{
  "dataset_name": "The RX Index GLP-1 Telehealth Prescribing Practices Evidence Crosswalk",
  "version": "1.0",
  "last_verified": "2026-08-01",
  "record_count": 82,
  "methodology_summary": "Final published values from two peer-reviewed studies were transcribed with denominators preserved, then cross-referenced against current primary regulatory, label, and clinical-guidance sources. Cross-study samples were not pooled. RX Index derived measures use arithmetic within one source sample only.",
  "records": [
    {
      "metric_id": "OP-001",
      "evidence_layer": "Observed operational practices",
      "domain": "Site offering",
      "measure": "Compounded GLP-1 only",
      "numerator": 17,
      "denominator": 49,
      "percentage": "34.7",
      "value_text": "",
      "unit": "percent of sites",
      "denominator_definition": "All 49 websites approached in the secret-shopper study",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from one eligible simulated patient; not a national prevalence estimate, legal conclusion, or patient-outcome measure.",
      "notes": null,
      "row_number": 1
    },
    {
      "metric_id": "OP-002",
      "evidence_layer": "Observed operational practices",
      "domain": "Site offering",
      "measure": "Branded GLP-1 only",
      "numerator": 5,
      "denominator": 49,
      "percentage": "10.2",
      "value_text": "",
      "unit": "percent of sites",
      "denominator_definition": "All 49 websites approached in the secret-shopper study",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from one eligible simulated patient; not a national prevalence estimate, legal conclusion, or patient-outcome measure.",
      "notes": null,
      "row_number": 2
    },
    {
      "metric_id": "OP-003",
      "evidence_layer": "Observed operational practices",
      "domain": "Site offering",
      "measure": "Both branded and compounded GLP-1",
      "numerator": 27,
      "denominator": 49,
      "percentage": "55.1",
      "value_text": "",
      "unit": "percent of sites",
      "denominator_definition": "All 49 websites approached in the secret-shopper study",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from one eligible simulated patient; not a national prevalence estimate, legal conclusion, or patient-outcome measure.",
      "notes": null,
      "row_number": 3
    },
    {
      "metric_id": "OP-004",
      "evidence_layer": "Observed operational practices",
      "domain": "Prescription outcome",
      "measure": "Issued a GLP-1-based prescription",
      "numerator": 45,
      "denominator": 49,
      "percentage": "91.8",
      "value_text": "",
      "unit": "percent of sites",
      "denominator_definition": "All 49 websites approached in the secret-shopper study",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from one eligible simulated patient; not a national prevalence estimate, legal conclusion, or patient-outcome measure.",
      "notes": null,
      "row_number": 4
    },
    {
      "metric_id": "OP-005",
      "evidence_layer": "Observed operational practices",
      "domain": "Fulfillment",
      "measure": "Mailed medication",
      "numerator": 34,
      "denominator": 49,
      "percentage": "69.4",
      "value_text": "",
      "unit": "percent of sites",
      "denominator_definition": "All 49 websites approached in the secret-shopper study",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from one eligible simulated patient; not a national prevalence estimate, legal conclusion, or patient-outcome measure.",
      "notes": null,
      "row_number": 5
    },
    {
      "metric_id": "OP-006",
      "evidence_layer": "Observed operational practices",
      "domain": "Intake",
      "measure": "Used an intake questionnaire",
      "numerator": 49,
      "denominator": 49,
      "percentage": "100.0",
      "value_text": "",
      "unit": "percent of sites",
      "denominator_definition": "All 49 websites approached in the secret-shopper study",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from one eligible simulated patient; not a national prevalence estimate, legal conclusion, or patient-outcome measure.",
      "notes": null,
      "row_number": 6
    },
    {
      "metric_id": "OP-007",
      "evidence_layer": "Observed operational practices",
      "domain": "Screening",
      "measure": "Collected height and weight",
      "numerator": 49,
      "denominator": 49,
      "percentage": "100.0",
      "value_text": "",
      "unit": "percent of sites",
      "denominator_definition": "All 49 websites approached in the secret-shopper study",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from one eligible simulated patient; not a national prevalence estimate, legal conclusion, or patient-outcome measure.",
      "notes": null,
      "row_number": 7
    },
    {
      "metric_id": "OP-008",
      "evidence_layer": "Observed operational practices",
      "domain": "Screening",
      "measure": "Asked about weight-loss goal",
      "numerator": 39,
      "denominator": 49,
      "percentage": "79.6",
      "value_text": "",
      "unit": "percent of sites",
      "denominator_definition": "All 49 websites approached in the secret-shopper study",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from one eligible simulated patient; not a national prevalence estimate, legal conclusion, or patient-outcome measure.",
      "notes": null,
      "row_number": 8
    },
    {
      "metric_id": "OP-009",
      "evidence_layer": "Observed operational practices",
      "domain": "Screening",
      "measure": "Asked about prior nonpharmacologic weight-loss attempts",
      "numerator": 32,
      "denominator": 49,
      "percentage": "65.3",
      "value_text": "",
      "unit": "percent of sites",
      "denominator_definition": "All 49 websites approached in the secret-shopper study",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from one eligible simulated patient; not a national prevalence estimate, legal conclusion, or patient-outcome measure.",
      "notes": null,
      "row_number": 9
    },
    {
      "metric_id": "OP-010",
      "evidence_layer": "Observed operational practices",
      "domain": "Screening",
      "measure": "Asked about diet and physical activity",
      "numerator": 26,
      "denominator": 49,
      "percentage": "53.1",
      "value_text": "",
      "unit": "percent of sites",
      "denominator_definition": "All 49 websites approached in the secret-shopper study",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from one eligible simulated patient; not a national prevalence estimate, legal conclusion, or patient-outcome measure.",
      "notes": null,
      "row_number": 10
    },
    {
      "metric_id": "OP-011",
      "evidence_layer": "Observed operational practices",
      "domain": "Screening",
      "measure": "Asked about medical conditions",
      "numerator": 48,
      "denominator": 49,
      "percentage": "98.0",
      "value_text": "",
      "unit": "percent of sites",
      "denominator_definition": "All 49 websites approached in the secret-shopper study",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from one eligible simulated patient; not a national prevalence estimate, legal conclusion, or patient-outcome measure.",
      "notes": null,
      "row_number": 11
    },
    {
      "metric_id": "OP-012",
      "evidence_layer": "Observed operational practices",
      "domain": "Screening",
      "measure": "Asked about medications and allergies",
      "numerator": 46,
      "denominator": 49,
      "percentage": "93.9",
      "value_text": "",
      "unit": "percent of sites",
      "denominator_definition": "All 49 websites approached in the secret-shopper study",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from one eligible simulated patient; not a national prevalence estimate, legal conclusion, or patient-outcome measure.",
      "notes": null,
      "row_number": 12
    },
    {
      "metric_id": "OP-013",
      "evidence_layer": "Observed operational practices",
      "domain": "Screening",
      "measure": "Asked about eating-disorder history",
      "numerator": 27,
      "denominator": 49,
      "percentage": "55.1",
      "value_text": "",
      "unit": "percent of sites",
      "denominator_definition": "All 49 websites approached in the secret-shopper study",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from one eligible simulated patient; not a national prevalence estimate, legal conclusion, or patient-outcome measure.",
      "notes": null,
      "row_number": 13
    },
    {
      "metric_id": "OP-014",
      "evidence_layer": "Observed operational practices",
      "domain": "Screening",
      "measure": "Requested patient-reported blood pressure, glucose, cholesterol, or triglycerides",
      "numerator": 18,
      "denominator": 49,
      "percentage": "36.7",
      "value_text": "",
      "unit": "percent of sites",
      "denominator_definition": "All 49 websites approached in the secret-shopper study",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from one eligible simulated patient; not a national prevalence estimate, legal conclusion, or patient-outcome measure.",
      "notes": "Composite questionnaire item as reported by the study; it does not indicate that all four values were requested by each site.",
      "row_number": 14
    },
    {
      "metric_id": "OP-015",
      "evidence_layer": "Observed operational practices",
      "domain": "Compounding personalization",
      "measure": "Asked questions related to personalizing a compounded GLP-1 formulation",
      "numerator": 22,
      "denominator": 49,
      "percentage": "44.9",
      "value_text": "",
      "unit": "percent of sites",
      "denominator_definition": "All 49 websites approached in the secret-shopper study",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from one eligible simulated patient; not a national prevalence estimate, legal conclusion, or patient-outcome measure.",
      "notes": null,
      "row_number": 15
    },
    {
      "metric_id": "OP-016",
      "evidence_layer": "Observed operational practices",
      "domain": "Clinician contact",
      "measure": "Required a video visit",
      "numerator": 13,
      "denominator": 49,
      "percentage": "26.5",
      "value_text": "",
      "unit": "percent of sites",
      "denominator_definition": "All 49 websites approached in the secret-shopper study",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from one eligible simulated patient; not a national prevalence estimate, legal conclusion, or patient-outcome measure.",
      "notes": null,
      "row_number": 16
    },
    {
      "metric_id": "OP-017",
      "evidence_layer": "Observed operational practices",
      "domain": "Clinician contact",
      "measure": "Required a telephone call",
      "numerator": 3,
      "denominator": 49,
      "percentage": "6.1",
      "value_text": "",
      "unit": "percent of sites",
      "denominator_definition": "All 49 websites approached in the secret-shopper study",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from one eligible simulated patient; not a national prevalence estimate, legal conclusion, or patient-outcome measure.",
      "notes": null,
      "row_number": 17
    },
    {
      "metric_id": "OP-018",
      "evidence_layer": "Observed operational practices",
      "domain": "Clinician contact",
      "measure": "Required no spoken communication with a clinician",
      "numerator": 33,
      "denominator": 49,
      "percentage": "67.3",
      "value_text": "",
      "unit": "percent of sites",
      "denominator_definition": "All 49 websites approached in the secret-shopper study",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from one eligible simulated patient; not a national prevalence estimate, legal conclusion, or patient-outcome measure.",
      "notes": "No spoken communication does not establish that no clinician reviewed the questionnaire asynchronously.",
      "row_number": 18
    },
    {
      "metric_id": "OP-019",
      "evidence_layer": "Observed operational practices",
      "domain": "Care coordination",
      "measure": "Asked whether the simulated patient had a primary care clinician",
      "numerator": 9,
      "denominator": 49,
      "percentage": "18.4",
      "value_text": "",
      "unit": "percent of sites",
      "denominator_definition": "All 49 websites approached in the secret-shopper study",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from one eligible simulated patient; not a national prevalence estimate, legal conclusion, or patient-outcome measure.",
      "notes": null,
      "row_number": 19
    },
    {
      "metric_id": "OP-020",
      "evidence_layer": "Observed operational practices",
      "domain": "Medication type",
      "measure": "Issued prescription was for a compounded GLP-1",
      "numerator": 39,
      "denominator": 45,
      "percentage": "86.7",
      "value_text": "",
      "unit": "percent",
      "denominator_definition": "The 45 sites that issued a prescription",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from the study sample; do not generalize to all telehealth prescribers or infer patient harm.",
      "notes": null,
      "row_number": 20
    },
    {
      "metric_id": "OP-021",
      "evidence_layer": "Observed operational practices",
      "domain": "Medication type",
      "measure": "Issued prescription was for a branded GLP-1",
      "numerator": 6,
      "denominator": 45,
      "percentage": "13.3",
      "value_text": "",
      "unit": "percent",
      "denominator_definition": "The 45 sites that issued a prescription",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from the study sample; do not generalize to all telehealth prescribers or infer patient harm.",
      "notes": null,
      "row_number": 21
    },
    {
      "metric_id": "OP-022",
      "evidence_layer": "Observed operational practices",
      "domain": "Verification",
      "measure": "Issued prescription despite incomplete requested photo evidence",
      "numerator": 9,
      "denominator": 45,
      "percentage": "20.0",
      "value_text": "",
      "unit": "percent",
      "denominator_definition": "The 45 sites that issued a prescription",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from the study sample; do not generalize to all telehealth prescribers or infer patient harm.",
      "notes": "The simulated patient supplied an upper-body photograph when a full-body or scale photograph had been requested.",
      "row_number": 22
    },
    {
      "metric_id": "OP-023",
      "evidence_layer": "Observed operational practices",
      "domain": "Fulfillment",
      "measure": "Automatically charged and shipped after approval without additional patient confirmation",
      "numerator": 34,
      "denominator": 45,
      "percentage": "75.6",
      "value_text": "",
      "unit": "percent",
      "denominator_definition": "The 45 sites that issued a prescription",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from the study sample; do not generalize to all telehealth prescribers or infer patient harm.",
      "notes": null,
      "row_number": 23
    },
    {
      "metric_id": "OP-024",
      "evidence_layer": "Observed operational practices",
      "domain": "Speed",
      "measure": "Prescription issued within five minutes or less",
      "numerator": 2,
      "denominator": 45,
      "percentage": "4.4",
      "value_text": "",
      "unit": "percent",
      "denominator_definition": "The 45 sites that issued a prescription",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from the study sample; do not generalize to all telehealth prescribers or infer patient harm.",
      "notes": "Both were compounded prescriptions.",
      "row_number": 24
    },
    {
      "metric_id": "OP-025",
      "evidence_layer": "Observed operational practices",
      "domain": "Mailed medication type",
      "measure": "Mailed medication was compounded",
      "numerator": 32,
      "denominator": 34,
      "percentage": "94.1",
      "value_text": "",
      "unit": "percent",
      "denominator_definition": "The 34 sites that mailed medication",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from the study sample; do not generalize to all telehealth prescribers or infer patient harm.",
      "notes": null,
      "row_number": 25
    },
    {
      "metric_id": "OP-026",
      "evidence_layer": "Observed operational practices",
      "domain": "Mailed medication type",
      "measure": "Mailed medication was branded",
      "numerator": 2,
      "denominator": 34,
      "percentage": "5.9",
      "value_text": "",
      "unit": "percent",
      "denominator_definition": "The 34 sites that mailed medication",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive result from the study sample; do not generalize to all telehealth prescribers or infer patient harm.",
      "notes": null,
      "row_number": 26
    },
    {
      "metric_id": "OP-027",
      "evidence_layer": "Observed operational practices",
      "domain": "Speed",
      "measure": "Median time from request to prescription",
      "numerator": "",
      "denominator": "",
      "percentage": "",
      "value_text": "1 day or less (IQR: 1 day or less to 2 days)",
      "unit": "time",
      "denominator_definition": "Sites that issued a prescription",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "The publication reports a study median; it is not a service-level benchmark for the full market.",
      "notes": null,
      "row_number": 27
    },
    {
      "metric_id": "OP-028",
      "evidence_layer": "Observed operational practices",
      "domain": "Supply",
      "measure": "Median medication supply mailed",
      "numerator": "",
      "denominator": "",
      "percentage": "",
      "value_text": "1 month",
      "unit": "months",
      "denominator_definition": "Mailed medication orders",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Study-sample median.",
      "notes": null,
      "row_number": 28
    },
    {
      "metric_id": "OP-029",
      "evidence_layer": "Observed operational practices",
      "domain": "Price",
      "measure": "Median all-in monthly price",
      "numerator": "",
      "denominator": "",
      "percentage": "",
      "value_text": "$217.33 per month (IQR: $159.36–$289.24)",
      "unit": "U.S. dollars per month",
      "denominator_definition": "Study purchases; price included medication, appointment, and membership charges",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Historical 2025 study prices; not a current market-price claim.",
      "notes": null,
      "row_number": 29
    },
    {
      "metric_id": "OP-030",
      "evidence_layer": "Observed operational practices",
      "domain": "Cross-platform prescribing",
      "measure": "Clinicians who prescribed to the same simulated patient through two or more websites",
      "numerator": 3,
      "denominator": "",
      "percentage": "",
      "value_text": "3 clinicians",
      "unit": "clinicians",
      "denominator_definition": "Count reported by the study; denominator not published as a rate",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "A count, not a market prevalence estimate.",
      "notes": null,
      "row_number": 30
    },
    {
      "metric_id": "OP-031",
      "evidence_layer": "Observed operational practices",
      "domain": "Non-prescribing outcomes",
      "measure": "Sites that did not issue a prescription",
      "numerator": 4,
      "denominator": 49,
      "percentage": "8.2",
      "value_text": "",
      "unit": "percent of sites",
      "denominator_definition": "All 49 websites approached",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "reported",
      "source_type": "Peer-reviewed research letter",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Reasons differed: two stopped at a bloodwork request, one initially denied based on duplicate-prescription data, and one transaction ended after a photo/weight mismatch.",
      "notes": "One duplicate-prescription denial was later reversed after a refund request, according to the study recap.",
      "row_number": 31
    },
    {
      "metric_id": "AD-001",
      "evidence_layer": "Publicly stated advertising practices",
      "domain": "Medication advertised",
      "measure": "Compounded semaglutide offered",
      "numerator": 79,
      "denominator": 79,
      "percentage": "100.0",
      "value_text": "",
      "unit": "percent of websites",
      "denominator_definition": "The 79 websites included in the 2024 advertising study",
      "fieldwork_start": "2024-07",
      "fieldwork_end": "2024-09",
      "publication_date": "2025-01-10",
      "geography": "United States web search; Google Shopping sponsored results",
      "measure_type": "reported",
      "source_type": "Peer-reviewed cross-sectional study",
      "source_title": "Online Advertising of Compounded Glucagon-Like Peptide-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama-health-forum/fullarticle/2829225",
      "source_doi": "https://doi.org/10.1001/jamahealthforum.2024.5018",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Website-advertising content, not a direct observation of what happened during a prescription attempt. Do not compare as a trend against the 49-site operational sample.",
      "notes": null,
      "row_number": 32
    },
    {
      "metric_id": "AD-002",
      "evidence_layer": "Publicly stated advertising practices",
      "domain": "Medication advertised",
      "measure": "Compounded tirzepatide offered",
      "numerator": 57,
      "denominator": 79,
      "percentage": "72.2",
      "value_text": "",
      "unit": "percent of websites",
      "denominator_definition": "The 79 websites included in the 2024 advertising study",
      "fieldwork_start": "2024-07",
      "fieldwork_end": "2024-09",
      "publication_date": "2025-01-10",
      "geography": "United States web search; Google Shopping sponsored results",
      "measure_type": "reported",
      "source_type": "Peer-reviewed cross-sectional study",
      "source_title": "Online Advertising of Compounded Glucagon-Like Peptide-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama-health-forum/fullarticle/2829225",
      "source_doi": "https://doi.org/10.1001/jamahealthforum.2024.5018",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Website-advertising content, not a direct observation of what happened during a prescription attempt. Do not compare as a trend against the 49-site operational sample.",
      "notes": null,
      "row_number": 33
    },
    {
      "metric_id": "AD-003",
      "evidence_layer": "Publicly stated advertising practices",
      "domain": "Medication advertised",
      "measure": "Compounded liraglutide offered",
      "numerator": 3,
      "denominator": 79,
      "percentage": "3.8",
      "value_text": "",
      "unit": "percent of websites",
      "denominator_definition": "The 79 websites included in the 2024 advertising study",
      "fieldwork_start": "2024-07",
      "fieldwork_end": "2024-09",
      "publication_date": "2025-01-10",
      "geography": "United States web search; Google Shopping sponsored results",
      "measure_type": "reported",
      "source_type": "Peer-reviewed cross-sectional study",
      "source_title": "Online Advertising of Compounded Glucagon-Like Peptide-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama-health-forum/fullarticle/2829225",
      "source_doi": "https://doi.org/10.1001/jamahealthforum.2024.5018",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Website-advertising content, not a direct observation of what happened during a prescription attempt. Do not compare as a trend against the 49-site operational sample.",
      "notes": null,
      "row_number": 34
    },
    {
      "metric_id": "AD-004",
      "evidence_layer": "Publicly stated advertising practices",
      "domain": "Medication advertised",
      "measure": "Branded GLP-1 offered",
      "numerator": 23,
      "denominator": 79,
      "percentage": "29.1",
      "value_text": "",
      "unit": "percent of websites",
      "denominator_definition": "The 79 websites included in the 2024 advertising study",
      "fieldwork_start": "2024-07",
      "fieldwork_end": "2024-09",
      "publication_date": "2025-01-10",
      "geography": "United States web search; Google Shopping sponsored results",
      "measure_type": "reported",
      "source_type": "Peer-reviewed cross-sectional study",
      "source_title": "Online Advertising of Compounded Glucagon-Like Peptide-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama-health-forum/fullarticle/2829225",
      "source_doi": "https://doi.org/10.1001/jamahealthforum.2024.5018",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Website-advertising content, not a direct observation of what happened during a prescription attempt. Do not compare as a trend against the 49-site operational sample.",
      "notes": null,
      "row_number": 35
    },
    {
      "metric_id": "AD-005",
      "evidence_layer": "Publicly stated advertising practices",
      "domain": "Medication advertised",
      "measure": "Compounded GLP-1 offered with a supplement",
      "numerator": 29,
      "denominator": 79,
      "percentage": "36.7",
      "value_text": "",
      "unit": "percent of websites",
      "denominator_definition": "The 79 websites included in the 2024 advertising study",
      "fieldwork_start": "2024-07",
      "fieldwork_end": "2024-09",
      "publication_date": "2025-01-10",
      "geography": "United States web search; Google Shopping sponsored results",
      "measure_type": "reported",
      "source_type": "Peer-reviewed cross-sectional study",
      "source_title": "Online Advertising of Compounded Glucagon-Like Peptide-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama-health-forum/fullarticle/2829225",
      "source_doi": "https://doi.org/10.1001/jamahealthforum.2024.5018",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Website-advertising content, not a direct observation of what happened during a prescription attempt. Do not compare as a trend against the 49-site operational sample.",
      "notes": null,
      "row_number": 36
    },
    {
      "metric_id": "AD-006",
      "evidence_layer": "Publicly stated advertising practices",
      "domain": "Sales channel",
      "measure": "Online-only sales",
      "numerator": 56,
      "denominator": 79,
      "percentage": "70.9",
      "value_text": "",
      "unit": "percent of websites",
      "denominator_definition": "The 79 websites included in the 2024 advertising study",
      "fieldwork_start": "2024-07",
      "fieldwork_end": "2024-09",
      "publication_date": "2025-01-10",
      "geography": "United States web search; Google Shopping sponsored results",
      "measure_type": "reported",
      "source_type": "Peer-reviewed cross-sectional study",
      "source_title": "Online Advertising of Compounded Glucagon-Like Peptide-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama-health-forum/fullarticle/2829225",
      "source_doi": "https://doi.org/10.1001/jamahealthforum.2024.5018",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Website-advertising content, not a direct observation of what happened during a prescription attempt. Do not compare as a trend against the 49-site operational sample.",
      "notes": null,
      "row_number": 37
    },
    {
      "metric_id": "AD-007",
      "evidence_layer": "Publicly stated advertising practices",
      "domain": "Sales channel",
      "measure": "In-person-only sales",
      "numerator": 6,
      "denominator": 79,
      "percentage": "7.6",
      "value_text": "",
      "unit": "percent of websites",
      "denominator_definition": "The 79 websites included in the 2024 advertising study",
      "fieldwork_start": "2024-07",
      "fieldwork_end": "2024-09",
      "publication_date": "2025-01-10",
      "geography": "United States web search; Google Shopping sponsored results",
      "measure_type": "reported",
      "source_type": "Peer-reviewed cross-sectional study",
      "source_title": "Online Advertising of Compounded Glucagon-Like Peptide-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama-health-forum/fullarticle/2829225",
      "source_doi": "https://doi.org/10.1001/jamahealthforum.2024.5018",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Website-advertising content, not a direct observation of what happened during a prescription attempt. Do not compare as a trend against the 49-site operational sample.",
      "notes": null,
      "row_number": 38
    },
    {
      "metric_id": "AD-008",
      "evidence_layer": "Publicly stated advertising practices",
      "domain": "Sales channel",
      "measure": "Both online and in-person sales",
      "numerator": 17,
      "denominator": 79,
      "percentage": "21.5",
      "value_text": "",
      "unit": "percent of websites",
      "denominator_definition": "The 79 websites included in the 2024 advertising study",
      "fieldwork_start": "2024-07",
      "fieldwork_end": "2024-09",
      "publication_date": "2025-01-10",
      "geography": "United States web search; Google Shopping sponsored results",
      "measure_type": "reported",
      "source_type": "Peer-reviewed cross-sectional study",
      "source_title": "Online Advertising of Compounded Glucagon-Like Peptide-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama-health-forum/fullarticle/2829225",
      "source_doi": "https://doi.org/10.1001/jamahealthforum.2024.5018",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Website-advertising content, not a direct observation of what happened during a prescription attempt. Do not compare as a trend against the 49-site operational sample.",
      "notes": null,
      "row_number": 39
    },
    {
      "metric_id": "AD-009",
      "evidence_layer": "Publicly stated advertising practices",
      "domain": "Clinician involvement advertised",
      "measure": "Any clinician involvement stated",
      "numerator": 78,
      "denominator": 79,
      "percentage": "98.7",
      "value_text": "",
      "unit": "percent of websites",
      "denominator_definition": "The 79 websites included in the 2024 advertising study",
      "fieldwork_start": "2024-07",
      "fieldwork_end": "2024-09",
      "publication_date": "2025-01-10",
      "geography": "United States web search; Google Shopping sponsored results",
      "measure_type": "reported",
      "source_type": "Peer-reviewed cross-sectional study",
      "source_title": "Online Advertising of Compounded Glucagon-Like Peptide-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama-health-forum/fullarticle/2829225",
      "source_doi": "https://doi.org/10.1001/jamahealthforum.2024.5018",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
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    },
    {
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      "notes": null,
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    },
    {
      "metric_id": "AD-011",
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      "domain": "Clinician involvement advertised",
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      "interpretation_guardrail": "Website-advertising content, not a direct observation of what happened during a prescription attempt. Do not compare as a trend against the 49-site operational sample.",
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    {
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      "domain": "Clinician involvement advertised",
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      "interpretation_guardrail": "Website-advertising content, not a direct observation of what happened during a prescription attempt. Do not compare as a trend against the 49-site operational sample.",
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      "interpretation_guardrail": "Website-advertising content, not a direct observation of what happened during a prescription attempt. Do not compare as a trend against the 49-site operational sample.",
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    {
      "metric_id": "AD-015",
      "evidence_layer": "Publicly stated advertising practices",
      "domain": "Testing advertised",
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      "denominator_definition": "The 79 websites included in the 2024 advertising study",
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      "source_doi": "https://doi.org/10.1001/jamahealthforum.2024.5018",
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      "interpretation_guardrail": "Website-advertising content, not a direct observation of what happened during a prescription attempt. Do not compare as a trend against the 49-site operational sample.",
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    },
    {
      "metric_id": "AD-016",
      "evidence_layer": "Publicly stated advertising practices",
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      "unit": "percent of websites",
      "denominator_definition": "The 79 websites included in the 2024 advertising study",
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      "source_type": "Peer-reviewed cross-sectional study",
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    },
    {
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      "denominator_definition": "The 79 websites included in the 2024 advertising study",
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      "source_type": "Peer-reviewed cross-sectional study",
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      "source_doi": "https://doi.org/10.1001/jamahealthforum.2024.5018",
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      "interpretation_guardrail": "Website-advertising content, not a direct observation of what happened during a prescription attempt. Do not compare as a trend against the 49-site operational sample.",
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    },
    {
      "metric_id": "AD-018",
      "evidence_layer": "Publicly stated advertising practices",
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      "unit": "percent of websites",
      "denominator_definition": "The 79 websites included in the 2024 advertising study",
      "fieldwork_start": "2024-07",
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      "source_type": "Peer-reviewed cross-sectional study",
      "source_title": "Online Advertising of Compounded Glucagon-Like Peptide-1 Receptor Agonists",
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      "source_doi": "https://doi.org/10.1001/jamahealthforum.2024.5018",
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    },
    {
      "metric_id": "AD-019",
      "evidence_layer": "Publicly stated advertising practices",
      "domain": "Compounding disclosure",
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      "denominator_definition": "The 79 websites included in the 2024 advertising study",
      "fieldwork_start": "2024-07",
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      "interpretation_guardrail": "Website-advertising content, not a direct observation of what happened during a prescription attempt. Do not compare as a trend against the 49-site operational sample.",
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    },
    {
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      "domain": "FDA-status disclosure",
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      "value_text": "",
      "unit": "percent of websites",
      "denominator_definition": "The 79 websites included in the 2024 advertising study",
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      "interpretation_guardrail": "Website-advertising content, not a direct observation of what happened during a prescription attempt. Do not compare as a trend against the 49-site operational sample.",
      "notes": null,
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    },
    {
      "metric_id": "AD-021",
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      "unit": "percent of websites",
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    },
    {
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      "denominator_definition": "The 79 websites included in the 2024 advertising study",
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    },
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    },
    {
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    {
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      "evidence_layer": "Publicly stated advertising practices",
      "domain": "Efficacy claim",
      "measure": "Made an efficacy claim not included in FDA-approved branded GLP-1 labels",
      "numerator": 32,
      "denominator": 79,
      "percentage": "40.5",
      "value_text": "",
      "unit": "percent of websites",
      "denominator_definition": "The 79 websites included in the 2024 advertising study",
      "fieldwork_start": "2024-07",
      "fieldwork_end": "2024-09",
      "publication_date": "2025-01-10",
      "geography": "United States web search; Google Shopping sponsored results",
      "measure_type": "reported",
      "source_type": "Peer-reviewed cross-sectional study",
      "source_title": "Online Advertising of Compounded Glucagon-Like Peptide-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama-health-forum/fullarticle/2829225",
      "source_doi": "https://doi.org/10.1001/jamahealthforum.2024.5018",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Website-advertising content, not a direct observation of what happened during a prescription attempt. Do not compare as a trend against the 49-site operational sample.",
      "notes": null,
      "row_number": 60
    },
    {
      "metric_id": "AD-030",
      "evidence_layer": "Publicly stated advertising practices",
      "domain": "Discontinuation information",
      "measure": "Discussed effects of discontinuation",
      "numerator": 29,
      "denominator": 79,
      "percentage": "36.7",
      "value_text": "",
      "unit": "percent of websites",
      "denominator_definition": "The 79 websites included in the 2024 advertising study",
      "fieldwork_start": "2024-07",
      "fieldwork_end": "2024-09",
      "publication_date": "2025-01-10",
      "geography": "United States web search; Google Shopping sponsored results",
      "measure_type": "reported",
      "source_type": "Peer-reviewed cross-sectional study",
      "source_title": "Online Advertising of Compounded Glucagon-Like Peptide-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama-health-forum/fullarticle/2829225",
      "source_doi": "https://doi.org/10.1001/jamahealthforum.2024.5018",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Website-advertising content, not a direct observation of what happened during a prescription attempt. Do not compare as a trend against the 49-site operational sample.",
      "notes": null,
      "row_number": 61
    },
    {
      "metric_id": "AD-031",
      "evidence_layer": "Publicly stated advertising practices",
      "domain": "Price",
      "measure": "Median advertised first-month price for compounded semaglutide",
      "numerator": "",
      "denominator": "",
      "percentage": "",
      "value_text": "$231 (IQR: $189–$294)",
      "unit": "U.S. dollars, first month",
      "denominator_definition": "Websites advertising compounded semaglutide",
      "fieldwork_start": "2024-07",
      "fieldwork_end": "2024-09",
      "publication_date": "2025-01-10",
      "geography": "United States web search; Google Shopping sponsored results",
      "measure_type": "reported",
      "source_type": "Peer-reviewed cross-sectional study",
      "source_title": "Online Advertising of Compounded Glucagon-Like Peptide-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama-health-forum/fullarticle/2829225",
      "source_doi": "https://doi.org/10.1001/jamahealthforum.2024.5018",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Historical advertised price during July–September 2024; discounts included.",
      "notes": null,
      "row_number": 62
    },
    {
      "metric_id": "AD-032",
      "evidence_layer": "Publicly stated advertising practices",
      "domain": "Price",
      "measure": "Median advertised first-month price for compounded tirzepatide",
      "numerator": "",
      "denominator": "",
      "percentage": "",
      "value_text": "$330 (IQR: $275–$399)",
      "unit": "U.S. dollars, first month",
      "denominator_definition": "Websites advertising compounded tirzepatide",
      "fieldwork_start": "2024-07",
      "fieldwork_end": "2024-09",
      "publication_date": "2025-01-10",
      "geography": "United States web search; Google Shopping sponsored results",
      "measure_type": "reported",
      "source_type": "Peer-reviewed cross-sectional study",
      "source_title": "Online Advertising of Compounded Glucagon-Like Peptide-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama-health-forum/fullarticle/2829225",
      "source_doi": "https://doi.org/10.1001/jamahealthforum.2024.5018",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Historical advertised price during July–September 2024; discounts included.",
      "notes": null,
      "row_number": 63
    },
    {
      "metric_id": "AD-033",
      "evidence_layer": "Publicly stated advertising practices",
      "domain": "Price",
      "measure": "Median advertised first-month price for compounded liraglutide",
      "numerator": "",
      "denominator": "",
      "percentage": "",
      "value_text": "$248 (IQR: $223–$274)",
      "unit": "U.S. dollars, first month",
      "denominator_definition": "Websites advertising compounded liraglutide",
      "fieldwork_start": "2024-07",
      "fieldwork_end": "2024-09",
      "publication_date": "2025-01-10",
      "geography": "United States web search; Google Shopping sponsored results",
      "measure_type": "reported",
      "source_type": "Peer-reviewed cross-sectional study",
      "source_title": "Online Advertising of Compounded Glucagon-Like Peptide-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama-health-forum/fullarticle/2829225",
      "source_doi": "https://doi.org/10.1001/jamahealthforum.2024.5018",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Historical advertised price during July–September 2024; only three sites offered compounded liraglutide.",
      "notes": null,
      "row_number": 64
    },
    {
      "metric_id": "RX-001",
      "evidence_layer": "The RX Index derived measures",
      "domain": "Questionnaire coverage",
      "measure": "Height/weight coverage minus patient-reported clinical-values coverage",
      "numerator": "",
      "denominator": "",
      "percentage": "63.3",
      "value_text": "63.3 percentage points",
      "unit": "percentage points",
      "denominator_definition": "Both source measures use all 49 operational-study websites",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "derived",
      "source_type": "Calculation from peer-reviewed study counts",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "true",
      "derivation_formula": "(49/49 × 100) − (18/49 × 100) = 63.3 percentage points",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "A difference in questionnaire-item coverage, not a validated quality score and not proof that labs or these values were clinically required for every patient.",
      "notes": "Primary original statistic for the page.",
      "row_number": 65
    },
    {
      "metric_id": "RX-002",
      "evidence_layer": "The RX Index derived measures",
      "domain": "Questionnaire coverage",
      "measure": "Medical-condition coverage minus eating-disorder-history coverage",
      "numerator": "",
      "denominator": "",
      "percentage": "42.9",
      "value_text": "42.9 percentage points",
      "unit": "percentage points",
      "denominator_definition": "Both source measures use all 49 operational-study websites",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "derived",
      "source_type": "Calculation from peer-reviewed study counts",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "true",
      "derivation_formula": "(48/49 × 100) − (27/49 × 100) = 42.9 percentage points",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive coverage contrast, not a clinical-quality score.",
      "notes": null,
      "row_number": 66
    },
    {
      "metric_id": "RX-003",
      "evidence_layer": "The RX Index derived measures",
      "domain": "Questionnaire coverage",
      "measure": "Medication/allergy coverage minus diet/physical-activity coverage",
      "numerator": "",
      "denominator": "",
      "percentage": "40.8",
      "value_text": "40.8 percentage points",
      "unit": "percentage points",
      "denominator_definition": "Both source measures use all 49 operational-study websites",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "derived",
      "source_type": "Calculation from peer-reviewed study counts",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "true",
      "derivation_formula": "(46/49 × 100) − (26/49 × 100) = 40.8 percentage points",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Descriptive coverage contrast, not a clinical-quality score.",
      "notes": null,
      "row_number": 67
    },
    {
      "metric_id": "RX-004",
      "evidence_layer": "The RX Index derived measures",
      "domain": "Clinician contact",
      "measure": "Required spoken clinician interaction",
      "numerator": 16,
      "denominator": 49,
      "percentage": "32.7",
      "value_text": "16 of 49 sites (32.7%)",
      "unit": "percent of sites",
      "denominator_definition": "All 49 operational-study websites",
      "fieldwork_start": "2025-08",
      "fieldwork_end": "2025-12",
      "publication_date": "2026-07-06",
      "geography": "Websites serving Connecticut; one eligible simulated patient",
      "measure_type": "derived",
      "source_type": "Calculation from mutually exclusive published categories",
      "source_title": "Online Prescribing of GLP-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama/article-abstract/2851149",
      "source_doi": "https://doi.org/10.1001/jama.2026.9131",
      "rxindex_derived": "true",
      "derivation_formula": "13 video + 3 telephone = 16 sites; 16/49 = 32.7%",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "“Spoken interaction” combines required video and telephone contact. It does not measure asynchronous clinician review or care quality.",
      "notes": null,
      "row_number": 68
    },
    {
      "metric_id": "RX-005",
      "evidence_layer": "The RX Index derived measures",
      "domain": "Compounding disclosure",
      "measure": "At-least-once compounded disclosure minus consistent compounded disclosure",
      "numerator": "",
      "denominator": "",
      "percentage": "69.6",
      "value_text": "69.6 percentage points",
      "unit": "percentage points",
      "denominator_definition": "Both source measures use all 79 advertising-study websites",
      "fieldwork_start": "2024-07",
      "fieldwork_end": "2024-09",
      "publication_date": "2025-01-10",
      "geography": "United States web search; Google Shopping sponsored results",
      "measure_type": "derived",
      "source_type": "Calculation from peer-reviewed study counts",
      "source_title": "Online Advertising of Compounded Glucagon-Like Peptide-1 Receptor Agonists",
      "source_url": "https://jamanetwork.com/journals/jama-health-forum/fullarticle/2829225",
      "source_doi": "https://doi.org/10.1001/jamahealthforum.2024.5018",
      "rxindex_derived": "true",
      "derivation_formula": "(68/79 × 100) − (13/79 × 100) = 69.6 percentage points",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "A disclosure-consistency contrast, not a legal determination for any individual site.",
      "notes": null,
      "row_number": 69
    },
    {
      "metric_id": "STD-001",
      "evidence_layer": "Standards and requirements crosswalk",
      "domain": "FDA status",
      "measure": "Compounded drugs are FDA approved",
      "numerator": "",
      "denominator": "",
      "percentage": "",
      "value_text": "No. FDA does not approve compounded drugs and does not review their safety, effectiveness, or quality before marketing.",
      "unit": "authoritative statement",
      "denominator_definition": "",
      "fieldwork_start": "",
      "fieldwork_end": "",
      "publication_date": "2026-03-03",
      "geography": "United States",
      "measure_type": "current authoritative fact",
      "source_type": "FDA",
      "source_title": "FDA Warns 30 Telehealth Companies Against Illegal Marketing of Compounded GLP-1s",
      "source_url": "https://www.fda.gov/news-events/press-announcements/fda-warns-30-telehealth-companies-against-illegal-marketing-compounded-glp-1s",
      "source_doi": "",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "This is a general regulatory statement; whether a particular compounded prescription is lawful depends on the applicable compounding facts and law.",
      "notes": null,
      "row_number": 70
    },
    {
      "metric_id": "STD-002",
      "evidence_layer": "Standards and requirements crosswalk",
      "domain": "Promotion",
      "measure": "Marketing a compounded drug as generic, the same as an FDA-approved drug, FDA approved, or clinically proven to produce the same result",
      "numerator": "",
      "denominator": "",
      "percentage": "",
      "value_text": "FDA identifies these as false or misleading promotional claims.",
      "unit": "regulatory guidance",
      "denominator_definition": "",
      "fieldwork_start": "",
      "fieldwork_end": "",
      "publication_date": "2026-06-15",
      "geography": "United States",
      "measure_type": "current authoritative fact",
      "source_type": "FDA",
      "source_title": "FDA to Telehealth Companies: What to Know When Promoting Compounded Drugs",
      "source_url": "https://www.fda.gov/drugs/human-drug-compounding/fda-telehealth-companies-what-know-when-promoting-compounded-drugs",
      "source_doi": "",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "This row addresses promotion, not the adequacy of an individual clinical encounter.",
      "notes": null,
      "row_number": 71
    },
    {
      "metric_id": "STD-003",
      "evidence_layer": "Standards and requirements crosswalk",
      "domain": "Licensure",
      "measure": "Provider authority to practice across state lines",
      "numerator": "",
      "denominator": "",
      "percentage": "",
      "value_text": "State-dependent. Providers generally must use an applicable full license, compact, registration, reciprocity, temporary-practice pathway, or other state exception.",
      "unit": "legal framework",
      "denominator_definition": "",
      "fieldwork_start": "",
      "fieldwork_end": "",
      "publication_date": "",
      "geography": "United States",
      "measure_type": "current authoritative fact",
      "source_type": "HHS telehealth guidance",
      "source_title": "Licensing across state lines",
      "source_url": "https://telehealth.hhs.gov/licensure/licensing-across-state-lines",
      "source_doi": "",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Not legal advice. Recheck the patient’s state medical board and statutes before publishing a state-specific claim.",
      "notes": null,
      "row_number": 72
    },
    {
      "metric_id": "STD-004",
      "evidence_layer": "Standards and requirements crosswalk",
      "domain": "Modality",
      "measure": "Universal federal requirement for a live video visit before a noncontrolled GLP-1 prescription",
      "numerator": "",
      "denominator": "",
      "percentage": "",
      "value_text": "No universal live-video requirement was identified in the cited federal telehealth and drug sources. State law, licensure, patient-location rules, standard of care, and platform facts still control.",
      "unit": "document-review finding",
      "denominator_definition": "",
      "fieldwork_start": "",
      "fieldwork_end": "",
      "publication_date": "",
      "geography": "United States",
      "measure_type": "current-verification finding",
      "source_type": "HHS/FDA source review",
      "source_title": "HHS telehealth guidance; DEA controlled-medication extension; current Wegovy and Zepbound labeling",
      "source_url": "https://telehealth.hhs.gov/providers/best-practice-guides/direct-to-consumer/asynchronous-direct-to-consumer-telehealth | https://telehealth.hhs.gov/licensure/licensing-across-state-lines | https://www.dea.gov/press-releases/2025/12/31/dea-extends-telemedicine-flexibilities-ensure-continued-access-care | https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b | https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b",
      "source_doi": "",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Phrase narrowly. This is not a 50-state legal survey and does not mean every asynchronous prescription is lawful or clinically appropriate.",
      "notes": "Narrow document-review finding for noncontrolled semaglutide and tirzepatide; not a fifty-state legal conclusion.",
      "row_number": 73
    },
    {
      "metric_id": "STD-005",
      "evidence_layer": "Standards and requirements crosswalk",
      "domain": "Baseline testing",
      "measure": "Universal baseline laboratory panel specified for every Wegovy or Zepbound patient",
      "numerator": "",
      "denominator": "",
      "percentage": "",
      "value_text": "No universal baseline laboratory panel was identified in the current prescribing information reviewed. The labels contain contraindications, warnings, and condition-specific monitoring instructions.",
      "unit": "label-review finding",
      "denominator_definition": "",
      "fieldwork_start": "",
      "fieldwork_end": "",
      "publication_date": "",
      "geography": "United States",
      "measure_type": "current-verification finding",
      "source_type": "FDA label / DailyMed review",
      "source_title": "Current Wegovy and Zepbound prescribing information",
      "source_url": "https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b | https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b",
      "source_doi": "",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Absence of a universal label-mandated panel does not mean testing is unnecessary for a particular patient. Clinical evaluation and monitoring are individualized.",
      "notes": "Second official label URL: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b",
      "row_number": 74
    },
    {
      "metric_id": "STD-006",
      "evidence_layer": "Standards and requirements crosswalk",
      "domain": "Contraindications",
      "measure": "Personal or family history of medullary thyroid carcinoma or MEN2",
      "numerator": "",
      "denominator": "",
      "percentage": "",
      "value_text": "Listed as a contraindication in current Wegovy and Zepbound prescribing information.",
      "unit": "label requirement",
      "denominator_definition": "",
      "fieldwork_start": "",
      "fieldwork_end": "",
      "publication_date": "",
      "geography": "United States",
      "measure_type": "current authoritative fact",
      "source_type": "FDA label / DailyMed",
      "source_title": "Wegovy and Zepbound prescribing information",
      "source_url": "https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b | https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b",
      "source_doi": "",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Label summary only; use the current full prescribing information for clinical decisions.",
      "notes": "Second official label URL: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b",
      "row_number": 75
    },
    {
      "metric_id": "STD-007",
      "evidence_layer": "Standards and requirements crosswalk",
      "domain": "Gastrointestinal risk",
      "measure": "Severe gastroparesis",
      "numerator": "",
      "denominator": "",
      "percentage": "",
      "value_text": "Current Wegovy and Zepbound labels state the products are not recommended in patients with severe gastroparesis.",
      "unit": "label statement",
      "denominator_definition": "",
      "fieldwork_start": "",
      "fieldwork_end": "",
      "publication_date": "",
      "geography": "United States",
      "measure_type": "current authoritative fact",
      "source_type": "FDA label / DailyMed",
      "source_title": "Wegovy and Zepbound prescribing information",
      "source_url": "https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b | https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b",
      "source_doi": "",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Not a complete risk-screening checklist.",
      "notes": "Second official label URL: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b",
      "row_number": 76
    },
    {
      "metric_id": "STD-008",
      "evidence_layer": "Standards and requirements crosswalk",
      "domain": "Pregnancy",
      "measure": "Planned pregnancy and semaglutide",
      "numerator": "",
      "denominator": "",
      "percentage": "",
      "value_text": "Current Wegovy prescribing information says to discontinue at least two months before a planned pregnancy.",
      "unit": "label statement",
      "denominator_definition": "",
      "fieldwork_start": "",
      "fieldwork_end": "",
      "publication_date": "",
      "geography": "United States",
      "measure_type": "current authoritative fact",
      "source_type": "FDA label / DailyMed",
      "source_title": "Wegovy prescribing information",
      "source_url": "https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b",
      "source_doi": "",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Clinical decisions require the current full label and a licensed clinician.",
      "notes": null,
      "row_number": 77
    },
    {
      "metric_id": "STD-009",
      "evidence_layer": "Standards and requirements crosswalk",
      "domain": "Contraception",
      "measure": "Oral hormonal contraception and tirzepatide",
      "numerator": "",
      "denominator": "",
      "percentage": "",
      "value_text": "Current Zepbound prescribing information warns that efficacy of oral hormonal contraceptives may be reduced and directs a switch to a non-oral method or addition of a barrier method for four weeks after initiation and each dose escalation.",
      "unit": "label statement",
      "denominator_definition": "",
      "fieldwork_start": "",
      "fieldwork_end": "",
      "publication_date": "",
      "geography": "United States",
      "measure_type": "current authoritative fact",
      "source_type": "FDA label / DailyMed",
      "source_title": "Zepbound prescribing information",
      "source_url": "https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b",
      "source_doi": "",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Clinical decisions require the current full label and a licensed clinician.",
      "notes": null,
      "row_number": 78
    },
    {
      "metric_id": "STD-010",
      "evidence_layer": "Standards and requirements crosswalk",
      "domain": "Clinical assessment",
      "measure": "Individual health history and clinical indications",
      "numerator": "",
      "denominator": "",
      "percentage": "",
      "value_text": "WHO states GLP-1 therapies should be prescribed by a medical practitioner after considering individual health history and clinical indications.",
      "unit": "clinical guidance",
      "denominator_definition": "",
      "fieldwork_start": "",
      "fieldwork_end": "",
      "publication_date": "2025-12-02",
      "geography": "Global",
      "measure_type": "authoritative guidance",
      "source_type": "World Health Organization",
      "source_title": "Obesity: GLP-1 therapies",
      "source_url": "https://www.who.int/news-room/questions-and-answers/item/obesity-glp-1-therapies",
      "source_doi": "",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "WHO guidance is clinical guidance, not a U.S. state-law checklist.",
      "notes": null,
      "row_number": 79
    },
    {
      "metric_id": "STD-011",
      "evidence_layer": "Standards and requirements crosswalk",
      "domain": "Longitudinal care",
      "measure": "Behavioral support and chronic-care context",
      "numerator": "",
      "denominator": "",
      "percentage": "",
      "value_text": "WHO states GLP-1 therapy should be associated with structured behavioral interventions including healthy diet and physical activity and should not replace other means of weight control.",
      "unit": "clinical guidance",
      "denominator_definition": "",
      "fieldwork_start": "",
      "fieldwork_end": "",
      "publication_date": "2025-12-02",
      "geography": "Global",
      "measure_type": "authoritative guidance",
      "source_type": "World Health Organization",
      "source_title": "Obesity: GLP-1 therapies",
      "source_url": "https://www.who.int/news-room/questions-and-answers/item/obesity-glp-1-therapies",
      "source_doi": "",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Clinical recommendation, not a legal prerequisite for every prescription.",
      "notes": null,
      "row_number": 80
    },
    {
      "metric_id": "STD-012",
      "evidence_layer": "Standards and requirements crosswalk",
      "domain": "Nutrition assessment",
      "measure": "Baseline nutrition assessment and ongoing support",
      "numerator": "",
      "denominator": "",
      "percentage": "",
      "value_text": "A joint multi-organization advisory describes baseline nutrition assessment and ongoing attention to gastrointestinal symptoms, protein intake, resistance training, physical activity, sleep, stress, substance use, and social context.",
      "unit": "expert advisory",
      "denominator_definition": "",
      "fieldwork_start": "",
      "fieldwork_end": "",
      "publication_date": "",
      "geography": "United States / clinical practice",
      "measure_type": "clinical recommendation",
      "source_type": "Joint clinical advisory hosted by The Obesity Society",
      "source_title": "Nutritional Priorities to Support GLP-1 Therapy for Obesity",
      "source_url": "https://www.obesity.org/nutritional-priorities-to-support-glp-1-therapy-for-obesity/",
      "source_doi": "",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Consensus-style clinical guidance, not a statute, FDA label mandate, or validated scoring system for telehealth platforms.",
      "notes": null,
      "row_number": 81
    },
    {
      "metric_id": "STD-013",
      "evidence_layer": "Standards and requirements crosswalk",
      "domain": "Compounded dosing",
      "measure": "Dosing errors with compounded injectable semaglutide",
      "numerator": "",
      "denominator": "",
      "percentage": "",
      "value_text": "FDA reports adverse events, including some hospitalizations, associated with measurement and dosing errors and with doses or titration beyond approved-label schedules.",
      "unit": "FDA safety concern",
      "denominator_definition": "",
      "fieldwork_start": "",
      "fieldwork_end": "",
      "publication_date": "",
      "geography": "United States",
      "measure_type": "current authoritative fact",
      "source_type": "FDA",
      "source_title": "FDA’s Concerns with Unapproved GLP-1 Drugs Used for Weight Loss",
      "source_url": "https://www.fda.gov/drugs/drug-alerts-and-statements/fdas-concerns-unapproved-glp-1-drugs-used-weight-loss",
      "source_doi": "",
      "rxindex_derived": "false",
      "derivation_formula": "",
      "last_verified": "2026-08-01",
      "interpretation_guardrail": "Adverse-event reports do not by themselves establish causation or incidence. Do not use this row to estimate patient risk.",
      "notes": null,
      "row_number": 82
    }
  ]
}