Prescribing GLP-1 Medication Via Telehealth: Is It Safe?
Processes and protocols that enable a successful virtual weight management program
The simple answer—yes it is. However, the controversy surrounding the weight loss medication means that it’s anything but a simple answer. There are several factors to consider when deciding to build a virtual weight loss program.
Prescribing GLP-1 agonist medications for weight loss has opened the door to addressing the obesity crisis facing the United States today. In fact, about 39.6% of the U.S. population are obese according to the Food Research and Action Center (FRAC). However, it’s also been met with considerable criticism due to GLP-1s side effects and its marketing by some organizations as a “miracle weight loss pill” (something we’ve heard before).
What makes this case unique? The wide adoption of telemedicine. Health leaders want to know how telehealth fits in and whether it’s safe to offer virtual GLP-1 programs to their patients (as they should). So, is it the health solution we’ve been waiting for or is it more trouble than it’s worth?
To help answer this question, we tapped into our own VP of Clinical Affairs, Dr. Mohit Joshipura, an Internal Medicine Physician and telehealth leader who has experience with designing and implementing nationally distributed medical weight management programs.
What are GLP-1 agonists and what do they do?
GLP-1 stands for “glucagon-like-peptide-1”, which is a naturally occurring hormone in your intestines. The hormone is released after eating food and (by binding to GLP-1 receptors in the pancreas) helps increase the secretion of insulin in your body, which then regulates blood sugar levels.
“GLP-1 agonist medications act by stimulating these GLP-1 receptors. In addition, the medication inhibits the release of a hormone known as glucagon. Glucagon serves to increase blood sugar, and when its release is inhibited, this leads to reduced blood sugar levels.” said Dr. Mohit Joshipura, VP of Clinical Affairs at OpenLoop Health.
Also, GLP-1 agonist medications increase satiety and slow the movement of food through your gastrointestinal (GI) tract, making you feel fuller for longer. This is thought to be due to multiple mechanisms of action ranging from hormones in the gut to neuronal pathways in the brain. This is what has led to its use as a successful treatment for patients struggling to control their weight. It’s important to note that these medications are often paired with long-term lifestyle changes like healthier diets and consistent exercise.
Branded GLP-1s vs. GLP-1 Compounds
A big pain point for the weight management healthcare sector right now is supply and demand. Currently, the demand for GLP-1s far outweighs the supply that major manufacturers like Novo Nordisk and Eli Lilly can produce, which is where compounds have played a role.
So, what’s the difference between the two?
Branded GLP-1s (e.g. Wegovy, Saxenda)
Injectable
Branded GLP-1s are approved by the FDA
Currently, there are only two GLP-1s that are FDA approved for weight loss (Wegovy and Saxenda).
Branded GLP-1s like Ozempic are FDA approved for type 2 diabetes, but not currently for weight loss. Use of these medications for weight loss is considered to be off-label.
GLP-1 Compounds
Injectable
Not FDA approved; off-label
Clinical entities must ensure that the ingredients are pharmaceutical grade and NOT research grade.
Clinical entities must ensure that semaglutide is being used in its base form and NOT its salt form. Also, the location where the base form is sourced/manufactured must be identified.
Clinical entities must ensure that the compounding pharmacy conducts and provides third-party quality testing for potency, sterility and endotoxins.
While branded GLP-1s are preferred, due to their FDA approval and standardized manufacturing/quality processes, if a clinical entity does decide to utilize compounded GLP-1s, it must ensure strict due diligence and an updated awareness of recommendations (at the FDA level) and regulations (at the state level). Patient safety must remain a top priority with regard to all clinical and business decisions.
Why do many clinical practices offer compounded GLP-1 agonist medications?
You’re probably asking yourself, “if compounds aren’t FDA approved, why would I use them in my weight management program?” It’s a great question, and according to Dr. Joshipura, there are a few reasons that many clinical practices choose to pursue this route.
1. Cost and affordability
This is a big reason a clinician might prescribe a compound instead of a branded GLP-1. These medications are expensive, to the tune of thousands of dollars, and “for the average American, $2000 a month out of pocket is often not realistic,” said Dr. Joshipura. The lower cost of compounds makes it an attractive proposition, but again, the risks must be understood and the previously listed factors must be taken into account.
2. Coverage
The reason GLP-1 medication has a higher out-of-pocket cost for patients is because many health insurers don’t cover the medication at all or if they do, it is often based on multiple prerequisites and limitations. As a result, patients who could benefit from the treatment aren’t able to access that level of care.
3. Supply chain
The major manufacturers of GLP-1s can’t keep up with demand on both the diabetic side and the obesity side, so practices use compounded GLP-1s to fill that supply gap. It’s also important to note that, “the patents for all branded GLP-1s are still held exclusively by these drug manufacturers…” said Dr. Joshipura. As a result, once supply catches up with demand, compounding pharmacies will be asked to stop production.
Are GLP-1s safe to prescribe via telehealth?
Another important question! Both telehealth and GLP-1s have experienced recent booms in the world of healthcare, so there are few things to note here.
According to Dr. Joshipura, GLP-1s have not demonstrated any startling short-term risks, but that’s not to say that they are without their side effects. For example, those who have been diagnosed with a particular type of thyroid cancer are not eligible for the treatment. But overall, their safety and efficacy profile in the short-term has been quite promising and make it a good candidate for telehealth.
“The second approach that makes this a good medication to have in your pocket when you're prescribing or practicing via telehealth is that there's really no in-person exam component that is imperative prior to prescribing these medications,” said Dr. Joshipura.
Patients are (with appropriate instruction) able to easily administer the medication from home. However, if any symptoms do present themselves, telehealth works as a quick and easy platform for your patients to check in about any changes in health.
What protocols and processes enable a successful virtual GLP-1 weight management program?
When organizing your virtual weight management program, here are a few things that will help provide a better patient experience.
Metabolic testing and labs
Technically, you don’t need labs in order to offer GLP-1 treatment. However, by ordering them, you’re both ensuring the safety of the patient and maximizing the efficacy of the program.
“When you're prescribing the medication as part of a more comprehensive weight management solution, it is important to get an idea of what the patient's overall metabolic profile looks like,” says Dr. Joshipura.
The provider can then go over the patient's most up-to-date metabolic data during that initial telehealth visit and make note of any potential risks or comorbidities. “You're much more likely to get a safer, more successful and more sustainable program.”
Modality of care - partial synchronous component
Ideally, there should be a synchronous component to these programs, whereby the patient and provider can speak directly to one another. It’s only after a more dedicated conversation that you can fully understand health history, their metabolic health profile and the patient’s goals. This promotes a more collaborative treatment plan and fosters a more engaged patient base.
Frequency of visits
While the drug is being uptitrated, there should be frequent, month-by-month follow-ups to discuss rate of weight loss and side effects. Gastrointestinal side effects such as nausea are quite common. It’s important to know how your patient is feeling during their treatment. Once the patient reaches a steady state, follow-ups can then be reduced to quarterly.
Incorporate better lifestyle habits in addition to GLP-1s
"If you can pair some of these powerful tools (pharmaceutical and lifestyle) together as a part of your (virtual) platform, your ability to get sustained results for your patients over time increases significantly,” says Dr. Joshipura.
Don’t just rely on the medication when crafting your GLP-1 program, since we know from research that a certain amount of weight gain is almost inevitable once the GLP-1 agonist medication is stopped. Medication should be paired with long-term diet, exercise and behavioral changes, since those are the programs that see the best patient results and outcomes.
By incorporating all of the above protocols and processes into your virtual weight management program, you’re creating a standardized flow that is easy to sustain and prioritizes patient safety.
Powering GLP-1 telehealth programs with our fully-vetted clinician network and white-label solutions
The GLP-1 agonist medications’ favorable benefit/risk profile and at-home usability makes GLP-1 programs great candidates for telehealth. However, it’s important to know that whether you are treating a patient in-person or virtually, patient safety should be your number one priority.
At OpenLoop, safety and security are at the heart of every one of our solutions. We power GLP-1 programs and ensure patient safety through our NCQA-certified clinician network and intuitive, HIPAA-compliant technology platform. Easily book GLP-1 appointments, make payments, order labs, chart, schedule and see patients all in one easy-to-use platform.
Interested in how you can get started? Get in touch here!
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