NORC’s Social Data Collaboratory conducted a cross-sectional content analysis of public posts from Facebook, Instagram, TikTok, and YouTube in 2023 to examine content characteristics, marketing practices, and prevalence of financial disclosures and key clinical information for glucagon-like peptide 1 receptor agonists (GLP-1 RAs), ADHD stimulants, and autoimmune biologics (this research is currently under review for journal publication).

• Non-commercial creators generated the most content (≥69 percent across the four social media platforms), often with embedded commercial elements that suggest the potential for undisclosed financial sponsorship.​
• Only 14-38 percent of posts with efficacy claims included any information on health risks or side effects.

Findings from NORC’s research suggest that current DTCA regulations may not fully address the evolving challenges posed by social media platforms. This brief outlines potential policy options to enhance oversight and align promotional practices with modernized standards for consumer safety.

According to NORC’s survey results, 44 percent of consumers and 78 percent of prescribers reported seeing influencer content on prescription drugs. NORC’s social media data analysis showed that non-commercial creators such as patients, lifestyle influencers, and certain providers accounted for most posts with promotional elements, with telehealth companies and medical spas notable among them. Prescription drug content produced by these entities remains largely unregulated. 

One potential approach to addressing this regulatory gap could involve amending the Federal Food, Drug and Cosmetics Act (FDCA) to clarify the scope of FDA oversight over individuals or entities that receive financial benefits from the promotion of prescription drugs on social media. This includes:

• Influencers
• Telehealth companies and providers
• Medical spas 
• Other entities that digitally connect consumers with prescribers

Such revisions could include definitions for these entities with exemptions for content that specifically addresses an individual’s personal experience with prescription drugs. Additionally, clarifying what constitutes a financial benefit, including indirect financial gains such as compensation (either monetary or other in-kind remuneration) from regular promotion of a prescription drug, might also provide greater clarity around regulated entities while mitigating risks of First Amendment challenges.

While all prescription drug promotion must be “truthful, non-misleading, and accurate,” new research reveals that promotion of certain compounded drugs—such as compounded GLP-1 RAs—often does not meet this standard. These drugs are not FDA-approved, have raised FDA concerns around adverse events, and remain highly prevalent on social media. In NORC’s surveys, 80 percent of prescribers who had patients ask about drugs they saw on social media reported inquiries about GLP-1 RAs, and over half of consumers recalled seeing promotions for them on social media. 

One possible avenue for addressing this regulatory ambiguity could be to clarify the FDA’s regulatory authority under the FDCA with respect to false and misleading advertising of compounded and pharmacy-made drugs. Updating the 1971 Memorandum of Understanding Between the Federal Trade Commission and the Food and Drug Administration (“1971 Memorandum”) and other applicable documents to reflect this clarification may help foster consistency across rulemaking and guidance.

NORC’s social media data analysis found that off-label promotion was common in social media posts—appearing in up to 85 percent of relevant posts for some drug classes and platforms—and that clear disclosures of financial sponsorship appeared in fewer than 15 percent of posts with promotional language.

Given these findings, an update to federal regulations could be considered to address emerging promotional practices on social media by clarifying the required disclosures in prescription drug advertising. This might include considerations such as:

• Disclosure of sponsorships or financial relationships with manufacturers or marketers
• Disclosure of promotion for uses not approved by the FDA
• For compounded drugs: disclosures regarding lack of FDA approval, inclusion of balanced risk and efficacy information, and the prohibition of false equivalency to FDA-approved drugs

To ensure this definition is inclusive and comprehensive, formal processes could be established to solicit public input, engage independent research and advocacy organizations, and incorporate perspectives from patients—particularly those managing chronic conditions who are frequently exposed to prescription drug content on social media. Collaboration with the Federal Trade Commission (FTC) to develop a joint interagency definition would further strengthen its credibility and enforceability.

While the FDCA authorizes the FDA to regulate prescription drug promotion, there remains some ambiguity and instances of necessary “liaison activity” between the FDA and the FTC. Moreover, certain entities (e.g., sponsored social media influencers), drugs (e.g., compounded drugs), and disclosures (e.g., financial relationships) lack explicit language in statute that would enable greater federal oversight and enforcement, which consumers largely support. NORC’s consumer survey found that over half (57 percent) of consumers believe it is extremely or very important to have the government regulate how prescription drugs are promoted on social media.

In response, the FDA and the FTC could consider pathways to collaborate in monitoring and enforcement of prescription drug promotion on social media, consistent with their statutory authorities. Updating the 1971 Memorandum to reflect modern digital advertising practices and new categories of regulated content could help formalize interagency collaboration, potentially including a formal joint task force as appropriate.

Such efforts could include:

• Developing surveillance protocols across major social media platforms, leveraging advanced analytic tools, data infrastructure, and enhanced staffing for timely monitoring
• Clarifying the roles of the Office of Prescription Drug Promotion (OPDP), which oversees prescription drug advertising, and the Advertising and Promotional Labeling Branch (APLB), which has the authority to regulate advertising of biologic medicines
• Establishing defined enforcement mechanisms, potentially ranging from written warnings to escalating fines and other civil penalties for repeated violations
• Publishing joint annual reports detailing monitoring activities, compliance trends, and enforcement outcomes for transparency

NORC’s survey research found that consumers value and desire transparency in promoted prescription drug content. Sixty-six percent of consumers surveyed believe that it is very or extremely important for pharmaceutical sponsorships to be disclosed.

To address this, reporting requirements could be considered for all financial transactions and incentive arrangements related to the promotion of prescription drugs on social media. A centralized, publicly available FDA database could track the financial relationships involving influencers, providers, telehealth platforms, and intermediary companies. 

The responsibility for disclosure could rest with the paying entity, with specific provisions for intermediary companies such as digital platforms that financially benefit from connecting patients to virtual prescribers or promoting compounded alternatives to FDA-approved drugs. These measures could improve transparency around the commercial drivers of prescription drug-related content.

This research was supported by Arnold Ventures. Sneha Dave, founder and executive director of Generation Patient, provided subject matter expertise.