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Digital EditionWhy the GLP-1 Boom Has a Litigation Wave Right Behind It
GLP-1 receptor agonist medications have become one of the most widely prescribed drug classes in modern medicine. Originally developed for managing Type 2 diabetes, drugs like semaglutide and tirzepatide have exploded in popularity as weight-loss treatments, fueling a market that analysts project will reach tens of billions of dollars in the coming years. Patients are accessing these medications through traditional physician offices, hospital-affiliated weight reduction centers, compounding pharmacies, and a rapidly expanding universe of online prescribing platforms.
The results, in many cases, have been remarkable. Patients are losing significant amounts of weight. Some are coming off insulin entirely because their diabetes has effectively reversed. But the sheer scale and speed of adoption — combined with gaps in oversight, patient screening, and long-term monitoring — is creating conditions that risk management professionals recognize all too well: the precursors to a wave of litigation.
“There isn’t a great deal of information specifically for physicians yet,” said Anne Marie Lyddy, MHA, CPHRM, Senior Risk Management Consultant at ProAssurance, when asked about current GLP-1 litigation trends.
“But I looked at the key risk management areas for health care professionals that include GLP-1s because it’s going to come. And when it does come, those are the areas that we’d love for physicians to know about now.”
A Perfect Storm of Risk Factors
Anne Marie Lyddy, MHA, CPHRM, Senior Risk Management Consultant, ProAssurance
Lyddy’s concern is grounded in a convergence of factors that are difficult to ignore. The first is the proliferation of compounded medications and counterfeit products. The FDA has raised alarms about unauthorized and improperly compounded GLP-1 formulations that may contain incorrect ingredients or dosages, creating direct pathways to patient harm.
“That’s the area the FDA has raised concerns about because of the widespread use — unauthorized use, improperly compounded medications, and where patient harm could come into play,” Lyddy said.
Beyond compounding concerns, adverse events are becoming more visible. Gastrointestinal complications and other serious events are on the rise. One of the earliest red flags involved anesthesia. Because GLP-1 medications slow gastric emptying, patients on these drugs experienced delayed or inadequate effects from anesthesia — a potentially dangerous situation during surgery.
“The first call I ever got — which was about two and a half years ago — was from an anesthesiologist in the Bay Area who had read an article that patients on GLP-1 medication experienced delayed gastric emptying which increased their risk of aspiration,” Lyddy said. “At that point, we hadn’t heard anything. That question was the first we’d heard. Now it’s very well known that this is an area of concern.”
Today, physicians routinely ask surgical patients whether they are taking a GLP-1 medication. Those who are may need to discontinue the drug before a procedure or fast for extended periods, and anesthesiologists must adjust their protocols accordingly. The consequences of failing to do so range from patients requiring higher doses of anesthesia — which carries its own complications — to patients waking up during surgery.
Dosing errors represent another documented risk. Lyddy pointed to reported cases in which patients received incorrect doses due to confusion between milligrams and milliliters, resulting in overdoses. “This is something the drug information groups are particularly worried about,” she said.
Then there is the question of who is prescribing, and to whom. The explosion of online GLP-1 prescribing platforms has created an environment in which physicians may never physically see — or even speak with — their patients. Instead, they review basic online intake forms and rely on patients to self-report their weight, height, and medical history.
“Physicians are ultimately on the hook because they’re the ones prescribing these medications, and they may never have even set sight on their patient,” Lyddy said. “Those are probably the companies that people looking to abuse something will gravitate toward — wherever the focus or oversight is the least.”
The potential for abuse is particularly acute among patients with a history of eating disorders such as anorexia or bulimia, a population more prone to misusing appetite-suppressing medications. And liability does not stop with the prescribing physician. The corporate entities behind online clinics, compounding pharmacies, and other organizations involved in the dispensing chain could all face exposure.
“Physicians are certainly at risk. The companies that employ the physicians and create the opportunity for patients to sign up — the corporate entities behind the clinics — are also liable,” Lyddy said. “Compounding pharmacies are another group that could be on the hook. And who’s really monitoring them?”
There are also longer-term clinical risks that are only beginning to come into focus. Patients who discontinue GLP-1 medications frequently experience significant weight regain, raising questions about whether adequate long-term management plans are in place. Additionally, GLP-1 medications can cause loss of muscle mass along with fat — a side effect that requires proactive monitoring and dietary guidance that may not always be provided.
“Along with fat, it doesn’t discriminate,” Lyddy said. “When people stop eating, yes, fat first, but then muscle mass loss happens, and that can be significant for patients.”
How Physicians and Health Systems Can Get Ahead of the Risk
While the litigation landscape is still developing, Lyddy emphasized that the time for preparation is now — not after claims begin to mount. She outlined several critical areas where physicians and health systems should focus their risk mitigation efforts.
Rigorous patient selection. Not every patient is an appropriate candidate for GLP-1 therapy, regardless of demand. Physicians must conduct thorough screenings that account for contraindications including a history of pancreatitis, thyroid cancer, and eating disorders. The temptation to prescribe broadly — particularly when GLP-1 services offer an attractive income stream — must be tempered by sound clinical judgment.
“A lot of people are using it for cosmetic purposes. So physicians really need to do their homework and avoid prescribing for high-risk patients,” Lyddy said. She drew a parallel to earlier trends in which physicians, facing financial pressure, added cosmetic surgery or other services to boost revenue
Ongoing patient monitoring. Prescribing the medication is only the beginning. Physicians must have systems in place for tracking patients over time — monitoring for adverse effects, assessing muscle mass changes, evaluating dietary habits, and managing the rebound weight gain that frequently occurs when patients stop the drug.
Thorough patient education. Patients must understand the risks inherent in GLP-1 therapy, including the effects on anesthesia, the potential for muscle mass loss, the likelihood of weight regain upon discontinuation, and the importance of honest self-reporting. Informed consent is not just good medicine — it is a critical layer of legal protection.
Due diligence on business partnerships. For physicians considering affiliations with online prescribing platforms or other GLP-1-focused businesses, Lyddy urged careful vetting before signing any contracts. “They really, really have to ask questions upfront before they sign on the dotted line,” she said. “What’s your patient selection? Look at the program to see if they have appropriate monitoring of these patients.”
ProAssurance, which provides professional liability insurance for physicians, is already fielding inquiries from both physicians and insurance agents seeking to understand the risk landscape. Lyddy noted that ProAssurance evaluates each situation individually, examining patient sourcing, screening protocols, and oversight structures to assess the risk profile.
“We’ll look at each situation, to ensure that they’re using responsible companies,” Lyddy said. “It’s more of an oversight that we take a look at.”
Preparing Now for What’s Coming
The trajectory of GLP-1 medications — massive adoption, fragmented oversight, emerging adverse events, and expanding access through minimally supervised online platforms — bears similarities to other moments in health care that ultimately produced significant litigation. Physicians and health systems that take proactive steps now to tighten their screening, monitoring, and patient education practices will be far better positioned when claims do arrive.
“I think where we’re going to see it with the physicians we insure will be in three critical areas,” Lyddy said. “How are you monitoring your patients? How are you selecting your patients? And are you educating them on the risks that are inherent in this choice?” &
