Compounded semaglutide and tirzepatide still sold after shortages ended, study finds

A secret-shopper study published in JAMA Health Forum found that 75 weight-loss clinics and medical spas in West Virginia and Oklahoma were still selling compounded GLP-1 receptor agonists in the fall of 2025, months after federal shortages of semaglutide and tirzepatide ended and the FDA moved to stop compounded copies of those drugs ^[1][2][3].

Researchers posed as customers and called businesses that advertised GLP-1 drugs for weight loss between August and October 2025. They started with 103 businesses found through location-based web searches in January 2025 and confirmed 75 that said they were offering compounded products ^[1][3].

Of those 75 businesses, 69 (92.0%) offered compounded semaglutide — the molecule in Ozempic, Wegovy and Rybelsus — and 65 (86.7%) offered compounded tirzepatide, the molecule in Mounjaro and Zepbound ^[1][2]. One business offered an unnamed triple receptor agonist, and at one business the active ingredient was unknown or not identified ^[1].

Seven businesses (9.3%) said they offered oral or sublingual compounded formulations ^[1][3]. Whether those oral products deliver the drug the same way as approved pills has not been reported.

Additives were common. Forty-four businesses (58.7%) said their compounded GLP-1 products included an added ingredient, most often B vitamins (42 businesses, 56.0%). Levocarnitine (5 businesses, 6.7%) and glycine (4 businesses, 5.3%) were less common ^[1][3].

What the study found about care and suppliers

Forty-two businesses (56.0%) said consultations were handled by a nurse practitioner or physician assistant, 30 (40.0%) by a physician, and one (1.3%) by a registered nurse ^[1][2]. In-person visits were required at 52 businesses (69.3%), 17 (22.7%) allowed in-person or virtual visits, and 4 (5.3%) were virtual only ^[1][2][3].

Follow-up visits at least once a month were required by 46 businesses (61.3%). Fourteen (18.7%) allowed less frequent follow-ups, 7 (9.3%) left the schedule to the patient or clinician, and 3 (4.0%) required no follow-up ^[1][2].

Researchers identified 24 compounding pharmacies as suppliers and analyzed 23, excluding one multistate facility ^[3]. Four of 21 state-licensed facilities (19.0%) were not licensed to perform sterile compounding ^[1][2][3]. Since 2023, one of 23 facilities (4.3%) had received two FDA warning letters, both citing sterile compounding violations, and 3 of 22 (13.6%) had faced state-level disciplinary action, with two of those actions citing sterile compounding ^[1][3]. Three of 23 (13.0%) had an open FDA Form 483 ^[1].

The study did not report prices charged by these businesses, and it did not report testing of the products for potency or contamination.

Why it matters for patients

Compounded drugs are not FDA-approved, so they do not carry the same assurance of strength, purity and stability as Ozempic, Wegovy, Rybelsus, Mounjaro or Zepbound ^[2][3]. The FDA removed tirzepatide from its shortage list in December 2024 and semaglutide in February 2025, then prohibited distribution of compounded versions after May 22, 2025 ^[2]. The study shows the market continued past that date ^[1][2].

The licensing findings are the part researchers say patients can look into. The study authors wrote that clinicians or patients considering these products should verify the compounding facility's licensure status with the FDA or the relevant state board of pharmacy, and contact the facility directly to find out whether the bulk drug substance is made in an FDA-registered facility that can provide a valid certificate of analysis ^[3].

Michael J. DiStefano, PhD, an assistant professor at the University of Colorado Anschutz Medical Campus who was one of the study's secret shoppers, told Healio that the compounded GLP-1 supply chain "is highly diffuse" and poses a challenge for regulators. He said he thinks people should not buy compounded GLP-1 products from a vendor that will not name the supplying pharmacy, because the pharmacy name can be checked with a state board of pharmacy ^[2].

What happens next

The findings apply only to August through October 2025, and the authors say they should not be generalized beyond that period ^[3]. The research covered brick-and-mortar businesses in two states, so it may not reflect online-only telehealth sellers, and the authors note their search method may have missed some businesses and that businesses may have given incorrect information on the calls ^[3]. No new FDA enforcement action against compounded GLP-1 sellers was announced in these reports.