Some compounding pharmacies are making slight tweaks to the composition of their GLP-1s to sidestep an FDA ban on copying approved semaglutide and tirzepatide products, suggest the findings of a study published July 17 in JAMA Health Forum.
Surging demand for GLP-1s led the FDA to add semaglutide, tirzepatide and liraglutide to its shortage list between 2022 and 2023, fueling a robust market for compounded versions sold through weight-loss clinics, medical spas, and telehealth platforms. However, the FDA has since declared the shortages resolved and banned compounders from producing exact copies of the branded drugs.
Lead author Michael DiStefano, PhD, a researcher at the University of Colorado Anschutz Medical Campus in Aurora, placed secret shopper calls to 103 weight-loss clinics and medical spas in West Virginia and Oklahoma from August to October 2025, confirming 75 businesses offered compounded GLP-1 receptor agonists for weight loss. Of those, 92% offered compounded semaglutide and 86.7% offered compounded tirzepatide.
Nearly 59% of the businesses confirmed their compounded products contained an additional ingredient, most commonly B vitamins (56%), followed by levocarnitine (6.7%) and glycine (5.3%). Seven businesses, or 9.3%, offered oral or sublingual formulations. Most consultations were conducted in person (69.3%) by nurse practitioners or physician assistants (56%), and 61.3% of businesses required follow-up visits at least once a month.
The study identified 23 single-location compounding pharmacies supplying these businesses. Four lacked licenses for sterile compounding, one had received two FDA warning letters citing sterile compounding violations since 2023 and three had faced state pharmacy board disciplinary action.
The researchers said the findings suggest compounders shifted toward adding ingredients like B vitamins after the FDA resumed enforcement against copying approved GLP-1 drugs, raising ongoing oversight questions for a market they estimate could include more than 4,000 similar businesses nationwide.
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