Your patients are sourcing compounded GLP-1s online. Here's what to do about it

For clinicians working in med spas, wellness clinics and functional medicine practices, glucagon-like peptide-1 (GLP-1) drugs have become a near-constant presence in exam rooms, online and in the media. Novo Nordisk and Eli Lilly and Company spent more than $700 million advertising their GLP-1 drugs in 2025 alone — the equivalent of the entire Super Bowl ad spend.

These once-in-a-generation pharmaceuticals now show promise for a wide range of conditions beyond diabetes and obesity, which only adds to patient demand. But the access gap between what’s commercially available and what insurance covers has pushed many patients toward compounded alternatives, sometimes from reputable pharmacies and sometimes from far less reliable sources. Many are turning to telehealth platforms or direct-to-consumer websites without consideration of how these medications interact with other medical conditions or treatments.

The practical question for independent providers isn’t whether this is happening. The question is: When it comes up in your practice, do you have a clear way to handle it?

How do I know compounded GLP-1 drugs will land in my exam room?

A study reviewed by researchers at the Yale School of Medicine examined 79 websites selling compounded GLP-1 drugs and found that many failed to clearly disclose whether the drugs were compounded, lacked Food and Drug Administration approval, or carried known risks and contraindications. Patients are often buying these medications without a complete clinical picture and then showing up in your practice with unexplained symptoms.

Consider this scenario: A patient comes in for a routine visit complaining of persistent nausea, fatigue and lightheadedness. Nothing in their chart explains it. A few targeted questions later, you learn they’ve been self-administering a compounded GLP-1 they ordered online. The online platform didn’t have their full medication history, and you didn’t know the GLP-1 had been added to their list of medications. Now your practice is responsible for sorting out what they’re taking, whether it was documented anywhere, and how to keep the chart, the workflow and the care plan aligned.

For independent practices, this can quickly turn into a compliance problem if there is no clear process for handling it. These practices often have less institutional support to handle the extra calls, intake questions, medication clarification and follow-up.

The good news is that clinicians do not need to control the internet to control the encounter. A simple workflow can make the response faster, safer and more consistent.

How do I help patients realize they need to disclose compounded GLP-1 use?

Adding a question to your intake form or previsit screening, such as “Are you currently taking any medications, supplements or weight management products prescribed by another provider or obtained online?” Doing so gives patients a low-pressure way to disclose. Building the question into your standard intake normalizes the disclosure and catches it before the visit rather than after.

What should a provider ask when a patient says they started compounded semaglutide or compounded tirzepatide from a telehealth site?

When a patient tells you they’re using a compounded semaglutide or tirzepatide, your first goal is to get the medication history clear. For example, you should ask the following questions:

• What is the product name, and who prescribed it?
• What dose are they taking, and how often?
• Where did it come from — a pharmacy, a website or a friend?
• Do they have the label, packaging or any documentation from the prescriber?

If the patient can’t answer these questions, document that. Your chart should reflect how the conversation went, not just that it happened.

What should be documented when a patient is already taking a compounded GLP-1?

Once a compounded GLP-1 comes up in the encounter, treat it the same way you’d treat any undisclosed medication. It needs to be resolved before care proceeds. At a minimum, document the following:

• The product name and source (or that the patient was unable to identify them)

• The dose and frequency, as reported by the patient

• Any side effects, symptoms or contraindication concerns discussed

• The counseling that took place and the clinical decision made

• The follow-up plan

In a compliance-minded practice, the chart should show how the team handled the issue. This distinction matters if your documentation is ever reviewed.

What should staff do when a patient calls about compounded semaglutide or compounded tirzepatide?

Patients don’t always wait for the exam room. Many will raise the topic with whoever answers the phone. Staff who aren’t prepared to handle these questions create liability.

Give your team a standard script. It should do the following three things:

• Acknowledge the question without dismissing it.
• Gather the key facts (what the patient is taking, where it came from and what they’re experiencing).
• Route the question to the right clinician without offering clinical guidance on the spot. Consistency prevents a patient from receiving different answers depending on who answers the phone.

What should independent practices have in place to stay compliant when compounded GLP-1s come up?

For practices operating under management or business services arrangements, compounded GLP-1s carry an added layer of compliance sensitivity. Fee-splitting rules, ownership structures and state-level regulations around clinical oversight can all come into play when nonphysician entities are involved in care decisions.

A clear written protocol does more than protect individual patient encounters; it documents that clinical decision-making is in the hands of licensed providers, which is exactly what regulators look for. If your practice doesn’t already have a written policy on how to handle compounded medications from outside sources, this is a good moment to create one. That policy should cover the following:

• Standard intake screening questions

• Documentation requirements for undisclosed or outside medications

• Escalation thresholds (when does the front desk route to clinical staff versus urgent review?)

• A clear chain of clinical oversight

What comes next for patients seeking GLP-1 drugs?

Compounded GLP-1s are likely the leading edge of a broader shift: more patients accessing medications through alternative channels, with uneven information and inconsistent oversight. The regulatory environment around compounded GLP-1s is already shifting, which means the landscape your patients are navigating will continue to change.

What won’t change is your obligation to understand what your patients are taking and to document how you responded. Practices that build a clear, consistent process now will be better positioned to manage that complexity without it becoming a compliance problem.

The clinical noise around GLP-1s is loud. The practice risk is quieter, but real. A simple intake question, a training conversation with your staff and a one-page written policy can go a long way.

Amanda Guarniere, MSN, APRN, NP-C, is a Yale-educated nurse practitioner with 15 years of clinical experience, vice president of sales and marketing at GuardianMD, and a leader in medical oversight infrastructure for clinics, med spas, and telehealth platforms.