Telehealth & Reviews
What happens at a GLP-1 “medical review” — and what a rubber-stamp intake looks like
Every GLP-1 telehealth program advertises a “medical review” before prescribing. Whether that review is a genuine clinical evaluation or a formality is the single most important thing to find out before you pay. The FDA-approved labels for Wegovy and Zepbound spell out exactly what a prescriber has to check: contraindications, pregnancy status, drug interactions, and conditions that require monitoring. An intake that never asks about them cannot be screening for them. The Federation of State Medical Boards' model telemedicine policy puts it bluntly: prescribing “based solely on static online questionnaires” is “not acceptable.”
This page goes deep on one step of the telehealth pipeline: the clinical evaluation itself. For the full journey — intake to first dose, pharmacy fulfilment, dose escalation, renewals — see our companion guide, how GLP-1 telehealth actually works.
The standard the evaluation is held to
A telehealth prescription is not held to a looser standard than an office visit. The Federation of State Medical Boards — the association of the state boards that license US physicians — adopted a model telemedicine policy in April 2022 stating that treatment decisions made virtually “will be held to the same standards of appropriate practice as those in in-person settings,” and that a documented medical evaluation and relevant clinical history — enough “to establish diagnoses and identify underlying conditions and/or contra-indications to the treatment” — must be obtained before any prescription is issued.
Two caveats keep this honest. First, the FSMB document is model policy — guidance that individual state boards adopt, adapt, or decline at their discretion — not a federal law. Second, the binding rules come state by state: the FSMB's board-by-board overview of telemedicine policies shows every state board requires physicians practicing telemedicine to be licensed (or registered) in the state where the patient is located, while the details of how a visit must be conducted vary considerably from state to state.
What a real GLP-1 evaluation has to cover
The clearest checklist for what a prescriber must consider is the FDA-approved prescribing information itself.
Eligibility
Both drugs are indicated alongside a reduced-calorie diet and increased physical activity — not instead of them — for adults with obesity, or adults with overweight plus at least one weight-related comorbid condition. The pivotal trials behind the weight-management indication defined those groups as BMI 30 or above, or BMI 27 to below 30 with a condition such as hypertension, dyslipidemia, or obstructive sleep apnea. An evaluation that never establishes your BMI and, if you are in the 27–30 range, never asks about a qualifying condition is not applying the indication.
The hard stops
Both labels carry the same boxed warning and the same contraindication: no prescribing for anyone with a personal or family history of medullary thyroid carcinoma, or with Multiple Endocrine Neoplasia syndrome type 2 — so the family-history question is the screening question for the boxed warning. Pregnancy is the other hard stop: both labels say the drugs may cause fetal harm and must be discontinued when pregnancy is recognized, and Wegovy's medication guide tells patients to stop the drug two months before a planned pregnancy. An evaluation that never asks a woman of reproductive age about pregnancy, breastfeeding, or pregnancy plans has skipped the question the label treats as decisive — our pregnancy and fertility explainer covers why.
The history that changes the plan
Beyond the hard stops, the labels' warnings sections define a history a prescriber needs in order to prescribe responsibly:
- Pancreatitis. Acute pancreatitis, including fatal cases, has been observed with both drugs, and both labels say to discontinue promptly if it is suspected.
- Gallbladder disease. Acute gallbladder disease occurred in clinical trials of both drugs (Wegovy, Zepbound labels).
- Insulin or a sulfonylurea. Combining either drug with insulin or an insulin secretagogue raises the risk of hypoglycemia, and the other drug's dose may need reducing — which requires knowing your medication list.
- Diabetic retinopathy. Patients with type 2 diabetes and a history of retinopathy should be monitored for progression.
- Mental health — and a warning that has since been removed. Until early 2026 both labels carried a Suicidal Behavior and Ideation warning telling prescribers to monitor for depression or suicidal thoughts and to discontinue if they emerged. On January 13, 2026 the FDA requested its removal from Saxenda, Wegovy and Zepbound, saying its evaluation “did not identify an increased risk of suicidal ideation or behavior with the use of GLP-1 RA medications”, and the current labels record the section as withdrawn: Wegovy’s current prescribing information lists “Suicidal Behavior and Ideation (5.10)…(Removed) 02/2026” and Zepbound’s current prescribing information lists “Suicidal Behavior and Ideation (Removed)”. Neither label now carries a mood warning. A good intake still asks about mental health history, and a prescriber remains the person to raise it with — but the labelled monitoring duty no longer exists, and any program still citing it is citing a superseded label. We set out what the underlying evidence does and does not show in GLP-1s, mood and antidepressants.
- Severe stomach or bowel disease. Zepbound is not recommended in severe gastrointestinal disease, including severe gastroparesis.
- Birth-control pills. Directly relevant to women, and product-specific rather than class-wide: the Zepbound label advises those on oral contraceptives to switch to a non-oral method or add a barrier method for four weeks after starting and after each dose increase, and the Foundayo (orforglipron) label carries the same class of instruction with a 30-day window. The semaglutide labels carry no such instruction. Which label applies to you is the whole question — see our label-by-label comparison. An evaluation that never asks about contraception cannot deliver that counseling.
Side effects and how they are managed are their own subject — see our guide to GLP-1 side effects in women.
Video visit or questionnaire: does the format matter?
A synchronous visit happens in real time — video or phone. An asynchronous review means a clinician evaluates your written intake and message history on their own schedule. Asynchronous care is not inherently a rubber stamp: the FSMB model policy says a physician-patient relationship “may be established via either synchronous or asynchronous telemedicine technologies” so long as the standard of care is met. Whether your state's rules require more than that varies — the FSMB's state-by-state compilation runs ten pages of differing statutes — so we will not generalize. Format is not the test; the test is whether the questionnaire can come back with questions. The same FSMB policy draws exactly that line: physicians using adaptive questionnaires “must have the ability to ask follow-up questions or obtain further history,” and prescribing “based solely on static online questionnaires” is not acceptable.
The rubber-stamp intake: red flags
The FDA maintains a page on its concerns with unapproved GLP-1 drugs that includes the agency's own consumer warning signs and counts, as of May 31, 2026, 990 adverse event reports for compounded semaglutide and more than 730 for compounded tirzepatide — including dosing errors serious enough to require hospitalization. In March 2026 the agency warned 30 telehealth companies over illegal marketing of compounded GLP-1s; a third, quieter wave followed in June (our report). In the table below, each red flag is labeled by its basis — the FDA's stated concerns, the FSMB's model policy, or our own editorial judgment, marked plainly as such.
| Red flag at the “medical review” stage | Why it matters | Basis |
|---|---|---|
| No screening and prescription by a licensed clinician required at all | A warning sign the FDA itself tells consumers to avoid when obtaining these drugs | FDA concerns page |
| No licensed clinician available to answer your questions | Also on the FDA's list of warning signs | FDA concerns page |
| Static questionnaire with no way for the reviewer to ask you anything | Prescribing on a static form alone is what the FSMB model policy calls not acceptable | FSMB model policy |
| Intake never asks about thyroid cancer family history, pregnancy, medications, or pancreatitis | These map to the labels' contraindications, pregnancy warnings, and interaction warnings — unasked means unscreened | Wegovy / Zepbound labels; our view on the inference |
| Marketing that presents the compounded product as the same as the FDA-approved drug | The central allegation in the FDA's warning letters to 30 telehealth companies | FDA warning letters |
| Prices far below every competitor, pitched as too good to pass up | Deep-discount pricing is on the FDA's list of warning signs for unapproved products | FDA concerns page |
| “Approval” framed as the product — a plan and price quoted before anyone has reviewed your history | An evaluation whose outcome is pre-sold is not an evaluation; real programs decline some applicants | Our view |
| No follow-up pathway: nobody named for side effects, mood changes, or dose questions after the sale | The labels' remaining monitoring instructions (retinopathy, hypoglycemia, gastrointestinal reactions) presume ongoing clinical contact; the mood-monitoring instruction was removed in 02/2026 | Our view, grounded in the current labels' monitoring language |
What a real evaluation should ask you
Each question below traces to the label sections cited above. Expect to answer most of them:
- Height and weight — and, if your BMI is between 27 and 30, whether you have a weight-related condition
- Personal or family history of medullary thyroid carcinoma; MEN 2
- Whether you are pregnant, breastfeeding, or planning pregnancy
- Your contraception method, including whether you take birth-control pills
- Every current medication — especially insulin or a sulfonylurea
- Any history of pancreatitis or gallbladder disease
- Type 2 diabetes, and any history of diabetic retinopathy
- Mental health history, including depression
- Severe stomach or digestive problems, such as gastroparesis
- Kidney problems, and what you have already tried for weight
Questions to ask before you pay
- Who is the clinician reviewing my intake, and are they licensed in my state?
- Can I ask that clinician a question before the prescription is issued?
- Is the medication FDA-approved and branded, or compounded? (Our compounded vs branded explainer covers why the answer matters.)
- Under what circumstances would you decline to prescribe to me?
- Who monitors me afterward — for side effects, mood changes, and dose escalation — and how do I reach them?
- What is the plan if I become pregnant, or decide to try?
- Do you coordinate with my primary care doctor, or send records if I ask?
A program that answers these readily is behaving like a medical practice; one that treats them as friction is telling you what its “medical review” is for. For how specific programs handle this step, see our comparison of GLP-1 telehealth programs for women; for the questions to settle before starting at all, our GLP-1 FAQ.
Sources
- DailyMed. WEGOVY (semaglutide) — current Structured Product Label v19, published June 30, 2026. dailymed.nlm.nih.gov
- DailyMed. ZEPBOUND (tirzepatide) — current Structured Product Label v38, published May 6, 2026. dailymed.nlm.nih.gov
- FDA. FDA's Concerns with Unapproved GLP-1 Drugs Used for Weight Loss (adverse event counts as of May 31, 2026). fda.gov
- FDA. FDA Warns 30 Telehealth Companies Against Illegal Marketing of Compounded GLP-1s. Press announcement, March 3, 2026. fda.gov
- Federation of State Medical Boards. The Appropriate Use of Telemedicine Technologies in the Practice of Medicine. Adopted by the FSMB House of Delegates, April 2022. fsmb.org
- Federation of State Medical Boards. Telemedicine Policies: Board-by-Board Overview (last updated September 2024). fsmb.org