Patients who bought gray-market retatrutide before its approval should be screened without judgment and brought back into supervised care rather than penalized, Rob Stransky of NiceRx said in a Q&A with The American Journal of Managed Care. Stransky founded the telehealth company, which currently offers compounded GLP-1 therapies prescribed by licensed providers.

Retatrutide is Eli Lilly's investigational agonist of the glucose-dependent insulinotropic polypeptide, GLP-1 and glucagon receptors, meaning it targets three hormone pathways rather than the one or two the approved weight-loss drugs hit. It is not approved, and that gap has fueled an online gray market of unregulated vials sold as research chemicals.

Cost is the driver

Stransky is blunt about what moves this market: cost is the single biggest driver. When a patient loses coverage or faces a few hundred dollars a month out of pocket, he said, a $100 unregulated product online becomes tempting even though there is no way to verify what is in it.

The pressure is building rather than easing. In a Business Group on Health survey, 14% of employers have already dropped coverage of GLP-1s for weight loss or plan to do so in 2027. Stransky argues the fix is not coverage alone but affordable, supervised options that keep a prescriber and a licensed pharmacy involved.

Asking the question routinely

His prescription for intake is unglamorous and probably right: ask about peptide and GLP-1 use the same routine way a clinician asks about supplements or alcohol, as a standard question for every patient rather than a flag raised only when something looks off. Framed that way, he said, a patient has no reason to hide the answer.

A research letter published in October in JAMA Network Open analyzed Reddit posts from 13,589 users reporting current retatrutide use and called for exactly that: nonjudgmental screening for nonapproved peptide use.

What is actually in the vial

The compound is only part of the exposure. These products typically come from unregulated or overseas labs with no sterility assurance, no verified concentration and no consistent batch-to-batch quality control, Stransky said, so a patient cannot know the dose being injected or what else is in the vial.

In practice, he said, that can produce symptoms that do not track cleanly with the drug's expected profile, which is difficult for a clinician to manage when there is no reliable record of what was administered.

Bottom line

Stransky expects disclosure to rise once an approved option exists, and says plans should treat approval as a chance to transition people into monitored care with a clinical check-in rather than a compliance problem to punish. Whether insurers narrowing coverage for 2027 see it that way is the unsettled part.