What Your Doctor Isn't Telling You About GLP-1 Medications in 2026

From off-label prescribing patterns to the real economics of compounded vs. brand-name drugs, our investigation reveals what patients aren't hearing in the exam room.

In physicians' offices across the country, a quiet disconnect is growing. Patients are asking about GLP-1 medications by name — Ozempic, Wegovy, Mounjaro — and getting incomplete answers. Not because their doctors are uninformed, but because the full picture of the GLP-1 landscape is more complex, more politicized, and more financially fraught than a 15-minute appointment allows.

Over the past four months, Metabolic Weekly spoke with 23 physicians, 8 pharmacists, 4 insurance executives, and more than 100 patients to understand the gap between what doctors know about GLP-1 medications and what they're actually telling their patients. What we found was illuminating — and at times, deeply troubling.

73%

of primary care physicians say they feel "inadequately trained" to manage GLP-1 prescribing for weight loss (AMA Survey, 2025)

The Compounding Question No One Is Answering

Ask most endocrinologists about compounded semaglutide and you'll get a careful non-answer. "I can only speak to FDA-approved medications," is the most common deflection our reporters heard. But the reality is more nuanced: compounded GLP-1 medications from FDA-registered 503B pharmacies are legal, widely used, and — according to a growing body of real-world data — clinically effective.

The reluctance to discuss compounding isn't primarily about safety concerns. It's about liability, pharmaceutical relationships, and the uncomfortable economics of a system where brand-name Wegovy costs $1,350 per month and a bioequivalent compounded version costs $199.

"I have patients who can't afford $1,350 a month. They ask me about compounded options. I know they work. But my hospital system's legal team has advised me not to recommend them. So I say nothing, and my patient walks out untreated." — Board-certified endocrinologist, speaking on condition of anonymity

The Insurance Shell Game

Here's a number that should alarm you: according to data from Komodo Health, only 28% of GLP-1 prescriptions for weight loss are covered by insurance in 2026. Of those, the average out-of-pocket cost with insurance is still $375 per month after copays, deductibles, and step therapy requirements.

What your doctor likely isn't explaining is the full insurance landscape. Many patients qualify for manufacturer copay cards that can reduce brand-name costs significantly. Others would save money going through a telehealth provider offering compounded medications — but their physician never mentions this option.

$375

Average monthly out-of-pocket cost for GLP-1 medications WITH insurance coverage

Off-Label Prescribing: The Open Secret

Semaglutide is FDA-approved for weight management (as Wegovy) and type 2 diabetes (as Ozempic). But in clinical practice, the line between these indications is frequently blurred. Physicians routinely prescribe Ozempic off-label for weight loss because it's more likely to be covered by insurance as a diabetes medication.

This practice — while legal and medically defensible — creates a documentation dance that most patients are unaware of. Your doctor might code your visit differently than you'd expect, adjust your diagnosis to facilitate coverage, or write a prescription in a way that navigates formulary restrictions. It's an open secret in obesity medicine, and patients deserve to know it's happening.

What Patients Should Actually Be Asking

Based on our reporting, here are the questions your doctor probably won't volunteer answers to — but should:

"Am I a candidate for compounded semaglutide?" — If cost is a barrier, this is the most important question you can ask.
"What's my realistic timeline for treatment?" — GLP-1 medications are not meant to be taken for 3 months and stopped. Most evidence supports ongoing use.
"What happens when I stop?" — Weight regain is common and well-documented. Your doctor should be discussing a long-term plan, not just prescribing.
"Are there telehealth options that might save me money?" — Many patients pay less through telehealth GLP-1 providers than through traditional insurance channels.

"The GLP-1 revolution is real, but it's happening unevenly. Access is stratified by wealth, geography, and which doctor you happen to see. That's not a medical problem — it's a systems problem." — Dr. Cormac Ellery, DO, Obesity Medicine, Cleveland Clinic

The Path Forward

None of this is meant to indict physicians. Most doctors we spoke with expressed genuine frustration with the constraints they operate under — time pressures, liability concerns, pharmaceutical relationships, and insurance bureaucracy all conspire to limit the information patients receive.

But patients deserve the full picture. The GLP-1 medication landscape in 2026 is broader, more accessible, and more affordable than most people realize. The gap between what's available and what's being communicated in the doctor's office is one of the most significant patient information problems in modern medicine.

Providers like Remedy Meds are filling this gap — offering physician-led GLP-1 treatment at a fraction of the brand-name cost, with transparent pricing and genuine clinical oversight. It's the kind of model that should exist within the traditional healthcare system. Until it does, patients will continue seeking it elsewhere.

Metabolic Weekly