Patients who turned to gray-market retatrutide before its approval should be screened without judgment and brought back into supervised care rather than penalized, said Rob Stransky, founder of NiceRx, in a Q&A with The American Journal of Managed Care® (AJMC®).
Retatrutide, Eli Lilly’s investigational agonist of the glucose-dependent insulinotropic polypeptide, glucagon-like peptide-1 (GLP-1), and glucagon receptors, has fueled an online gray market of unregulated vials sold as research chemicals.1 In October, a research letter in JAMA Network Open that analyzed Reddit posts from 13,589 users reporting current retatrutide use called for nonjudgmental screening for nonapproved peptide use.2 Meanwhile, 14% of employers surveyed by the Business Group on Health have already dropped coverage of GLP-1s for weight loss or plan to do so in 2027.3
Stransky, whose telehealth company currently offers compounded GLP-1 therapies, discussed what routine peptide screening should look like at intake, the dosing and purity risks of gray-market products, and how health plans should handle members who used unapproved versions once retatrutide reaches the market.
AJMC: How often are NiceRx patients asking about retatrutide or disclosing that they’ve already used it or other gray-market peptides? How do your clinicians respond when they do?
Stransky: It’s not something we hear often. Most of our patients come to us specifically because they want medically supervised care, so unapproved or gray-market use isn’t a common disclosure for us. When it does come up, the approach is the same regardless of frequency: the clinicians never penalize disclosure. The goal in that conversation is to find out what was actually taken, counsel honestly on the risks of an unregulated product, and work with the patient on a supervised path forward.
AJMC: What should a nonjudgmental screening for nonapproved peptides look like in a telehealth or primary care intake?
Stransky: Practically, it means asking about peptide and GLP-1 use the same routine way you’d ask about supplements or alcohol as a standard question for every patient, not a flag that only comes up if something looks off. It means the question is framed without judgment, so a patient has no reason to hide the answer.
AJMC: Beyond the drug itself, what risks come from gray-market products, such as dosing, purity, and contamination, and what have you seen in practice?
Stransky: The drug risk is only part of it. These products typically come from unregulated or overseas labs with no sterility assurance, no verified concentration, and no consistent quality control from batch to batch, so a patient can’t actually know what dose they’re injecting or what else might be in the vial.