TikTok’s hidden ‘Ozempic economy,’ where weight-loss influencers trade referrals for drug discounts and cash

In the comments under the videos, viewers share their own tales of pound shedding with Mounjaro, Ozempic, Wegovy, and other prescription weight loss drugs, and express their desire to emulate her success.

“How’d you get started on it?” asks one user. 

“Click the link in my bio it’s the Ivim health one,” Johnston writes back with a heart emoji. This link has a unique code to track Johnston’s referrals to Ivim Health, a one-and-a-half-year-old telehealth company that deals almost exclusively in antidiabetic drugs like Ozempic and Mounjaro and their compounds, prescribing and shipping the medications to patients around the country. 

Weight loss influencers like Johnston are the latest sensation on TikTok, reflecting a worldwide craze for the so-called GLP-1 (glucagon-like peptide-1) drugs. Search for “Ozempic” on TikTok and you’ll find an endless feed of formerly obese people attesting to the efficacy of the injectable medications.

What’s less readily apparent are the relationships between some of these influencers and the dispensers of the medications. Johnson did not respond to Fortune’s queries about her relationship with Ivim, but interviews with several other influencers and industry insiders, including the CEO of Ivim, revealed a web of financial incentives and payments underpinning much of the weight loss content on platforms like TikTok, YouTube, and Instagram.

Tara Jay, a Long Island mom who lost 120 pounds on a combination of weight loss medications and picked up 1 million TikTok views in the process, says she gets paid an amount that’s “less than $20” every time someone uses her referral link to register with Ivim. And it’s hardly unusual: Jay says that telehealth companies that prescribe weight loss drugs solicit her for partnerships about once per week, often offering to pay her a fee each time one of her referrals gets a prescription, something Jay says she doesn’t do.

Many of the influencers swear by the drugs they’re promoting, and say their videos and referrals to telehealth companies that can prescribe are born out of a genuine desire to help others get access to a life-changing drug.

“I’m not doing this for money. I really got involved with this company to absolutely help people who just weren’t able to get it from their doctors’ or their insurance,” says Jay.

But several medical experts that Fortune spoke to say there’s reason to be cautious about the alliance between internet influencers and telehealth companies in promoting the new class of prescription drugs, most of which are technically anti-diabetes drugs whose weight loss benefits are just now being recognized by the Food and Drug Administration. 

Americans increasingly turn to social media for health advice, so it matters if those pushing the hottest drugs on the market are profiting without any disclosures, medical backgrounds, or relationships with the actual pharmaceutical companies, says Amrita Bhowmick, an adjunct assistant professor at the University of North Carolina’s Gillings School of Global Public Health. 

“Telehealth companies are not held to the same regulatory standards as a pharmaceutical company that owns or manufactures that drug,” says Bhomwick, who has become an expert on healthcare influencers as the chief community officer of patient-to-patient connection website Health Union.

A mutually beneficial partnership

While the pharmaceutical companies that produce Ozempic and Mounjaro spend hefty sums of money on traditional TV ads, the influencer marketing on social media appears to be primarily led by telehealth companies.

Ivim was incorporated in April 2022 by brothers Taylor and Anthony Kantor. The 35-person company lists headquarters in a high-end Columbus strip mall between Sur la Table and Kendra Scott, according to Google Street View. But despite these low-key corporate data points, on TikTok the hashtags #ivimhealth and #ivim each have over 6 million views and Ivim CEO Anthony Kantor notes that the company has concurrent contracts with over 30 influencers. 

“By registering with Ivim, you have already been preapproved for a GLP-1 medication,” says the company’s medical director Taylor Kantor in a YouTube video, which appears to contradict the guidance of the drugmakers that individuals with kidney problems, pancreatitis or a body mass index lower than 27 should not be prescribed Ozempic, Wegovy or Mounjaro. (Ivim CEO and cofounder Anthony Kantor, who also is Taylor Kantor’s brother, responded to Fortune’s query about the video, and said that it’s “a bit more nuanced than that,” adding that they’ve changed the registration process “quite a few times.”) 

Valhalla Vitality, another telehealth company, began as a purveyor of psychedelic treatments for conditions, including post-traumatic stress disorder, but moved into weight loss drugs a year and a half ago, according to founder and CEO Philip D’Agostino. Conventional medical care and insurance often don’t cover the kind of treatments that telehealth companies like Valhalla provide, D’Agostino says. “My whole goal for this was to give people the access to the tools that they need to control their health in their own hands—with the supervision of a trusted medical professional,” he says.

D’Agostino said the company works with influencers to help educate the public. “If we’re paying somebody, it’s because it’s somebody who’s going to go on Instagram Live and bring in other people and help educate a larger group,” he said. And he’s gotten more than an education, noting that revenues consistently grow 100% month-over-month for the relatively green Queens, N.Y.–based company.

He said Valhalla doesn’t tell influencers what to say, but noted that the company approves the videos that the influencers post. “The only agreements that we have with our influencers is that they’re honest, and that they give us a chance to review it before they post,” he says. Valhalla’s payments to influencers can range from cash—which D’Agostino described as a “couple hundred dollars for a couple of hours’ work”—to discounts on medication.

Carsten Snejbjerg/Bloomberg via Getty Images

For Rachel Cox, a 34-year-old mom based in small-town Kingsport, Tenn., who shed 80 pounds on Mounjaro, Valhalla’s discounts have been helpful. Cox, who amassed nearly 200,000 likes and 23,000 followers on TikTok by chronicling her weight loss journey, partnered with the company earlier this year after insurance stopped covering her Mounjaro prescription.

Because Mounjaro retails for over $1,000 per month out of pocket, Cox had to switch over to a compound version of tirzepatide (meaning that she fills the syringes herself with pharmaceutical compounds that constitute a tirzepatide), which also falls outside of insurance coverage. To help cover payments of $544 per vial and, in her words, “help people,” Cox refers her followers to Valhalla, which prescribes compound GLP-1s and tirzepatides. Every time someone uses Cox’s code to register for Valhalla’s $100 initial consultation or gets a GLP-1 or tirzepatide compound prescription through the company, she earns points, which translate to discounts on her medications. 

“I get a lot of messages from people thanking me, because when their Mounjaro was declined [by insurance coverage], they didn’t know where to go,” she says of the weight loss TikTok community. Switching to “sharing [her] compounded journey” has been “amazing” because her audience has found Valhalla through her content, transforming them from internet acquaintances to “true friends.”

The legal gray area where telehealths and influencers meet

Celebrity spokespeople are nothing new, of course. And affiliate marketing is a well-established business model among internet influencers, who earn commissions from sellers for referring customers. When it comes to telehealth prescriptions and influencer marketing, though, the rules around what’s acceptable are not so clear-cut. 

Dr. Aaron Kesselheim, a professor at Harvard Medical School’s Center for Bioethics, says the rules around how telehealth companies compensate influencers could vary on a state-by-state basis, and even be determined at a local level. “A lot of state regulatory practices with respect to telehealth companies and their practices are still in the early stages,” he says. “Would these relationships be considered kickbacks or improper self-dealing under state fraud or self-dealing statutes should be some of the key questions,” he said.

Because telehealth, this class of weight loss drugs, and influencers are all relatively novel concepts, local and federal regulators have not differentiated between payments based on referrals or flat fees for endorsing a product. “In either case, the influencer is posting sponsored content and is required to disclose clearly and conspicuously that their posts are ads. If they’re advertising a prescription drug, additional warnings and disclosures are likely to be required by the FDA,” says Alexandra Roberts, a professor of law and media at Northeastern University School of Law. “If any representations are false, misleading, or unsubstantiated, both the influencer and the company that is paying them to post or paying them commission may be liable under not just FTC law, but also state or federal false advertising law. And if the posts falsely create the perception of affiliation with the company that makes Ozempic, that can be deceptive too.”

Ivim’s CEO Kantor says influencers who use the firm’s referral links “should be mentioning” their relationship with the company—”we definitely tell them that in our agreement.” D’Agostino, the Valhalla CEO, said that if his company discovers that an influencer in its network is not disclosing their relationship with the company, their contract is immediately terminated. (Fortune found influencers with referral links to both telehealth companies who did not appear to have clear disclosures of their commercial relationships.) Still, Valhalla’s practice of reviewing influencer posts beforehand suggests “a level of marketing coordination that consumers of the content probably aren’t aware of,” said Kesselheim, of Harvard Medical School’s Center for Bioethics, though he noted that alone was unlikely to be illegal.

An interesting legal wrinkle could also involve whether a telehealth firm is considered a technology platform that connects medical providers to patients. In that case, “Section 230 might come into play,” says Roberts, referring to the section of the federal Communications Decency Act that shields platforms from civil liability for content posted by third-parties (for example, influencers). Among the many variables that could come into play are the details about who provided the influencer with the product they endorsed—in this case weight loss drugs—and if the discounts on medication that an influencer received from a telehealth have any bearing on that determination.

The mania for weight loss drugs comes shortly after several telehealth companies became embroiled in controversies over their prescription practices for drugs to treat mental health issues. Cerebral, one of the largest telehealth companies, became the subject of a Department of Justice investigation in 2022 following reports that it overprescribed Xanax and Adderall. Pharmacy chains including Walmart and CVS stopped filling Adderall prescriptions from ADHD-focused telehealth Done in 2022.

While GLP-1 and tirzepatides are not controlled substances like Adderall and Xanax, the drugs are considered relatively novel for weight loss (Wegovy has been on the market for just two years as a weight loss drug; Ozempic for about six to treat diabetes), and their long-term effects and potential adverse effects are still unknown. Many patients report that after they stopped taking the drugs—often because their prescriptions expired and they could not afford to pay out of pocket—they gained back the weight, sometimes getting heavier than they were prior to starting on the medications.

Still, the drugs have become so associated with weight loss that even WeightWatchers, synonymous with American dieting, has in-part pivoted to GLP-1 and tirzepatide prescriptions. Meanwhile telehealths like Ro and Calibrate that became VC and consumer darlings during COVID-19 have launched programs to meet weight loss demands. And just like the demand for medicine from home during the pandemic, the GLP-1 fever has spawned a slew of new companies designed to dose: Ivim, Slym, bmiMD, Push Health, Sunrise, Mochi Health, Accomplish Health, and many more. 

Kantor, the CEO of Ivim, says the company’s goal is to provide patients not just medication, but education and access to resources like health coaches.

Welcome to the GLP-1 ‘Bestie Bash’

For many weight loss influencers, the TikTok videos are most of all a testament to their own positive experiences, and a way to provide community and support for others who have faced similar struggles to get slim.

This October, Ivim influencer Rachael Knight Gullette, who goes by LoveNestConversation and claims to have lost 146 pounds in two and a half years, is hosting a meetup for the prescription weight loss community called the Big Nashville GLP1 Bestie Bash. 

The goals: “the most amazing weekend of meeting each other in person, sharing our success stories, providing encouragement to our fellow GLP1 family, and making new friends.”

Chace Franks is a board-certified nurse practitioner who has garnered over 85,000 followers posting about GLP-1s on TikTok. For him, the people of weight loss TikTok have become his tribe as they often organize in the comments of his videos. “The GLP-1 community on Tiktok has really banded together a portion of society that has been treated unfairly—whether it’s fatphobia, weight bias, things like that; it’s like a support group, almost,” says Franks, who is an adviser for Ivim. 

“If you look at the comments on my videos or creators’,” he says, “it’s people hyping people up—it’s promoting body positivity.”