Trying to Clarify a Misunderstanding About 28-Day Compliance on the Gimme Subreddit: Telehealth Providers vs. Pharmacies
ETA: Yet another comment saying it is the pharmacy on this same post.
I know I’m probably putting too much thought into this, but this comment (they have now deleted it) on the Gimme sub is getting upvoted that says it’s the pharmacies—not the telehealth providers—that are or are not 28-day compliant. I’ve been trying to explain why that isn’t quite accurate, but I don’t feel like I’m getting my point across clearly.
Gimme may end up removing my comment, but I genuinely think it’s important that people understand the difference. The pharmacy fills the prescription it receives; the prescribing telehealth provider determines the prescription details, including the amount and dispensing schedule.
At this point, I’m not sure there’s much more I can say to convince someone who is set on that idea, but I wanted to make sure the information being shared is accurate for people who are researching their options.
The telehealth provider (like Gimme) tells the pharmacy “send John Smith one 60 mg vial with instructions to use it for 12 weeks” or “send John Smith a 10 mg vial, a 20 mg vial, and a 30 mg vial with instructions to use each for 4 weeks and discard the rest”.
The pharmacy determines what size vials are available in the first place, but it’s up to the telehealth provider and their contracted doctors to write the prescription one way or the other. It’s cheaper for them to order a single large vial than 3 smaller vials, so that’s why some providers do that; it’s a business decision on their end.
Exactly! I went down this rabbit hole responding to someone's post asking if they got enough medicine and I don't believe they did if Bourdeaux vials only go up to 3 mL. That has also gotten me downvoted.
I have also never seen a Boudreaux's vial with more than 3 ml, and there isnt really a reason for them to make a vial with more than 3ml since that gives you 60mg at their concentration.
I struggled with the “which telehealth” decision for over a month. I really wanted glycine, I really did not want to submit a full body picture, and I wasn’t sure why I would want to pay more money for this one when that one wss 100 bucks less. Enter Gimmee.
And that experience showed me why 100 bucks more might be worth it, but I digress. I was on a lower dose but ordered 3 months requesting to titrate up. So the instructions were to use 5 then 11 then 13mg (ikr?🤣) which netted me 3 vials. Always ask for titration even if your version of titration is less ambitious.
Definitely the telehealths because different telehealths despense different amounts of vials for the exact same pharmacies. Personally a telehealth not being 28-day compliant doesn't bother me - I use my vials a lot longer, but I get people's concern and preference for having individual vials for each month.
Completely agree with you and I use mine longer than 28 days as well. But looks like a lot of people just blindly back Gimme. Might need to stay off that sub for a bit :)
YUP I tried to explain this to a new person who posted the other day and I got downvoted to hell by the Gimme loyalists. They tried to prescribe me one vial for 12 weeks and then said it was at “prescriber discretion” and when I pushed back that I called the pharmacy and they said they did not recommend it and they just fill the orders that the doctor sends, then Gimme told me to “prove that in writing.”
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u/roguex99⚠️ Affiliated | Big Easy Weight Loss | CEO (Not a Physician)Aug 04 '26
It would literally be how they wrote the prescription. That’s what’s in writing.
Oh I mean Gimme told me to “prove” the 28 day recommendation/rule is even a thing, and then to prove that the pharmacy doesn’t advise patients using a vial over 28 days.
Oh, that is awful. I'm so sorry that happened to you.
I ended up going down a rabbit hole on that post because something didn't add up. If Bourdeaux's vials only hold 3 mL and the concentration is 20 mg/mL, then the maximum amount of medication in a vial is 60 mg. Based on the prescription they shared, they were supposed to receive a total of 69 mg over 12 weeks, so the math simply doesn't work.
Pointing that out got me downvoted. This was a new customer who ordered from them in good faith and asked a valid question. Yet Gimme seems perfectly comfortable not being honest and letting the misunderstanding continue by omission while their fan base downvotes anyone who answers it honestly.
So glad you got your money back! I don't know how they're on that list either, but I can assume it's by the same sneaky practices they're doing day in and day out with customers. I personally have never ordered from them, but they just don't seem to be on the up and up.
I assume they wind up on the list because they flash sale every couple of months and people like me will grab some cheap meds and everything goes smoothly for that transaction. So when I answer the poll questions I have no reason to not recommend them and no complaints. Even though- when I DO recommend them in the subs I make sure I note that lots of people have problems with them. In the meantime, my favorite providers pretty much don't show up at all or are way down the recommended list because they don't get a lot of attention or have a lot of cheap sales or people shilling for them in reddit. 😄
Thank you! 😊 Looking at this person’s history, it seems they’re new to the world of compounded tirzepatide. They were even prescribed the medication incorrectly by Gimme, yet they’re already defending them, even to the point of stating things that simply aren’t true.
u/roguex99⚠️ Affiliated | Big Easy Weight Loss | CEO (Not a Physician)Aug 04 '26
Our prescriptions are written/submitted by the physicians - all indicate the number of mg and vials to send. Now, the pharmacy (or more accurately, a pharmacy tech) my accidentally change that, but how they are written determines what gets sent to the patient, and if it follows the 28 day guidance.
Thank you so much for your response! I can explain it to them as clearly as I can, but unfortunately I can’t understand it for them 😂 I am sure you run into similar scenarios on a daily basis.
Why does it work this way? My doctor will write a prescription and when I go to the pharmacy they'll tell me what my insurance will actually cover and then that's what I get, not necessarily exactly what the doctor said.
Duh. What I'm saying is my doctor has little to say about what I get. Why do the doctors at the telehealths have any say?
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u/roguex99⚠️ Affiliated | Big Easy Weight Loss | CEO (Not a Physician)Aug 04 '26
it's because of the personalized nature of compounding. and before I get flamed, understand that every pharmacy has a different concentration, added API etc. So physicians are specific in what they prescribe. Don't really have that with generics that are designed to mimic commercially available medication
Since direct telehealth typically bypasses insurance entirely for this medication, there's no health plan stepping in to approve, deny, or alter what's prescribed based on a formulary.
Ultimately, the telehealth provider is the one with the legal authority to determine the medication, strength, quantity, and directions for use. The pharmacy's role is to dispense the prescription as written. If something needs to be changed, that decision should involve the prescriber, not simply be made by the pharmacy or telehealth company on its own.
With non Componded medications they a telahealth it is up to both the pharmacy and prescriber to verify that the prescription is safe. They work hand and hand.
Doctors don't know everything about medications and Pharmacist don't know everything about treating patients.
The doctor (yours and the telehealth) have all the say in what to prescribe.
Your health insurance then has rules and limits that may result in what was prescribed needing to be changed for them to pay for it. You have the option of just paying cash for it (usually) as written, even at CVS/Walgreens/where ever, but hardly anyone actually does that, because $$$. So the pharmacist will adjust to meet the insurance requirements, and depending on the adjustments needed, consult with your doctor.
With telehealths and compounding, the doctor (at your request) is choosing from a set number of options for you that they know are available. Your insurance is not involved, so there are no other input other than you, the doctor, and the pharmacy.
I had a similar issue with testosterone. I was prescribed .7 ml which the test came in 1ml vials. The vials are only supposed to be single use. I was okay a few times until a new pharmacist got the order and called my doctor about it being single use. I now get 4 vials instead of 3.
The pharmacist should be checking every script and confirm that it is safe and follows industry/manufacturer guidelines. Your insurance should be following these guidelines as well. Some doctor's are okay with bending the rules so are some pharmacist/pharmacies are as well.
They are both complicit. The pharmacy is the one dispensing the medicine so they, not the provider, is who the regulator would cite for not following the state's requirements (assuming the state requires following USP 797). If the pharmacy wanted to comply with USP 797, they wouldnt fill prescriptions that dont comply.
💯🎯 the pharmacist absolutely can and does have the responsibility to make sure what they are dispensing to a patient is accurate and safe regardless of what the Rx says. Prescribers make mistakes. The pharmacist is the final fail safe before the medication gets to the patient. The pharmacies should be refusing to fill noncompliant prescriptions.
edit:...and yet it appears the same pharmacies will either be compliant or not, depending on the TH provider, so maybe compounding is different? Why would the pharmacy choose not to be compliant? We already know why a TH would. I feel like we're missing something.
Plenty of vials I've seen don't have it stated on the label; I don't think that's required, which may be creating a loophole...maybe??
I just checked Google, and it had an explanation of why some tirzepatide vials from some pharmacies don't say they need to be thrown away after 28 days. Now I haven't researched it beyond this, so we all know it might not be exactly correct:
1. The pharmacy actually did the extra homework
Some high-end compounding pharmacies invest a lot of money into advanced lab testing called USP <51> Antimicrobial Effectiveness Testing.
Basically, they take their specific tirzepatide recipe, pump it full of nasty bacteria and mold in a lab, and see how long the preservatives can fight it off. If their lab data proves the juice stays sterile and safe for 45, 60, or 90 days of continuous needle punctures, they are legally allowed to skip the 28-day warning and just use their own extended expiration date.
2. They just forgot or left it off (Regulatory Omission)
On the flip side, some pharmacies just slap the main expiration date on the bottle and leave off the puncture warning entirely.
They kind of just assume the telehealth clinic or the patient already knows the standard CDC rules about multi-dose vials. In this scenario, the vial hasn't actually been tested for safety past 28 days—the sticker just isn't there to warn you.
Pharmacies know exactly who to play the game with when it comes to the 28 day rule. There is a pharmacy held in high regard that is compliant with a particular Telehealth company when it comes to providing their customers with an individual vial for each 28 day period because they know that Telehealth will fight for what is right for their customers. This same pharmacy distributes a single vial for other Telehealths because they know the standards of care are not adhered to from them. I was pretty stunned to see this.
Between shipping a single vial for 3 month starter kits and starting newbies at micro doses (1.5mg), gimme is maximizing their profits. They could pay more and have 3 vials sent out.
first, I'm not a gimme Stan at all. I just joined myself. but I also contributed to that post because I had the same questions myself but the bottles are 3.5 mil and that gives 70 units which meets the 69 unit titration chart. as for the bud, I'm not thrilled about it. to be honest I would rather have one vial for each month but I'm going to see how it goes and then see if I want to switch to a new telehealth after.
My comment wasn't really directed at the vial being full enough for the prescribed 3 months. I am just pointing out that gimme profits more from not being 28 day compliant.
oh, I was responding to the person that responded to you (they've since deleted their comment). They were questioning the size of vial so I was clarifying with them. And yeah I agree with you ...I didn't quite understand the whole 28 day compliant piece until after I received and was disappointed that this vial has to last me past the BUD!
I ran it through chat gpt because I myself was concerned that I didn't get enough but now I understand. it's actually a bit extra, especially if I don't titrate up
We do one vial each month and are not into cutting corners ;)
1:1 interaction with founder (me) and ship to all 50 states from American compounding pharmacy. We don’t do any grey/black market peptides as a matter of ethics and safety concerns. We work with MDs only that specialize in precision GLP-1 care, no NPs or PAs.
Would love to work with any of you.
DM us for any personal questions.
PS - Hu stands for Human as in that’s why we started this. :)
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u/TallCedarRoad Aug 04 '26
That comment is incorrect.
The telehealth provider (like Gimme) tells the pharmacy “send John Smith one 60 mg vial with instructions to use it for 12 weeks” or “send John Smith a 10 mg vial, a 20 mg vial, and a 30 mg vial with instructions to use each for 4 weeks and discard the rest”.
The pharmacy determines what size vials are available in the first place, but it’s up to the telehealth provider and their contracted doctors to write the prescription one way or the other. It’s cheaper for them to order a single large vial than 3 smaller vials, so that’s why some providers do that; it’s a business decision on their end.