How the GLP-1 Telehealth Boom Happened
Blockbuster trial results, a $1,000-a-month price wall, and a drug-shortage loophole combined to move some of the most in-demand prescriptions in America onto telehealth websites — until the loophole closed.
In just a few years, drugs designed to treat diabetes and obesity became some of the most sought-after prescriptions in the United States, and a wave of telehealth companies built businesses on getting them to people quickly and cheaply. This is a story about three things colliding: striking clinical trial results, prices most people could not easily afford, and a legal loophole that opened and then closed. Understanding how those pieces fit together explains why "GLP-1" went from a technical term to a household word, and why the way many people obtained these drugs online is now in flux.
The science that lit the fuse
The demand started with data. In the STEP 1 trial, published in 2021, adults with overweight or obesity who took semaglutide 2.4 mg once a week lost an average of 14.9% of their body weight over 68 weeks, compared with 2.4% for those on placebo. In that trial of 1,961 adults, 86% of the semaglutide group lost at least 5% of their body weight. Researchers described it as the first anti-obesity drug to approach the kind of results usually associated with bariatric surgery in a large randomized trial.
A related drug raised the ceiling. In SURMOUNT-1, published in 2022, tirzepatide (which acts on two hormone pathways, GLP-1 and GIP) produced average weight changes of 15.0%, 19.5%, and 20.9% at the 5 mg, 10 mg, and 15 mg doses over 72 weeks, versus 3.1% for placebo, among 2,539 adults with obesity. Then, in 2023, the SELECT trial extended the story beyond weight. Among 17,604 adults who had cardiovascular disease and overweight or obesity but not diabetes, semaglutide 2.4 mg reduced major adverse cardiovascular events to 6.5% versus 8.0% on placebo (hazard ratio 0.80) over a mean follow-up of about 40 months, roughly a 20% relative reduction. That result suggested the drugs could do more than help people lose weight, and demand widened further.
STEP 1 was described as the first anti-obesity drug to approach bariatric-surgery-level results in a large randomized trial.
Mass demand meets a price wall
By 2024, interest had gone mainstream. A nationally representative KFF poll fielded in late April and early May of 2024 found that about 1 in 8 US adults (12%) said they had ever taken a GLP-1 drug, and 6% were currently taking one. Use was far higher among people with specific conditions: 43% of adults with diabetes and 26% with heart disease reported having taken one.
But cost was a wall. In the same poll, roughly half of users (54%) said it was difficult to afford the drugs, with brand list prices cited in the range of about $936 to $1,349 per month. That affordability gap is the hinge of this whole story. When a treatment works well but costs more than $1,000 a month, a large group of motivated patients starts looking for cheaper ways to get it, and that is exactly what happened.
The shortage loophole that powered the boom
Surging demand quickly outstripped supply. Starting in 2022, the FDA placed semaglutide and tirzepatide products on its official drug shortage list. That listing did more than signal scarcity; it opened a legal door. Under Section 503A of the Federal Food, Drug, and Cosmetic Act, pharmacies normally cannot compound (mix or prepare) a drug that is essentially a copy of an FDA-approved product. But the FDA treats a drug on its shortage list as not "commercially available," which lifts that bar. So while semaglutide and tirzepatide sat on the shortage list, compounding pharmacies (503A) and outsourcing facilities (503B) could legally make copies.
That is the engine telehealth platforms ran on. Compounded versions were widely reported to sell for roughly $150 to $300 per month through these platforms, versus brand list prices above $1,000. At the peak of the shortage in 2024, compounded GLP-1s were widely reported to make up on the order of 30% of US GLP-1 supply. Named companies built substantial businesses on this model; Hims & Hers, for example, reported 2024 revenue of about $1.48 billion, up roughly 69% year over year, alongside a growing GLP-1 member base. It is worth being clear that the 30% supply share and the compounded price range are widely reported approximations from trade press and company statements, not a single official government figure. Treat them as directional.
When a treatment works well but costs more than $1,000 a month, a large group of motivated patients starts looking for cheaper ways to get it.
What the low-friction model risked
Cheaper and faster came with real safety questions. In a July 2024 alert, the FDA reported adverse-event reports, some requiring hospitalization, tied to dosing errors with compounded injectable semaglutide. Patients and providers miscalculated conversions between milligrams and units or milliliters, in some cases administering 5 to 10 times, and in reported instances up to 20 times, the intended dose. The FDA has emphasized that compounded GLP-1 products are not FDA-approved, and their quality, safety, and efficacy are not FDA-verified.
A 2026 "secret shopper" study, published in JAMA, gave a sense of how loose online prescribing had become. Researchers tested 49 direct-to-consumer telehealth websites. About 92% (45 of 49) issued a GLP-1 prescription, and roughly 69% (34) mailed the drug, most selling compounded rather than FDA-approved products. The large majority required little or no direct communication with a clinician, and some prescriptions were approved within minutes. The authors said this may increase the risks of medical and financial harm. This was a single audit of 49 selected sites at one point in time, so its percentages describe those sites, not all US telehealth prescribing, and the small numbers should be read as illustrative rather than as population estimates.
The window closes
The legal basis for large-scale compounding depended on the shortages continuing, and they did not last. The FDA declared the tirzepatide shortage resolved on December 19, 2024, and the semaglutide shortage resolved on February 21, 2025. Removing the drugs from the shortage list removed the exception that made copying them legal, and the FDA set deadlines to wind compounding down.
- Tirzepatidecompounding by 503A pharmacies was to stop around February 18-19, 2025, and by 503B outsourcing facilities by March 19, 2025.
- Semaglutidethe 503A deadline was April 22, 2025, and the 503B deadline was May 22, 2025.
The transition has not been tidy. The Outsourcing Facilities Association sued the FDA over the semaglutide decision, and litigation over compounded GLP-1s continued into 2026, meaning the legal status of some compounded activity remained unsettled as of mid-2026. Telehealth companies that had grown quickly on compounded sales flagged revenue headwinds as the window closed. In short, the boom was built on a temporary legal condition; when that condition ended, the model that made these drugs cheap and easy to get online had to change, and where it lands next is still being decided in court and in regulation.
The throughline is straightforward. Powerful clinical results created demand, high prices pushed many patients toward cheaper online options, and a shortage-driven legal exception let telehealth platforms meet that demand at scale, with uneven oversight and documented safety risks along the way. As the exception has closed, the central tension it papered over remains: effective drugs that many people still cannot easily afford.
- 01 STEP 1 trial results for semaglutide 2.4 mg (-14.9% vs -2.4% body weight at 68 weeks).
- 02 Jastreboff AM, Aronne LJ, et al., 'Tirzepatide Once Weekly for the Treatment of Obesity,' N Engl J Med (PubMed record), 2022 pubmed.ncbi.nlm.nih.gov ↗SURMOUNT-1 trial results for tirzepatide; treatment-regimen estimand -15.0%/-19.5%/-20.9% vs -3.1% placebo at 72 weeks.
- 03 SELECT cardiovascular outcomes trial; MACE 6.5% vs 8.0%, HR 0.80, ~20% relative reduction over a mean follow-up of about 40 months.
- 04 Nationally representative poll on GLP-1 use (12% ever/6% now/43% diabetes/26% heart disease), affordability (54%), and list prices ($936-$1,349).
- 05 US FDA, 'FDA clarifies policies for compounders as national GLP-1 supply begins to stabilize,' 2025 fda.gov ↗Shortage-resolution dates and compounding wind-down deadlines; note on Outsourcing Facilities Association litigation.
- 06 US FDA, 'Compounding When Drugs Are on FDA's Drug Shortages List' (Human Drug Compounding), 2024 fda.gov ↗Explains the Section 503A shortage-list exception that allowed compounding of copies.
- 07 July 2024 safety alert on dosing errors (5 to 20 times the intended dose), some requiring hospitalization, with compounded semaglutide.
- 08 Chetty AK, Chen AS, Ross JR, Ramachandran RS, JAMA (via Yale School of Medicine news release), 2026 medicine.yale.edu ↗'Secret shopper' study of 49 direct-to-consumer telehealth sites: 45/49 (92%) prescribed, 34/49 (69%) mailed the drug, mostly compounded.
- 09 Pharmacy Times and trade-press reporting on GLP-1 shortage, compounding, and telehealth economics, 2025 pharmacytimes.com ↗Directional figures on compounded market share (up to ~30%), compounded vs brand pricing ($150-$300 vs $1,000+), and telehealth company revenue.
Wellness Wire Editorial
The Wellness Wire editorial team. Our explainers are researched from primary sources — clinical-trial reports and FDA labeling — and written for general education. They are not individually reviewed by a clinician and are not a substitute for medical advice.
