As demand remains high for GLP-1 drugs, primary care physicians are concerned about the risks of patients using third-party telehealth prescribers to get their hands on these medications, a new survey found.
One in eight Americans have used a GLP-1, according to data from KFF back in May.
Public awareness of GLP-1 drugs has increased in the past year, with about one-third (32%) of adults now saying they have heard “a lot” about these drugs, up from 19% in July 2023. Most adults who have taken GLP-1 drugs say they took them to treat a chronic condition including diabetes or heart disease (62%), while about four in ten say they took them primarily to lose weight, the KFF survey found.
Researchers estimate that more than 137 million U.S. adults are eligible for semaglutide, mainly for weight loss, diabetes, or cardiovascular prevention, according to study published in JAMA Cardiology.
As demand soars, there's been a sharp increase in third-party telehealth providers offering GLP-1 prescriptions to patients. A STAT investigation identified more than 100 telehealth sites marketing GLP-1 medications such as semaglutide and tirzepatide. But, just a handful of networks of doctors, nurse practitioners and physician assistants are writing the prescriptions, STAT reported.
A Sermo survey of 2,000 primary care physicians conducted in January found that two-thirds of PCPs (67%) said the are concerned about the potential health risks if their patients access GLP-1 prescriptions for weight loss through a third-party telehealth company.
The survey defined third-party telehealth prescribers as those who prescribe GLP/GIPs for weight loss to patients who may be under the care of a different traditional primary care physician who is not otherwise part of their practice and is distinct from specialists in their system’s network.
Few respondents (18%) said they were comfortable with their patients using third-party telehealth prescribers for GLP-1 weight loss treatment and more than half (57%) said that they caution their patients against accessing GLP-1s for weight loss through these services.
The survey findings were released by Omada Health, a digital health company that targets chronic disease management.
Primary care physicians are mainly concerned about overprescribing or clinically inappropriate prescribing, cited by 56% of doctors, and continuity of care such as follow-up visits, titration, and/or tapering off the medication, cited by half of physicians.
Physicians also believe compounded GLP-1 medications are less regulated, less consistent and less safe than branded medications, according to the survey findings. Of the surveyed physicians, 42% reported that they advise their patients against using compounded GLP-1s for weight loss.
Compounded semaglutide injections have the same active ingredient as the buzzy branded weight loss drugs but are not required to go through the Food and Drug Administration's rigorous approval process.
Because compounded medications are not FDA-approved, they do not carry standardized FDA-required labeling, including side-effect warnings, boxed warnings, or risk evaluation and mitigation strategies (REMS) that apply to approved drugs. However, they are still subject to state board of pharmacy oversight and must comply with USP compounding standards and Sections 503A and 503B of the Federal Food, Drug, and Cosmetic Act, according to The Alliance for Pharmacy Compounding.
A majority of primary care doctors also believe GLP-1s need to be paired with changes in diet and exercise to be effective in driving healthy weight loss. Slightly more than half (53%) said they require patients to try non-pharmacological approaches before prescribing GLP-1/GIPs.
PCPs estimated that nearly 30% of their patients have requested GLP-1 prescriptions for weight loss. On average, physicians reported approving more than half of these requests (53%), with approvals more frequently granted to patients with cardiometabolic comorbidities (75%) or diabetes (79%).
Omada Health offers virtual chronic care for diabetes, hypertension, prediabetes, and musculoskeletal issues. The company works with more than 2,000 organizations including health plans, health systems and employers.
Omada doesn't prescribe weight loss medications, but it offers a weight health program to provide support and wraparound services to health plan members and employees who are taking GLP-1 medications.
"We made the decision not to prescribe GLP-1 medications early on because we believe that we are best positioned to serve as the behavior-change companion that health plans, PBMs, and large self-insured employers look to for GLP-1 companion care support for users throughout their journey," Wei-Li Shao, president of Omada Health told Fierce Healthcare. "Ultimately, we believe that the decision to start, stop, or continue a GLP-1 should be made in the medical home -- between the patient and their primary care physician."
Shao said Omada Health's role as an "in-between-visit healthcare provider" supplements the existing healthcare system rather than replace it.
As employers and health plans grapple with how to address the ongoing demand for GLP-1 weight loss drugs, it opens up opportunities for digital health companies to offer up weight management programs geared toward individuals on GLP-1s. The programs often focus on lifestyle change include coaching, nutrition/diet and exercise support.
A recent analysis from Omada Health suggests that it is possible for individuals to maintain the weight loss after discontinuing GLP-1s by implementing lifestyle modification strategies that include diet, exercise, sleep and stress management. Omada members, on average, experienced virtually no weight gain 16 weeks after discontinuing a GLP-1 compared to an average of 6% to 7% weight gain estimated from trial data, according to the company's analysis.
A number of digital health companies, including Ro, Noom, 23andMe, WeightWatchers, Calibrate, Sesame and Hims & Hers along with telehealth giant Teladoc, have launched weight loss programs to support the management of GLP-1s or now offer access to obesity medications.
Some of these companies are offering consumers access to compounded semaglutide as part of a subscription service.
There is growing interest in compounded GLP-1 medications as a more affordable alternative, but these drugs are under increased scrutiny due to safety concerns and questions over how they are marketed.
Hims & Hers has found itself in hot water after its controversial Super Bowl ad, which featured a montage of junk food, abdominal fat, statistics about the health risks of obesity and big pharma's high prices. The ad then promotes Hims & Hers' weight loss products, including compounded GLP-1 medications, as an alternative to pricey branded GLP-1s such as Ozempic and Wegovy.
The pharma industry and two lawmakers called the company out for "deceptive" advertising and for perpetuating a stigma on obesity.
Hims & Hers, through a spokesperson, said the company complies with existing laws and noted that compounding is explicitly permitted by the FDA and has been done safely with a high level of oversight from the FDA for decades.