> Another point I could raise is that telemedicine has turned the entire prescription system into nothing more than a parasitic middleman/gatekeeper.

I’m curious what you mean by this. I’m not sure what you mean by “prescription system” specifically.

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A_D_E_P_T 15 hours ago | parent | next [-]

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.

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hombre_fatal 15 hours ago | parent [-]

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.

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kube-system 15 hours ago | parent [-]

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.

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staticassertion 3 hours ago | parent | next [-]

> 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.

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hombre_fatal 15 hours ago | parent | prev | next [-]

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.

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rootusrootus 15 hours ago | parent | next [-]

> 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.

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kube-system 15 hours ago | parent | prev | next [-]

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.

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tptacek 15 hours ago | parent [-]

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.

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kube-system 15 hours ago | parent [-]

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.

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tptacek 14 hours ago | parent [-]

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.

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kube-system 14 hours ago | parent | next [-]

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.

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rootusrootus 14 hours ago | parent | prev [-]

> 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.

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tptacek 13 hours ago | parent [-]

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.

	▲	rootusrootus 12 hours ago \| parent [-]
		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.

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bsder 15 hours ago | parent | prev [-]

> 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.

	▲	Tarq0n 3 hours ago \| parent [-]
		That sounds like people making an informed decision about their body to me. Doctors don't need to be inserted into every risky decision.

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phil21 15 hours ago | parent | prev [-]

> 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.

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kube-system 15 hours ago | parent [-]

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.

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phil21 14 hours ago | parent [-]

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.

	▲	kube-system 10 hours ago \| parent [-]
		> 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.

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pedalpete 15 hours ago | parent | prev | next [-]

The "perscription system" used to be that you'd have to go see a doctor, the doctor knew who you were, and would make decisions on what prescriptions/medications you should be given.

Due to drug advertising rules, the prescription system has been turned on its head, and the patient now goes to their doctor asking for a specific prescription.

Telemedicine took advantage of this and has effectively removed the middleman (the doctor) in many cases and you just sign-up look at a person on a camera, and get your drugs sent to you.

	▲	jmye 11 hours ago \| parent [-]
		> Telemedicine took advantage of this and has effectively removed the middleman (the doctor) in many cases and you just sign-up look at a person on a camera, and get your drugs sent to you. This is only true for a handful of drugs that are basically OTC already (or that have OTC formulations). Additionally, telemedicine didn’t take advantage of drug advertising- that’s an odd assertion.

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tastyfreeze 15 hours ago | parent | prev | next [-]

Go to doctor, get prescription for restricted medicine, pick up prescription.

If you can call up a teledoc and they give you a prescription based on your description why could you not just go buy the meds yourself without a prescription. You have essentially diagnosed yourself and just asked the doctor for permission to buy the drug you want.

	▲	jmye 11 hours ago \| parent [-]
		That’s… not how actual telemedicine works. That’s how jackasses “disrupt” healthcare for very specific drugs. Mostly birth control, ED meds, and various hair regrowth meds. It’s really clear that some of you are really mad about something you don’t understand.

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ai_critic 15 hours ago | parent | prev | next [-]

I take certain medications--nothing interesting, nothing controlled, nothing abusable. I have to deal with a whole thing just to get refills, because my PCP forces me to come in every time--and even that is now just a telehealth call that is annoying.

In Mexico, for meds like mine, you can just buy them at the pharmacy. There's no reason for all this nonsense.

(Edit: same PCP refused to prescribe GLP-1s early, without any scientific or medical reason not to. Delayed my weightloss by months until I found a place that would.)

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phil21 15 hours ago | parent | prev [-]

> I’m curious what you mean by this. I’m not sure what you mean by “prescription system” specifically.

They basically operate as a "pay for a prescription" service.

Figure out what drug you want, google the drug name and telehealth. You will be marketed in a wink wink sort of manner over how easy it is to get them, just hours away! Then if you are not a total idiot, you answer certain questions in the right manner on the intake form, the doctor (usually NP/PA or similar for most things) will quickly run through that and expect you to answer correctly - perhaps guide you a bit if you don't.

5 minutes later you have a prescription in the web portal and it's sent to your pharmacy of choice.

It really shows how the whole "permission slip" program is BS. I've used these services a couple times vs. my normal doctor just to save time and expense of an office visit. If I can click some buttons, have a call 30 minutes later, and be on my way to the pharmacy for $50 it's sometimes the path I take now vs. traditional route.

Someone used to the traditional doctor/patient relationship thing and prescriptions being "holy" would be shocked at how easy and gamed it all is.

	▲	cycomanic 5 hours ago \| parent [-]
		Well that's a problem with the profit driven US health system (although admittedly other countries have similar problems to varying degrees) not prescriptions in general though? In particular the take home from this should be to make it more difficult to get the prescriptions not to do away with prescriptions.