The health care industry has never encountered anything quite like Ozempic before. First approved to treat Type 2 diabetes, this drug and others like it—known as GLP-1 agonists—hit blockbuster status because of their remarkable success rate as weight-loss aids. (Although it’s become shorthand for this type of drug, Ozempic is actually only prescribed for weight-loss off-label.) With relentless demand, they’ve been in shortage in the United States since 2022. They’re the Taylor Swift Eras Tour of pharmaceuticals: Supply is limited, prices are sky-high, and even people who couldn’t care less are at least ambiently aware of what’s happening.
When drugs are officially in shortage, the US allows pharmacies to make their own “compounded” versions of them. Compounded medications are essentially custom copies; unlike generic medications, which are FDA-approved drugs without brand names that are introduced into markets after patents expire, compounded drugs are intended as substitutes provided for specific reasons (like drug shortages) and are not subject to the same approval processes. In essence, dupes are legalized. And there’s no need to wait for any patents to expire to sell off-brand options of GLP-1 meds. Telehealth startups have jumped into the GLP-1 marketplace to sell these compounded drugs, offering easy-to-access copies at a far more affordable price.
Over the past two months, WIRED tested the process of ordering compounded semaglutide—the active ingredient in Ozempic and Wegovy—from a sample of the most prominent telehealth companies offering the medication in the United States. We focused on some of the brands we saw regularly advertising on social media. We wanted to observe the vetting process for potential patients and see what sort of documentation someone who wants to purchase these medications needs to produce. We found that it is remarkably easy to purchase these prescription drugs, even if one has no medical need. Most companies do not require lab work or medical records. Many do not even require a quick video conference or telephone call.
WIRED writers Kate Knibbs and Emily Mullin discuss how GLP-1 meds work and how shortages may be resolved.
We attempted to place an order with six companies: Hims & Hers, ReflexMD, Alan Meds, Henry Meds, Ro, and Get Thin MD.
Each company had a different intake process, although they all begin by asking patients to answer health-related questions. The questionnaires are easy to fill out. “It only takes five minutes,” the intake landing page for Alan Meds says.
Several of the companies asked for full-body photographs and copies of my driver’s license or other forms of official identification. They all had health care providers review the answers. Only one, Henry, required a synchronous video conference. Notably, this brief human-to-human interaction led to a treatment adjustment. The practitioner steered me towards the injectable version of the medication instead of the pill version that Henry offers, noting that it had more evidence of efficacy. (In fact, no oral semaglutide medication has ever been FDA-approved for weight loss.)
WIRED tested these processes from Illinois; some telehealth companies have vetting protocols that differ on a state-by-state basis, to comply with laws. Hims, for example, primarily offers “asynchronous” visits, where patients record and upload a video of themselves, except in states where it is required to conduct video conferences in real time.
When making the orders, I was truthful while filling out the intake questionnaires, with one exception, made deliberately to see if the companies would insist upon verification: I adjusted my weight upwards on the forms to ensure my BMI came out to 27, the FDA having authorized semaglutide as a weight-loss treatment from this point and up. I used my WIRED email address and a company card issued to our editor-in-chief.
Hims was the sole company that did not offer me GLP-1 meds, even though it accepted my exaggerated weight without verification. It recommended, instead, a combination of the glucose-regulating drug metformin, vitamin B12, the antidepressant bupropion, and naltrexone, a drug used to reduce cravings. It did not permit me to go back to change my answers in a bid to qualify for a GLP-1 medication. (Hunterbrook Media, the editorial affiliate of hedge fund Hunterbrook Capital, recently conducted an investigation into Hims & Hers Health’s entry into the GLP-1 market, and one of its employees was offered compounded GLP-1 meds without their BMI being verified. Hunterbrook Capital is now shorting Hims.) Get Thin MD assessed me as a viable candidate for GLP-1 drugs, but then repeatedly declined my credit card, so it did not ship medication.
The other four companies sent vials of semaglutide. None asked for proof of BMI, nor did any require that I also show evidence of at least one weight-related ailment, even though the official recommendation for prescribing this type of medication to a person with a BMI of 27 is the presence of one such ailment. They did all send instructions for how to inject the medications safely, and the Henry practitioner who conferenced with me gave a very clear visual tutorial.
When asked how they safeguard against people exaggerating their weights to receive meds, ReflexMD and Henry did not respond. Ro spokesperson Nicholas Samonas said in a statement that each online visit is reviewed by “licensed providers” to determine if treatment is appropriate, and said that providers do require a metabolic health lab test “either with an at-home collection kit or at any Quest Diagnostics location,” if they deem it necessary. (My provider did not deem it necessary.)
A spokesperson from Alan Meds who identified herself only as Olivia sent an email noting that “licensed physicians” evaluate each case, “adhering to FDA guidelines for GLP-1 prescriptions.” She noted that they assessed “BMI, comorbidities, existing medications, and other lifestyle factors” to determine eligibility. “Just as with any medical encounter, our program relies on customers sharing truthful information and additional validation so that our contracted telemedicine partners can properly tailor a treatment recommendation. No matter whether medications are commercially available or compounded, telemedicine doctors rely on this same set of information,” she said. The Alan Meds’ physician assigned to me did order a metabolic lab test, but I was not required to complete it prior to the shipment of the medications.
WIRED’s experience ordering these medications suggests that people who do not meet the criteria to get these drugs prescribed will not have a difficult time circumventing the guardrails in place. If anything, it may be easier than what we encountered.
A Potential Market of Most People
So how many people, exactly, have this kind of medication sitting in their refrigerator, like me? It’s a surprisingly difficult question to answer. Telehealth companies are often coy about their numbers. The closest thing WIRED got to an answer on patient numbers was from Hims’ chief medical officer, Pat Carroll: “Since launching a couple of months ago, we’ve done thousands of visits,” he says.
“We do not have this data available,” FDA spokesperson Amanda Hils told WIRED via email.
There have not been any thorough accounts of how many patients are taking compounded GLP-1 meds altogether, nor are there statistics looking at how many telehealth companies are currently selling the meds, or how many compounding pharmacies are mixing GLP-1 drugs. “There are definitely more compounding pharmacies than I’d realized servicing this industry,” says Melinda Lee, a pharmacist who runs Parcel Health and a database called MedStockCheckr devoted to documenting GLP-1 drug availability and reviewing pharmacies. (Right now, MedStockCheckr lists 17 compounding pharmacies, but it is an incomplete list.)
Although we lack data on who is taking these drugs right now, the number of potential patients is vast. Roughly 43 percent of American adults are estimated to be obese (defined as having a BMI of 30 or higher), while about 31 percent are estimated to be overweight (having a BMI of 25 or above). That’s close to 200 million people. This means nearly three-quarters of the country’s adult population may benefit from these medications simply for weight management—and that’s before taking into account their efficacy as diabetes treatments, as well as their potential as cardiovascular health aids and substance use disorder treatments. It’s also before factoring in people who may seek these drugs for aesthetic purposes, a kind of Botox of the body.
“The mind-boggling part about this is the size of the addressable market,” says Scott Roth, the CEO of LegitScript, a company that provides health care industry certifications for telehealth providers and pharmacies. (It’s a widely-recognized seal of approval; Meta and some other companies require LegitScript certification to allow online pharmacies to run ads.) “It’s awesome to me that there are so many options, but it’s also a little scary, because fraudsters and bad actors flock to big market opportunities like this.”
With a potential customer base of most people—and that’s in the US alone—at least one industry analyst projects annual sales of GLP-1s could be up to $100 billion within the next decade. Hence, the huge spike in companies offering these products. Of all the new companies requesting LegitScript certification in 2024, Roth says over 60 percent offer weight-loss drugs, and 98 percent of those companies offer compounded GLP-1 medications.
Telehealth companies often advertise on social platforms like Instagram, X, and TikTok, heavily emphasizing how similar their drugs are to the name-brands. The homepage for ReflexMD, for instance, greets would-be patients with a note that its meds contain “the active ingredient in Ozempic and Wegovy.” They often advertise sales and discounts. Henry Meds, for example, recently ran a 4th of July sale promoting the “freedom to feel healthy” and offering its oral semaglutide for $129 for the first month. Alan Meds ran a 4th of July sale offering 44 percent off with the slogan “Stop overpaying for Ozempic.” Ro, another big telehealth company, has an introductory-month price of just $99. (Brand-name GLP-1 drugs, meanwhile, can cost over $1,000 a month without insurance, and are often difficult to get covered.)
LegitScript also monitors certain health-related advertisements on social platforms. So far in 2024, the company has witnessed a spike in the number of “violative or problematic” GLP-1 ads, including those making false claims about what the drugs can do and ads from unlicensed pharmacies. In the first half of 2024, LegitScript has seen twice as many violative or problematic ads as it saw in 2023.
In addition to the sharp rise in telehealth providers offering compounded products, there’s also a wild cottage industry of outright Ozempic counterfeits, as Vanity Fair detailed last month. Brick-and-mortar med spas advertising online are also thriving in the Fauxcempic Era, and they often also offer compounded GLP-1 meds, in addition to allegedly appetite-suppressing supplements.
In this medical gold rush, Roth sees echoes of an earlier massively hyped medicine-turned-cultural-phenomenon. “It’s similar to the early days of erectile dysfunction,” he says. In fact, both Ro and Hims started as telehealth companies selling ED medications.
Questions About Compounding Quality Remain
Compounding pharmacies serve an important role in the US health care system, offering, for example, patients with allergies ways to get custom-mixed versions of lifesaving drugs. Advocates of compounding stress that the practice has been around for a long time, and that the FDA permits it to preserve vital access to medication. “Media reports describe it as a loophole,” says Alliance for Pharmacy Compounding CEO Scott Brunner. “It’s not a loophole. It’s very intentional policy.” Brunner has expressed frustration about how some coverage of the rise of compounding GLP-1s conflates unlicensed pharmacies peddling counterfeit drugs or research peptides with credentialed operations following proper guidelines.
The way these pharmacies have assumed a prominent role in this projected $100 billion industry—supplying companies with medications, such as oral GLP-1s, that are not FDA-approved—warrants closer study.
In Australia, compounding these medications has also been permitted due to the global nature of the shortage—but the government decided to ban compounding GLP-1s this past May, citing safety concerns. “I’m really concerned about the way in which this market has developed that compromises public safety,” Australia’s federal health minister Mark Butler said when the ban was announced.
The FDA has advised patients to be cautious about compounded GLP-1 drugs, emphasizing that it does not evaluate these medications for safety, quality, or efficacy before they’re sold. “Patients should be aware that some products sold as ‘semaglutide’ may not contain the same active ingredient as FDA-approved semaglutide products,” the agency wrote in January 2024. The FDA’s Adverse Event Reporting System (FAERS) database includes 442 cases of adverse events associated with compounded “semaglutide,” including seven deaths. However, the FDA tells WIRED that FAERS reports—like those of the more famous Vaccine Adverse Event Reporting System—are often missing information. “With that in mind, the FDA cannot confirm a direct correlation between adverse events reported in FAERS and the use of semaglutide,” FDA spokesperson Hils says.
“Some compounding pharmacies, in my view, are preying on peoples’ desperation,” says obesity researcher Justin Ryder, a professor at Northwestern. “They’re making what I’m sure is a lot of money from a product that is potentially the same—or potentially not.”
Eli Lilly and Novo Nordisk have both recently taken legal action against companies selling compounded versions of drugs, often alleging trademark infringement. Novo Nordisk has filed 21 lawsuits since last summer. This June, Eli Lilly initiated six lawsuits, following ten other lawsuits that the pharmaceutical company began last fall. In one, filed against a company selling compounded GLP-1s online, it alleged that passing compounded drugs off as having identical active ingredients as its products was “not merely deceptive—it’s dangerous.”
“Telehealth providers and compounding pharmacies that are claiming to offer or sell unapproved compounded products claiming to contain ‘semaglutide’ are sourcing their ingredients from entities other than Novo Nordisk,” Novo Nordisk spokesperson Jamie Bennett told WIRED. “As the FDA has cautioned, unapproved compounded ‘semaglutide’ drugs do not have the same safety, quality, and effectiveness assurances as Novo Nordisk’s FDA-approved semaglutide medicines, and patients should not use a compounded drug if an approved drug is available.”
“There’s huge safety implications,” Ryder says. In 2012, a compounding pharmacy caused a fungal meningitis outbreak that killed at least 64 people, among the worst pharmaceutical drug-contamination disasters in the United States. The supervisory pharmacist who oversaw the manufacture of this medicine was sentenced to prison time, and the event led to tightened oversight and licensing requirements for compounders.
Some of the leading compounding pharmacies that produce GLP-1 medications have landed in trouble for their practices. Hallandale Pharmacy, a popular supplier—two of my four vials came in its sleek blue packaging—has run into trouble with regulators for past infractions, which included concerns over record-keeping and facility conditions. It has received warning letters from the FDA, although the last one was closed out in May 2022, which means the FDA found that it had addressed outstanding issues. (Hallandale declined requests for comment.)
The FDA has found issues with pharmaceutical companies, too, though. In 2023, FDA inspectors found bacterial contamination at a Novo Nordisk production plant in North Carolina. “Leadership addressed immediately, and the site received FDA approval for full production for market in August 2023,” Novo Nordisk’s Bennett says.
Compounding advocates say that, although the drugs are not FDA-approved, they are still subject to rigorous quality control, in part due to post-2012 rule changes. Carroll, for example, says Hims did “due diligence” when choosing its pharmacy and that it has been satisfied with the medication quality. “We’ve seen an extremely good response from our customers,” he says. “No untoward side effects that we didn’t anticipate.” According to Carroll, Hims has not had to report any adverse effects to the FDA.
What’s Next?
As researchers continue to discover new potential use cases for GLP-1 drugs, and public interest and demand remains high, these drugs may be on the FDA’s official shortage list for months or even years to come. If the shortage ends, one type of compounding pharmacy (called 503a) would be required to stop production immediately while 503b pharmacies, which typically produce on a larger scale, would have 60 days. An end to the shortage would require some substantial pivots within this booming cottage industry. None of the telehealth companies that sent compounded semaglutide to WIRED made mention of what might happen in this scenario during the intake process.
Many people who take compounded drugs may be taken by surprise if they are told they must switch to brand-names—and pay much higher prices—within a matter of months.
However, even when the shortage does officially end, at least some of the telehealth companies do not plan to pivot away from compounding. “We believe there’s going to be more and more demand for the medication, so that may actually prolong the shortage list,” says Hims’ Pat Caroll. “We are convinced there’s a pathway, even when it comes off the shortage list, to supply these compounded medications.”
Even compounding skeptics suspect that it’s not going away any time soon. With demand so high, Ryder suspects pharmaceutical companies will need to ramp up production to serve “basically 40 percent of the US population” before shortages end. Until then, Ryder suspects this telehealth boom will continue unabated.
For now, the vials of compounded semaglutide WIRED ordered are sitting in the back of a fridge untouched.
