Primary care doctors raise alarm as telehealth companies get involved in obesity drugs

For tales on wholesome residing, subscribe to NPR’s Well being publication.

Each time David Davis talks to a nurse at Vida Well being, he thinks he’ll lastly get the OK for Zepbound.

And each time up to now he has been fallacious.

“I assumed, ‘All proper, I am going to undergo their hoops — I am going to bounce by their hoops,'” he says. “The extra they wished, the extra annoyed I might get.”

The 57-year-old energy plant employee who lives close to Santa Cruz, Calif., had already gotten a Zepbound prescription from his major care physician final December to deal with the obstructive sleep apnea that was leaving him exhausted each morning.

However earlier than Davis might fill it, his firm added a brand new requirement. He’d should get a brand new prescription by Vida Well being. The advantages group known as Vida “a cardiometabolic weight reduction answer” and framed it as a perk.

“Like we’d need it,” Davis says.

Telehealth corporations akin to Vida Well being and its rivals supply life-style assist so folks taking medication like Wegovy and Zepbound can have essentially the most success on the medication. However the corporations usually have one other job: limiting weight problems drug prices for employers.

Davis was annoyed that he now needed to work with Vida, however he did as he was advised: He acquired new blood work, stuffed out well being questionnaires and did video visits with a nurse.

The Vida Well being nurse stated he was a very good candidate for Zepbound however insisted he attempt two generic medication first: naltrexone, a drug used to curb alcohol and opioid use, and bupropion, an antidepressant. Neither drug is permitted for obstructive sleep apnea.

Davis was discouraged and known as his insurer’s affected person advocate. “What is the cope with this?” he recollects saying. “And the affected person advocate stated, ‘I’ve by no means heard of that, however that is not a rule.'”

Davis ultimately gave up and determined as an alternative to pay out-of-pocket for a less expensive, compounded model of the drug made by a web based pharmacy.

Vida Well being did not reply questions on Davis’ care, regardless of his willingness to waive affected person privateness. It additionally did not reply questions on how its enterprise mannequin works.

As a substitute, Vida stated in an announcement that its suppliers adhere to scientific eligibility standards and plan sponsors’ protection insurance policies when prescribing remedy: “At Vida Well being, our prime precedence is delivering customized, clinically applicable care for each affected person.”

In an emailed assertion, Blue Cross and Blue Protect of Texas, which handles Davis’ insurance coverage, stated it “is dedicated to offering its members entry to protected, applicable, and efficient well being care inside the advantages supplied by their very own well being plan.” It would not touch upon Davis’ state of affairs however stated it was reaching out to him.

Telehealth corporations pivoted when weight problems medication grew to become blockbusters

Telehealth corporations like Vida Well being existed earlier than weight problems medication grew to become blockbusters, says Jayne Hornung, the chief scientific officer at MMIT, an information firm targeted on the prescribed drugs market. On the time, they supplied additional assist for Kind 2 diabetes prevention and administration. However that has modified.

“They’ve seen this chance within the bigger market with the GLP-1s and all of the wraparound providers that they might present,” she says. “And it is simply exploded.”

These telehealth suppliers are employed by employers that wish to decrease how a lot they spend on their workers’ weight-related well being care, together with on weight problems medication, says Hornung.

The providers are common with employers. Precise numbers are laborious to come back by, however one firm, Omada Well being, advised traders final month that its membership grew by 51% over the past 12 months to greater than one million folks. The corporate stated that on the finish of 2025 it had “supported greater than 150,000 members on GLP-1s, in contrast with greater than 50,000 on the finish of 2024.”

“Omada is neither a gatekeeper of GLP-1s nor are we a merchandising machine,” firm President Wei-Li Shao says. “And you will find each extremes of that spectrum on the market within the market.”

He says Omada offers evidence-backed care with suppliers who already know what your plan will cowl.

However MMIT’s Hornung sees it in another way. She says the telehealth corporations could be helpful, however additionally they supply employers “utilization administration beneath the guise of life-style intervention.”

“The endgame is to ultimately get the affected person wholesome, get them on an train program and get them off the GLP-1s,” she says. “Employers do not wish to pay for this endlessly both.”

Main care physicians increase the alarm

Dr. Catherine Varney is the weight problems drugs director for UVA Well being in Charlottesville, Virginia. When telehealth suppliers employed by employers to handle prices attempt to get her sufferers to come back off their weight problems medicines, she’s alarmed.

“I am like, whoa, whoa,” she says. “They’re providing medical recommendation exterior the scope of their follow, they usually’re pushing the sufferers to come back off the medicines when the proof is obvious within the analysis scientific trials that confirmed that when sufferers got here off these medicines, they regained two-thirds of their weight again, simply the identical as in the event you would come off blood strain drugs. Your blood strain would go up. In case you got here off ldl cholesterol drugs, your ldl cholesterol would go up.”

That is what occurred to one among Varney’s sufferers, 64-year-old Penny Byer, a homemaker who raised 5 kids in Stuarts Draft, Virginia.

She began on Wegovy in April 2025 and acquired to a wholesome physique mass index. Then, Virta Well being, a telehealth supplier, was added to her household’s advantages package deal. Virta kicked her off the drug in December.

Her weight and her ldl cholesterol returned to the place they had been earlier than Wegovy.

“All the things’s come again with a vengeance,” she says. “After a few month of arguing forwards and backwards with them and [they] simply saved saying, ‘No, we’re not — no, we’re not prescribing it anymore.’ It doesn’t matter what I finished or papers I introduced them or texts I despatched them and — nothing mattered.”

Virta declined to reply questions on Byer’s care regardless of her willingness to offer it permission to take action.

The corporate stated its personal analysis discovered that sufferers might maintain weight reduction after stopping weight problems medication. That’s at odds with a a lot bigger systematic evaluation printed in The BMJ, previously often known as the British Medical Journal. That evaluation included 37 research and 9,341 sufferers, and it concluded that cessation of weight problems medicines is adopted by “speedy weight regain.”

The layered roles of telehealth providers

Dr. Carolynn Francavilla, vice chairman of the Weight problems Medication Affiliation, says packages like Vida’s could be useful for some obesity-drug sufferers who like utilizing telehealth apps for logging meals and getting different assist.

For instance, Omada linked NPR with a person, Jackie O’Gorman of Pequannock Township, N.J., who says her Omada telehealth coaches helped her attain her objective weight and had grow to be her “greatest buddies.”

However necessities like commonly stepping on the size and logging weight into an app do not work for everybody, Francavilla says. For some folks, that may be upsetting, particularly if they’ve a historical past of disordered consuming.

“If they do not observe these guidelines, then they might now not be eligible to get the remedy. In order that’s usually an enormous problem and could be very distressing for sufferers,” says Francavilla, who is typically paid by drugmaker Eli Lilly to teach different well being professionals about how its weight problems medicines work. “And, you already know, that is not an evidence-based follow. That isn’t one thing that must be finished to soundly take these medicines.”

Too usually, she says, these telehealth corporations appear to be prioritizing gatekeeping the medicines and retaining prices down over the wants of sufferers.