I'll give you a case in point. This article was discussed the other day:
> https://www.nytimes.com/2026/04/02/technology/ai-billion-dol...
People want GLP-1 drugs. They can't get them without a prescription. They pay $$$ to a "telemedicine" "doctor", recite a list of well-known symptoms, and buy the prescription.
The system is that you can't buy these drugs without the piece of paper, and the piece of paper is basically something that anybody can buy regardless of whether or not they actually need the drug. Wanting it is usually enough.
I think access is a good thing. The issue isn't with telemedicine but the fact that there's a prescription wall for helpful meds like GLP-1 in a country where we've failed people by creating one of the worst food environments.
Also, most doctor's visits aren't any different from getting it if you want it except it's gated on the mood/attitude of the doctor, maybe your ability to sell some sob story. And then you book a different doctor until you get it. Telemedicine just makes the process easier an arbitrary system.
GLP-1 prescriptions are easy to get in the US. It's filling the prescription that is the problem, because insurance rarely covers it and it is beyond the disposable income of most Americans.
The prescription hurdle is absolutely necessary -- these are not drugs that anyone can safely take without guidance. It's the price that needs to be fixed.
> these are not drugs that anyone can safely take without guidance.
Unless that risk is egregious, informed adults should be able to accept it if they so choose.
I know a lot of people on GLP-1 meds and even took a dose myself out of curiosity.
You take a dose every two weeks. And if you accidentally double dose because you misread 1U to mean 1 dose, it just gives you some nausea.
Are we going to pretend it's hard to take this drug now too? Or that the doctor has some magical insight into your getting-on? Remember to eat. That's it. I guess a few people might need the doctor to go "you're eating, right?" but I don't believe in infantilizing everyone over that.
> You take a dose every two weeks
Weekly, if you are following guidelines correctly. The half-life of most GLP1 peptides is 5-6 days.
I otherwise agree with your point entirely. Though anecdotally, I may have given my brother-in-law a single small vial of tirzepatide at his request so that he could experience it, and the results were ... not good. Turns out he's an idiot, thought that 'more is better', 'drinking enough water is for weenies', and 'I am not an alcoholic even though I get plowed most evenings.' All against my very specific advice on how to give it a try. Whoops.
My fault, yes, I should have realized he was too stupid to do it without adult supervision. He made himself so sick he almost went to the ER. Nothing really dangerous, of course, tirzepatide is pretty safe stuff, but overdosing on it can make you feel very shitty for a few days until the blood concentration drops.
One dose is one thing -- but there are other risks that can lead to complication or death here if taken improperly for a long period of time. Musculoskeletal issues, cardiac issues, thyroid issues, etc.
Additionally, getting the correct dose is not straightforward for a layperson as it is for other OTC drugs with standard doses.
There are similar risks, and probably more likely, to all sorts of consumables that aren't regulated at all. It is reasonable to ask whether the prescription regime for GLP-1s makes sense. It isn't the only substance posing that conundrum! Ondansetron is OTC in a lot of countries, but not in the US, Canada, or UK. But ondansetron is arguably less dangerous and more helpful than pseudoephedrine.
Pseudoephedrine, of course, isn't BTC because it's dangerous to take or complicated to dose. It's there because of the war on drugs. But I do agree that not all drugs are regulated appropriately. Marijuana also comes to mind.
I do think GLP-1s are just about right. It is appropriate to take them under personalized professional guidance.
Right, and I actually see the logic of that (unlike virtually everyone else on HN, and let's not rekindle that debate; the search bar avails). The point is you don't need a prescription to get it. People might be better off if GLP1s were also BTC. Hard to say!
Certainly you can abuse a GLP1 and get yourself very sick, or not abuse it and still end up with pancreatitis. But smoking and alcohol presumably cause way more cases of pancreatitis, and you don't need a script for a handle of Popov.
There used to be prescriptions for alcohol products and cigarettes have been sold as medical products -- the reason we accept them in society today is not because we think they have relative less risk to other things, but that their acceptance as recreational vices outweighs the harm that we know they cause.
> smoking and alcohol presumably cause way more cases of pancreatitis
Indeed. In fact, I think just recently there were updated studies for at least one of the popular GLP1s that disclaimed entirely a link to pancreatitis.
To be clear I don't think it's actually reasonable to suggest GLP1s should be OTC in 2026. Were that to happen it would be part of a regime change in drug regulation that I'd categorically oppose. The timeline on GLP1s (unlike Zofran) doesn't support it. There are arguments for why your doctors would want to know that you're taking it, and on what schedule. But it should be extremely easy to get.
Agree, it does feel like a class of medication that deserves more control than OTC would provide. I do think it should be largely voluntary, however, with doctors expected to provide it unless there is a specific contraindication that would make it harmful.
> Or that the doctor has some magical insight into your getting-on beyond a couple questions they ask you in your visit? Remember to eat. That's it.
Apparently we have forgotten people who died from eating disorders (previously called anorexia nervosa)?
There is a VAST difference between someone who weighs 300lbs asking for GLP-1 to combat morbidity and someone who is barely 100lbs asking for a GLP-1 to take off weight for bikini season. That's what needing to ask a doctor for a prescription is for.
That sounds like people making an informed decision about their body to me. Doctors don't need to be inserted into every risky decision.
> The prescription hurdle is absolutely necessary
You're totally missing the point thought. The prescription hurdle effectively does not exist. It's just a paywall.
You pay your $100, get a 3 minute call with a NP/PA/whomever, and basically the robot writes you a prescription for whatever you want. The point is you pay and you get the prescription. Patient safety has nothing to do with anything.
It's cheaper for most people to get the prescription written at a PCP.
The advantage to a telehealth is not getting the prescription written -- it's that they'll fill it for cheap through a tiny compounding pharmacy that is making it, technically illegally, but are small enough to be off the FDAs enforcement radar for the moment.
I have used both my PCP and telehealth for prescription writing, never once have I used a compounding pharmacy.
It's slightly cheaper for me to use telehealth vs. billing through my insurance. The downside is it doesn't go towards my deductible of course.
The stuff you are describing are entire supply chains of a sort where you want a GLP-1 or perhaps a few other things like TRT. Those you are signing up for the drug itself, which happens to include the prescription part with it.
Telehealth can be used for any old medication you want. It removes the permission slip part of the process and replaces it with a payment gateway. If you have $75-150 you can just click some buttons and have a prescription for nearly anything you want at most a day later. This includes antibiotics, ADHD meds (getting harder on these), certain benzos, etc.
HIMS/HERS/etc. and their smaller ilk are super popular, but they are the tip of the iceberg.
Telehealth providers can certainly work with compounding pharmacies but not necessarily. If you are looking to get a prescription for Diazapam you are going to be getting that sent to your local Walgreens or whatnot.
> It's slightly cheaper for me to use telehealth vs. billing through my insurance.
How? Usually PCP visit are cheap and everyone gets one for free.
> HIMS/HERS/etc. and their smaller ilk are super popular, but they are the tip of the iceberg. > Telehealth providers can certainly work with compounding pharmacies but not necessarily.
Yeah I’m aware there are a whole host of services telehealths provide but the primary reason people use them for GLP1s is to avoid the name brand cost.