Pharmacists must be aware of several critical factors when supplying weight loss medications through a bricks-and-mortar or online pharmacy to ensure safety and compliance. Richard Hough and Thorrun Govind explain…

Earlier this year, the BBC investigated prescription drugs that were being sold online without robust checks, which is very much an area where pharmacy owners are at risk of adverse publicity.

In June, it was also reported that women were landing in A&E after abusing weight loss medications obtained online.

Prescribing/supply

A good starting point is the most recent information published by the GPhC - Weight loss medications-FAQ - which forms part of the standards that patients and the public can expect when accessing pharmacy services.

Published in March 2024, this indicates that whilst face to face care isn’t mandatory, the GPhC advises that the mode of consultation should be “appropriate to meet the needs of the patient” and should provide the means to ensure that the prescriber has enough information to make an appropriate prescribing decision.

Prescribing weight loss treatments safely will include (but not be limited to) carrying out ongoing monitoring of the patient, ensuring weight and height information is accurate and verified, and talking to the patient. Prescribers must be mindful that eating disorders, body dysmorphia and mental health issues may play a part in the reason for individuals requesting these medicines.

There have also been shortages of licensed weight loss medication glucagon-like peptide-1 receptor agonists (GLP-1 RAs) leading to the GPhC taking action against pharmacies for inappropriately supplying medicines that are licensed to treat diabetes for weight loss.

This should be considered in the context of the January 2024, National Patient Safety Alert, which required prescribers to prescribe medicines for licensed indications only and not off-label for the management of obesity.

The Royal Pharmaceutical Society’s Prescribing competency framework is established guidance to assist prescribing practitioners. It sets out what good prescribing looks like and describes the demonstrable knowledge, skills, characteristics, qualities and behaviours for a safe and effective prescribing role. This framework also provides helpful considerations for those supplying medications too.

Advertising

The Medicines and Healthcare products Regulatory Agency (MHRA) regulates medicines and medical devices in the UK and is the governmental agency which is responsible for ensuring that medicines and medical devices work and are acceptably safe.

The MHRA’s Blue Guide provides general advice and information on advertising and promotion of medicines. It also explains legislative provisions and requirements on advertising medicines and provides additional clarification, where necessary, on the interpretation of the law and its application to certain commonly encountered situations.

The Blue Guide should also be considered alongside the Advertising Standards Authority (ASA) Code of Conduct, rule 12.12  of which  states that prescription-only medicines (POMs) cannot be advertised directly to the public. It is also an offence under the Human Medicines Regulations 2012 to publish an advertisement that is likely to lead to the use of a POM.

The Blue Guide provides guidance on how the home page of websites should be configured and states that “buy now” or ‘’add to basket’’ icons should not be used. The ASA further confirms that advertising should not give the impression that a medical consultation is unnecessary, for example by offering a diagnosis or suggesting treatment by post, electronic communication or telephone.

It is often possible to talk about the services you offer more widely, but emphasis should usually be on promoting the consultation for a particular condition, such as weight management, (i.e. the service) rather than promoting a named POM which might be used to treat the condition.

The guidance published by the GPhC further confirms that it expects pharmacy owners to make sure that their websites do not allow a person to choose a POM and its quantity before there has been an appropriate consultation with a prescriber.

Digital Clinical Excellence (DiCE) UK Forum Best Practice Guidance includes many recommendations about how to provide an asynchronous weight management service, i.e. where a health assessment is undertaken remotely, gathering pertinent medical information using an online assessment form, which is then reviewed by a prescribing clinician before a prescription is issued.

However, the PDA has recently reported that significant numbers of pharmacist prescribers who use a questionnaire-based model of consultation, as advocated by DiCE, are being investigated by the GPhC, which considers it inappropriate to provide weight loss treatments solely based on a questionnaire model without verifying the reliability of the information provided by the person.

The GPhC has provided some examples of good practice when it comes to weight management, which include comprehensive prescribing notes, which are accessible to other prescribers and the pharmacy team, and unique consultation and counselling methods, such as bespoke information leaflets, administration videos and follow-up by video or telephone.

With the increasing demand for weight loss POMs, it is absolutely vital that pharmacists review their current policies for supplying such products and can satisfy themselves that, if scrutinised by the GPhC, they can evidence that their processes support the safe and effective provision of such products.

Richard Hough is a partner and head of healthcare at Brabners and a former pharmacist. His co-author Thorrun Govind is a pharmacist and solicitor at Brabners.