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Understanding GLP-1 Agonists: The ‘Weight Loss’ Drugs Taking the World by Storm
What were once drugs intended for type 2 diabetes, GLP-1 agonists have exploded in popularity due to their secondary function to help lose weight. However, while there are currently 10 GLP-1 agonist drugs on the market, only three of these are FDA approved for the treatment of obesity.
“The weight loss benefits of GLP-1 seem to be what’s driving popularity,” said Kelly Riedl, PA-C, CPHRM, Senior Risk Management Consultant, ProAssurance. “However, because of that popularity we’ve seen supply not being able to keep up with demand, leading to drug shortages.”
Shortages further drive off-label prescribing and have led patients to seek alternative sources, through the web or from compounding pharmacies.
Off-label use of drugs, such as those that are compounded, can play an important role for patients. But it’s important to also note that compounded GLP-1 drugs are not
FDA approved, and thus have not undergone the same testing for safety or quality.
Prescribers and patients alike must better understand the environment surrounding GLP-1 drugs so that they can further increase patient safety and decrease potential liability.
Is That Web Pharmacy Even Legal?

Kelly Riedl, PA-C, CPHRM, Senior Risk Management Consultant, ProAssurance
While compounding pharmacies do have their place, that doesn’t necessarily mean all pharmacies on the web are operating legally.
According to the National Association of Boards of Pharmacy (NABP), more than 40,000 online pharmacies are operating illegally and in a way they would not recommend to patients.
“There are still some legitimate pharmacies operating online, but according to NABP’s estimates, it’s around 5%,” Riedl said.
“The good news is that an online search tool exists within NABP, which allows consumers to see whether a pharmacy meets patient safety or practice standards, adding a layer of safety when someone is looking for a drug,” she added.
However, online pharmacies are constantly popping up. JAMA reported last August that, looking specifically at GLP-1 drugs, more than 300 online pharmacies were advertising access to these drugs without a prescription.
“As it turns out, about 42% were linked to illegal pharmacy operations,” Riedl said.
When it comes to patient safety and other liability risks, illegal operations such as these will leave a gaping hole in risk mitigation. It’s important that when online shopping, offerings are scrutinized to avoid potential risk.
Lawsuits Around GLP-1 Drug Prescriptions
Looking at GLP-1s, it’s important to remember these drugs were originally created to treat type 2 diabetes. The same active ingredient subsequently has been shown to contribute to weight loss, and over time we have seen the FDA approval of certain GLP-1s specifically for weight loss. Many consumers have lauded the drugs for the secondary effect, and companies have begun compounding formulations that are not FDA approved and then promoting these as effective weight loss solutions.
However, GLP-1 agonists still have side effects.
“There have been several lawsuits alleging manufacturers of these medications have downplayed the risks of side effects, which can include gastrointestinal issues like gastroparesis,” Riedl said.
“Plaintiffs in these cases argue that companies promote these drugs as effective weight loss solutions without sufficiently informing or warning consumers and healthcare providers about the risks of serious and sometimes debilitating side effects,” she explained.
Manufacturers are also alleging unlawful marketing and sales of these drugs, taking aim at medical spas, weight loss clinics and other similar establishments. These lawsuits often focus on alleged false claims around FDA approval.
“The lawsuits coming from the manufacturers seem to be in an attempt to improve patient safety,” Reidl noted.
That said, sometimes this can lead to product liability claims, leading back to the prescriber: “The manufacturers will say, ‘well, no, we sufficiently put all the warnings on the label,’ meaning the duty to warn the patient falls back on the prescriber.”
It is doubly important, then, for prescribers to understand the nuances of GLP-1s, to know where their patients are getting the drugs they prescribe, and to communicate pertinent information around them.
Two Views: The Clinical and Consumer Standpoints
Reidl said that when it comes to GLP-1 agonist drugs, there are two main views to take.
“From a clinical standpoint, and as a clinician, we have to think about these drugs just like any other we might prescribe,” she said.
That means, no matter the drug being prescribed, the basic knowledge to ensure safe prescribing must exist. Not everyone is a good candidate for a drug, and there will always be risks and benefits to consider in a prescription decision.
“That’s why it’s important for patients to have a discussion with their provider about the risks, the benefits, and the alternatives. Side effects should be made known, especially the more troubling ones like gastroparesis,” said Riedl.
Looking at GLP-1s from the consumer standpoint, Riedl said drug shortages, cost, and convenience likely impact decision-making.
“There may even be a lack of communication between patient and provider due to the stigma around asking for help with weight loss,” she posited.
Cost and convenience drive consumers to look elsewhere for the promised effect of weight loss, meaning many will turn to the internet or other compounding pharmacies for these drugs.
But as noted, not all pharmacies are operating legally, and not all may disclose possible side effects. Convenient though it may be, online prescribing can put patients at serious risk.
To mitigate these risks, Riedl suggested clinicians work toward better communication, patient education, and a shared decision-making strategy.
This all starts, she said, by acknowledging that patients are seeing GLP-1 ads: “We need to make the assumption that patients are seeing these ads. They know they have the ability to acquire GLP-1s without a prescription, online, and with the convenience of them coming right to their homes,” Riedl said.
Once prescribers acknowledge that the ads are there, they can begin to educate patients on the true risks of non-FDA approved versions and “hopefully steer them away from making unsafe choices,” Riedl said.
Effective communication, she concluded, will be the crux of lowering potential risks for patients.
A GLP-1 Partner for Providers
Understanding the environment around GLP-1 agonist drugs starts with having the right team. Prescribers will want to stay up to date on the latest happenings around GLP-1s, including how they are being marketed to their patients, in order to provide accurate information and promote effective decision-making around these drugs.
No prescriber wants to place a patient in danger. They also do not want to omit vital information that can lead to unsafe decision-making.
ProAssurance, with its extensive expertise in healthcare professional liability, has kept a pulse on GLP-1s. The team has numerous publications and resources on off-label prescribing, including reports and videos, as well as informed consent sample forms. Some of these resources offer Continuing Medical Education (CME) credits to insureds. Prescribers have the information they need to better educate patients, right at their fingertips.
The Risk Management team at ProAssurance has received questions from underwriters about risks when physicians are contemplating dispensing compounded weight loss drugs as an added offering to their patients. They have also received questions from their insureds wanting to better understand the risks of prescribing these drugs off label during times when the drugs were in shorter supply.
“We’re looking at it holistically to determine the best way to approach it, especially in the interest of patient safety, and how we can best support our insureds. We want to ensure all opportunities to educate patients on these drugs are taken. Unsafely sourcing these drugs can lead to extreme consequences—for prescriber and patient alike,” said Riedl.
“We want everyone involved to have the information they need to avoid risks and other pain points, while still receiving proper care.
To learn more, visit: https://riskmanagement.proassurance.com.
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with ProAssurance. The editorial staff of Risk & Insurance had no role in its preparation.