Takeaway
Some patients need to find cheaper prescription medications online. When they do, help them verify sourcing and dosing to keep them safe.
Lifelong learning in clinical excellence | February 26, 2026 | 3 min read
By Heather Folz, PharmD, Notre Dame of Maryland University
Why wouldn’t we try to lower the cost of a prescription our insurance doesn’t cover, especially when it exceeds $1,000 per month? We hear about GLP-1 benefits from the media, friends, and family. We comparison shop for everything else. Why wouldn’t we do the same for medications? It’s being resourceful, right?
Understanding the landscape
Ideally, patients would obtain GLP-1 medications, and other medications, from state-licensed pharmacies that source products from FDA-registered wholesalers or manufacturers. In reality, barriers such as lack of insurance coverage, push patients to look elsewhere, particularly since Medicare and Medicaid generally don’t cover medications indicated solely for weight loss.
Online, patients may encounter:
1. FDA-approved medications dispensed by licensed pharmacies
2. Compounded drugs from state-licensed pharmacies or FDA-registered outsourcing facilities
3. Telehealth platforms with unclear sourcing
4. “Research-use” peptides marketed for injection
What providers and patients should know
1. Compounded drugs are not FDA-approved. The FDA doesn’t verify their safety, effectiveness, or quality before marketing.
2. Compounding has a legitimate role (e.g., dye-free formulations, liquid dosage forms, or during national shortages—as seen recently with GLP-1s).
3. Unnecessary compounding carries risk. Poor practices can lead to contamination or incorrect potency.
State boards of pharmacy oversee traditional compounders. The FDA inspects registered outsourcing facilities and applies current good manufacturing practice (CGMP) standards. However, patients purchasing online may not know who prepared the product or whether appropriate standards were followed. However, not all online pharmacies are unsafe. The FDA recommends looking for safe signs versus warning signs for online medications.
Signs that online medications are safer:
1. Requires a valid prescription
2. Provides a physical U.S. address and phone number
3. Has a licensed pharmacist available
4. Is licensed by a state board of pharmacy
Signs that online medications may NOT be safe:
1. No prescription required
2. Not licensed in the U.S. or your state
3. No pharmacist access
4. Damaged packaging or missing expiration dates
5. Prices that seem too good to be true
6. Charges for unordered products
7. No clear privacy protections
Another concern that may arise are questions about non-traditional GLP-1 dosing or “microdosing.” While it makes sense to use the lowest dose possible to get the desired effect, there’s currently little evidence to support that non-FDA approved doses or extended dosing intervals are effective, although case reports and modeling studies are promising. If these strategies are done with FDA-approved products, avoid using single dose pens like Trulicity or Zepbound since these products are formulated without preservatives making contamination possible. If using multi-dose pens such as Saxenda, Victoza, or Ozempic, confirm that the click charts patients are using are correct.
A clinical approach
We can’t control where patients obtain medications, but we can respond with empathy and curiosity. When a patient discloses using a nontraditional source or dosing regimen, we can either react with alarm or ask, “What led you to that option?”
Practical steps for clinicians:
1. Normalize the conversation.
Include online and telehealth medications in routine reconciliation.
2. Assess, don’t assume.
Ask about the source, packaging, dosing, and side effects.
3. Educate clearly.
Explain FDA approval, generics, and compounding in plain language.
4. Screen for harm.
Verify dosing accuracy and monitor for adverse effects.
4. Address access barriers.
Explore appeals, manufacturer programs, or referrals to licensed pharmacies.
5. Encourage transparency.
Invite patients to share vials or websites for review.
6. Preserve the relationship.
Even if patients continue to purchase medications outside traditional channels, provide safety counseling and close follow-up.
Finally, here are a few helpful resources:
“Compounding and the FDA: questions and answers”
“Considering an online pharmacy? Tips for buying medicine online”
“Tackle ongoing GLP-1 agonist questions”
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.