GLP-1 medications continue to reshape healthcare delivery, creating new opportunities for patient care while introducing significant compliance responsibilities for providers, telehealth organizations, pharmacies, and health plans. In this episode of Compliance Deconstructed, Jessica Zeff is joined by co-hosts Elvan Baker and Lorie Davis to examine the regulatory and operational challenges surrounding GLP-1 prescribing, including telehealth evaluations, compounded medications, fraud, waste, and abuse risks, prior authorization requirements, and practical compliance oversight. The reality is that organizations often focus on patient demand without fully evaluating how their operational processes support compliant prescribing practices. Jessica, Elvan, and Lorie discuss why synchronous telehealth visits, thorough clinical documentation, provider licensure verification, and informed patient conversations all play an important role in reducing regulatory risk while supporting appropriate access to care. From a compliance standpoint, GLP-1 oversight extends well beyond the prescription itself. The conversation explores FDA scrutiny surrounding compounded GLP-1 medications, the role of pharmacy benefit managers, documentation expectations for medical necessity, and how financial incentives, prescribing trends, and marketing practices can create fraud, waste, and abuse concerns when organizations fail to implement appropriate safeguards. In practice, compliance requires ongoing monitoring rather than one-time policy development. Jessica, Elvan, and Lorie share practical strategies for incorporating GLP-1 medications into annual compliance risk assessments through documentation audits, claims monitoring, pharmacy verification, marketing reviews, and cross-functional collaboration that helps organizations balance regulatory expectations with sustainable patient care. Key takeaways: Understand how synchronous and asynchronous telehealth models create different compliance obligations for patient evaluation, informed consent, documentation, and provider accountability.Review GLP-1 prescribing workflows to verify provider licensure, patient identity, clinical necessity, and complete medical documentation before prescriptions are issued.Evaluate how your organization manages compounded GLP-1 medications, including pharmacy sourcing, FDA marketing requirements, and communications regarding product equivalency.Monitor prior authorization processes, diagnosis coding, and supporting documentation to reduce compliance risks associated with medical necessity and reimbursement.Assess fraud, waste, and abuse risk by reviewing prescribing patterns, refill activity, provider compensation structures, refund policies, and potential kickback concerns.Incorporate GLP-1 medications into your compliance audit program with regular risk assessments, claims reviews, marketing audits, and collaboration across compliance, operations, clinical, legal, and pharmacy teams. Don't miss this year's HCCA Conference in Pittsburgh! Click here for all the info. Learn more about Healthcare Compliance and discover how Simply Compliance can help your company at simplycomplianceconsulting.com.
