reveals.
Amble Health didn’t reply to questions for this text.
The supply system for injectable variations of weight reduction medication is extra difficult than for a capsule. In its National Poison Data System alert, America’s Poison Centers 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 desirous 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 University’s Grossman School of Medicine.
Some telehealth firms aren’t doing sufficient, he stated, to ensure sufferers perceive the dangers or the advanced supply system related to the injectable medication.
“The consent is not adequate,” Caplan stated. “There’s no probing to see if you understood anything.”
Cella, with the American Telemedicine Association, stated the group has not addressed the problem of training sufferers in regards to the dangers of injecting weight reduction medication. But she pointed to the affiliation’s “Principles of Practice,” which states that telehealth enterprise fashions “must put the patient first.”
Proceed With Caution
Pharmaceutical firms should listing doubtlessly dangerous negative effects once they promote the name-brand variations of their FDA-approved drugs. Potential side effects of GLP-1s embrace nausea, vomiting, adjustments in imaginative and prescient, low blood sugar, and, in uncommon circumstances, thyroid most cancers. Meanwhile, telehealth firms haven’t traditionally adopted the identical guidelines that drugmakers have in disclosing treatment dangers in ads. But 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 medication. But for the reason that FDA declared the scarcity over final yr, firms that provide compounded medication are more and more going through authorized and regulatory challenges associated to their advertising techniques.
Mounjaro producer Eli Lilly and different drugmakers are suing a number of telehealth firms for selling compounded variations of their medication. In one authorized criticism, Eli Lilly alleged Mochi Health had engaged in “deceptive” enterprise techniques. In a movement to dismiss the lawsuit final yr, attorneys for Mochi Health referred to 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 stated in a written remark that telehealth firms 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.”
Meanwhile, Novo Nordisk has filed 130 lawsuits in opposition to “entities engaged in unlawful marketing and sale of knockoff semaglutide drugs,” stated Liz Skrbkova, a spokesperson for the drugmaker.
She stated 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 firms similar to Hims & Hers, SkinnyRx, Join Josie, and Genesis Health International. The FDA stated these and different firms 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 Center for Drug Evaluation and Research wrote to Hims & Hers on Sept. 9. HHS later referred the corporate to the Department of Justice after it introduced the launch of a $49 model of Novo Nordisk’s Wegovy capsule.
When requested in regards to the FDA warning, Abby Reisinger-Moley, a spokesperson for Hims & Hers, pointed to a March statement from the company saying a shift away from compounded weight reduction medication. The firm stated within the press launch that it had entered into an settlement with Novo Nordisk to promote name-brand variations.
Alex Smith, CEO of Join Josie, a web-based platform that helps ladies in menopause shed some pounds by prescribing GLP-1s, stated his firm additionally made adjustments in response to an FDA letter, to incorporate eradicating Join Josie’s identify from treatment vials. “Which I agree with,” Smith stated, “because you don’t want patients thinking you’re the compounding pharmacy.”
SkinnyRx and Genesis Health International didn’t reply to requests for remark.
But 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, govt director of the Center for Connected Health Policy.
Prior circumstances concerned attention-deficit/hyperactivity dysfunction drugs and different managed substances prescribed by telehealth suppliers, she stated. While these medication pose extra danger 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.
“Always approach anything on the internet with a hint of skepticism,” Kwong stated.
McClain was admitted to the hospital after injecting practically 9 instances the quantity of semaglutide that sufferers usually take as a primary dose of the favored weight reduction drug. That’s what her prescription from a telehealth supplier had dictated. (Arielle Weenonia Gray for KFF Health News)
‘Keeps Getting Worse’
McClain, the Tennessee girl hospitalized this yr 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.
At the time, the treatment was lined by her medical 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 get monetary savings by acquiring a less expensive, compounded GLP-1, McClain signed up for Mochi Health after doing her personal analysis. “That was just the most affordable option,” she stated.
But inside hours of her first dose, she stated, she discovered herself on the telephone with poison management.
After her overdose, McClain stated, she spoke to a scientific director at Mochi Health, as soon as by telephone however principally by way of e mail, about her lingering signs earlier than communication paused.
David Pilip, a spokesperson for Mochi Health, stated in an announcement that the corporate wouldn’t focus on particular person sufferers attributable to privateness obligations. But he stated adversarial 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 at the 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 in opposition to the corporate. Her expertise, she stated, “just keeps getting worse.”
NBC News producer Jessica Herzberg and KFF Health News senior correspondent Fred Schulte contributed to this report.
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