UK online pharmacies face stricter rules for sales of weight-loss jabs | Drugs

Access to weight-loss jabs through online pharmacies is to be tightened up as part of a crackdown on inappropriate prescriptions – although some experts say even more must be done.

Weight-loss injections such as Wegovy, which contains the drug semaglutide, and Mounjaro, which contains the drug tirzepatide, have boomed in popularity after trials showed they can help people lose significant amounts of weight, with many people seeking private prescriptions.

However, concerns have been raised that the medications are being inappropriately prescribed through online pharmacies to people who do not meet the criteria for them.

A Guardian investigation previously revealed some online pharmacies operating in the UK have approved and dispatched private prescriptions of the jabs to people of a healthy weight, as well as to those who have lied about their weight to meet criteria for a prescription.

Now the general pharmaceutical council (GPhC), which regulates pharmacists, pharmacy technicians and pharmacy premises in England, Scotland and Wales, has said it is tightening the rules.

The changes mean pharmacies can no longer base decisions about online prescribing of weight-loss jabs – or other high-risk medications such as antimicrobials, laxatives and opioids – on the information provided in an online questionnaire alone, as some online pharmacies have done previously. Instead, such information must be verified independently.

In the case of weight-loss medications, the person’s height and weight, body mass index (BMI), or all three metrics, must be included in this process, with the guidance adding that verifying this information through a phone call with the person would not be appropriate.

It suggests such information could be verified by a video consultation, in person, from the person’s clinical records or by contacting another healthcare provider such as the person’s GP.

Among other changes, the new guidance also stresses all online prescribing should come with a means by which the person and prescriber can have timely two-way communication.

Duncan Rudkin, the chief executive at the GPhC, said the message of the updated guidance was clear.

“Online pharmacies should only supply a medicine if the prescriber has had an appropriate consultation with the person, and has made sure they have all the necessary information to check if that medicine is safe and suitable for them,” he said. He added that the GPhC had seen “too many cases of medicines being supplied inappropriately online and putting people at risk”.

“Our inspectors will continue to inspect online pharmacies and will be looking for evidence that pharmacies are meeting our standards,” Rudkin said. “We will also continue to work closely with other regulators in response to concerns and issues, and take action when needed to protect the public.”

The Guardian understands the guidance sets out the expectations of how pharmacies will meet GPhC standards, which are legal requirements.

Should the guidelines be breached, a spokesperson said the GPhC would generally give the pharmacy an improvement action plan as the first step. However, stronger measures, or enforcement action, could be taken, such as placing conditions on pharmacies – for example, limiting the medications they can supply, suspending a pharmacy, or taking action against pharmacy owners and pharmacists themselves.

The changes also stress online pharmacies must follow the law and guidance on the advertising and promotion of medicines, pointing to guidance from the Medicines and Healthcare Products Regulatory Agency (MHRA) and the Advertising Standards Authority (ASA). The GPhC said it was working closely with both bodies to tackle inappropriate activity in the area.

The issue is of growing concern, with a Guardian investigation revealing a growing number of complaints upheld by the MHRA against online adverts for weight-loss drugs. The investigation also revealed online pharmacies have been using loopholes in the rules to offer discount deals for weight loss “services” that include – and prominently feature – the jabs.

Dr Piotr Ozieranski, from the University of Bath, said adding weight-loss drugs to the list of high-risk medicines was a much-needed move that was long overdue.

“The updated pharmacy guidelines are spelling out specific requirements regarding consultations with patients and better coordination between different regulators,” he said.

But Ozieranski said it was not entirely clear how a pharmacist could practically check a person’s weight and height – which are needed to calculate a BMI – via a video call, and help from third parties could raise safeguarding concerns.

“And, if such information cannot be obtained through consulting with the patient, how will pharmacies quickly and reliably verify GP records, especially when both demand for these drugs and pressure on GPs are at an all-time high?” he said.

Ozieranski said the guidelines also failed to adequately address how patients were to be supported once they had started the medication, or be looked after in the long-term when unknown side-effects might become apparent.

“A glaring omission is detailed standards on financial conflicts of interest,” he added, noting individual pharmacists, pharmacies and related commercial actors were known to accept – often substantial – payments from drug companies, with the situation particularly acute in the field of weight loss.

“A serious reform would involve banning pharmacists or pharmacies from accepting payments altogether – ensuring that patient care isn’t compromised by commercial pressures,” he said.

However, Nick Kaye, the chair of the National Pharmacy Association, which has previously called for tougher regulation of the online sale of weight-loss jabs, welcomed the new guidelines.

“We’re pleased that the GPhC has taken on board concerns expressed by the NPA about a small number of patients who have been able to access higher risk medication, such as weight-loss injections, without proper consultation or examination of historical medical records,” he said.

“It is important to note that the vast majority of pharmacies, including online sellers, already adhere to good practice in this area and do all they can to support patients to attain and maintain a healthy weight in a carefully managed programme of treatment.

“It’s also important patients avoid unregulated sellers of medication, such as beauty salons, who could pose a serious risk to their health.”