GLP-1 & Telehealth
Medical Glossary

GLP-1 (Glucagon-Like Peptide-1) is a hormone naturally released by the intestines after eating. It signals fullness to the brain via the hypothalamus, slows gastric emptying, and stimulates insulin secretion in a glucose-dependent manner. GLP-1 receptor agonist medications like semaglutide and tirzepatide mimic this hormone pharmacologically, producing significant, clinically-documented weight loss that no diet program or supplement has matched in clinical trials. GLP-1 therapy is prescription-only and requires evaluation by a licensed medical provider.

Semaglutide is a GLP-1 receptor agonist medication used for chronic weight management and type 2 diabetes. Ozempic® and Wegovy® are FDA-approved brand-name medicines containing semaglutide. Compounded semaglutide may be prepared by a licensed pharmacy pursuant to an individual prescription; it is not a generic version of those brand medicines and is not represented as bioequivalent, clinically equivalent, or interchangeable. Clinical trials with FDA-approved semaglutide formulations (Wegovy®) demonstrated significant weight loss over 68 weeks. Compounded semaglutide has not undergone the same clinical trials. Semaglutide is administered as a once-weekly subcutaneous injection and requires a prescription from a licensed medical provider. Ozempic® and Wegovy® are registered trademarks of Novo Nordisk A/S. Open Water Rx is not affiliated with Novo Nordisk.

Tirzepatide is a dual GIP/GLP-1 receptor agonist medication used for chronic weight management and type 2 diabetes. Mounjaro® and Zepbound® are FDA-approved brand-name medicines containing tirzepatide. Unlike semaglutide, which activates only the GLP-1 receptor, tirzepatide activates both GIP (Glucose-Dependent Insulinotropic Polypeptide) and GLP-1 receptors simultaneously. This dual mechanism produces significantly greater appetite suppression and metabolic improvement. Clinical trials with FDA-approved tirzepatide formulations (Zepbound®) demonstrated significant weight loss over 72 weeks. Compounded tirzepatide has not undergone the same clinical trials. Mounjaro® and Zepbound® are registered trademarks of Eli Lilly and Company. Open Water Rx is not affiliated with Eli Lilly.

GIP (Glucose-Dependent Insulinotropic Polypeptide) is a gut hormone secreted by K-cells in the small intestine in response to food intake. It stimulates insulin secretion from the pancreas in a glucose-dependent manner and plays a role in fat storage, energy metabolism, and bone metabolism. GIP receptors are also found in the brain, where GIP signaling may contribute to appetite regulation. Tirzepatide is a dual GIP/GLP-1 receptor agonist that activates both GIP and GLP-1 receptors simultaneously, producing greater weight loss than GLP-1 agonists alone. The synergistic effect of dual receptor activation is believed to be responsible for tirzepatide's superior clinical efficacy compared to semaglutide.

A compounding pharmacy prepares customized medications for individual patients when commercially available products do not meet a patient's specific clinical needs — for example, when a specific dosage strength, formulation, or delivery method is not available in the commercially manufactured product. Section 503A of the Federal Food, Drug, and Cosmetic Act governs traditional compounding pharmacies that prepare medications based on individual patient prescriptions. Open Water Rx works exclusively with licensed compounding pharmacies operating under Section 503A.

Body Mass Index (BMI) is a numerical measure calculated from a person's height and weight (weight in kg divided by height in meters squared). BMI is used as a screening tool for weight categories: underweight (below 18.5), normal weight (18.5–24.9), overweight (25–29.9), and obese (30 or higher). For GLP-1 weight loss therapy, the general eligibility criteria are: BMI of 30 or higher, OR BMI of 27 or higher with at least one weight-related health condition such as type 2 diabetes, hypertension, dyslipidemia, or sleep apnea. Final eligibility is always determined by an independent licensed medical provider based on the individual patient's complete health profile. BMI is a screening tool, not a diagnostic measure, and does not account for muscle mass, bone density, or fat distribution.

Telehealth is the delivery of healthcare services using digital communications technology — including secure online forms, asynchronous messaging, and synchronous video consultations — allowing patients to receive medical care remotely without in-person clinic visits. Open Water Rx is a telehealth platform connecting patients with independent licensed medical providers for GLP-1 weight loss, NAD+ longevity, and men's health programs. In most states, the entire process — health evaluation, provider review, prescription, and medication delivery — can be completed without any in-person visit. Some states require a synchronous (live video) initial visit with a licensed provider before a prescription can be issued. Telehealth regulations vary by state and are subject to change.

A Valid Patient-Provider Relationship (VPPPR) is a legally required relationship between a patient and a licensed medical provider that must be established before a prescription can be issued. In telehealth, establishing a VPPPR typically requires a thorough health evaluation covering the patient's medical history, current medications, health conditions, and treatment goals. Some states additionally require a synchronous (live video) initial visit with the licensed provider before a prescription can be issued. Open Water Rx requires a VPPPR before any prescription is issued. All prescribing decisions are made solely by independent licensed medical providers based on the individual patient's health profile. Open Water Rx does not direct or influence those decisions.

NAD+ (Nicotinamide Adenine Dinucleotide) is a coenzyme found in all living cells that plays a critical role in energy metabolism, DNA repair, gene expression, and cellular aging. NAD+ is essential for the function of sirtuins — proteins that regulate cellular health and longevity. NAD+ levels naturally decline with age, which is associated with reduced energy, slower recovery, and increased susceptibility to age-related conditions. NAD+ therapy involves supplementing this coenzyme through IV infusion, subcutaneous injection, nasal spray, or oral formulations to support cellular energy, recovery, and healthy aging. Open Water Rx offers clinician-reviewed NAD+ programs through licensed compounding pharmacies.

B12 MIC is a metabolic support injection combining Vitamin B12 (cobalamin) with Methionine, Inositol, and Choline — compounds that support metabolism, liver function, and energy production. Methionine is an essential amino acid. Inositol supports insulin signaling. Choline is essential for liver function. B12 supports energy metabolism and neurological function. B12 MIC injections are used in metabolic health programs to support energy and liver health.

Asynchronous telehealth (async care) is a model of healthcare delivery where patients and providers do not interact in real time. Instead, patients submit health information, photos, or questionnaires through a secure platform, and licensed providers review and respond on their own schedule — typically within 24–72 hours. This model is more convenient for patients (no scheduling, no waiting rooms) and allows providers to review cases more thoroughly. Open Water Rx uses asynchronous telehealth for initial evaluations, follow-up reviews, and ongoing care. Some states require a synchronous (live video) initial visit before a prescription can be issued, even in an async-first platform.

Section 503A of the Federal Food, Drug, and Cosmetic Act governs traditional compounding pharmacies that prepare medications based on individual patient prescriptions from licensed practitioners. 503A pharmacies must comply with state pharmacy laws and USP standards. They may not compound medications that are essentially copies of commercially available FDA-approved drugs unless there is a documented clinical difference. Open Water Rx works with licensed 503A compounding pharmacies.

The STEP 1 (Semaglutide Treatment Effect in People with Obesity) trial was a Phase 3 randomized controlled trial published in the New England Journal of Medicine in 2021 (Wilding et al., PMID 33567185). The trial enrolled 1,961 adults with obesity (BMI ≥30) or overweight (BMI ≥27) with at least one weight-related condition. Participants received either semaglutide 2.4mg once weekly or placebo for 68 weeks, alongside lifestyle intervention. Results: participants on semaglutide achieved significant body weight loss compared to placebo. These trials involved FDA-approved semaglutide formulations (Wegovy®). Compounded semaglutide has not undergone the same clinical trials.

The SURMOUNT-1 trial was a Phase 3 randomized controlled trial published in the New England Journal of Medicine in 2022 (Jastreboff et al., PMID 35658024). The trial enrolled 2,539 adults with obesity (BMI ≥30) or overweight (BMI ≥27) with at least one weight-related condition. Participants received tirzepatide at doses of 5mg, 10mg, or 15mg once weekly, or placebo, for 72 weeks. Results: participants on tirzepatide 15mg achieved significant body weight loss compared to placebo. These trials involved FDA-approved tirzepatide formulations (Zepbound®). Compounded tirzepatide has not undergone the same clinical trials.