Since the GLP-1 boom began, obesity drugs haven’t just been prescribed in clinics; patients have shopped for them. According to a November poll of 1,350 Americans, around one in four people taking GLP-1s were getting these medications from online providers, websites, medical spas or aesthetic medical centers — rather than from their primary care doctors or specialists.
Often, these outlets sell low-cost copycats of obesity medications — compounded versions made by pharmacies that measure and dissolve drug ingredients, creating their own injectable product.
Earlier this month, Hims & Hers, a major online provider of obesity medications, announced that it would be selling a compounded version of the Wegovy pill for about $100 a month less than the official version sold by Novo Nordisk. Hims pulled this product from the market two days later, after federal regulators raised concerns. The episode captures the trade-off that many Americans are facing: Cheaper access, but with fewer guarantees about what they’re actually getting.
So, we asked experts if it matters where you get your obesity drugs.
What is a copycat GLP-1 drug?
Federal law allows compounding when there’s a drug shortage or when a patient needs a special formulation. However, after several years of limited supply, the Food and Drug Administration says that the GLP-1 shortages are over. Since then, many medical spas and telehealth companies have continued to sell compounded drugs, relying on providers who say these personalized versions are necessary.
These companies tend to sell slightly altered versions (for example, mixing in ingredients like Vitamin B12 or the molecule N.A.D.+) or custom doses that pharmaceutical companies don’t sell. Critics argue that these modifications are superficial tweaks, and Novo Nordisk has sued companies that produce compounded semaglutide — the generic for Ozempic and Wegovy — “under the fake guise of personalization.”
Compounded GLP-1 drugs can be cheaper and easier to obtain, since many insurance companies balk at covering the more expensive brand-name versions. But these copycat drugs also come with more uncertainty, said Dr. Amy Sheer, an obesity medicine physician at University of Florida Health, since they are not approved by the F.D.A. While regulators do oversee the compounding process, the scrutiny is generally lighter than for approved drugs.
So, compounded drugs face lower standards for safety, quality and effectiveness. The F.D.A. has sent warning letters to compounding pharmacies about GLP-1 products that were not produced in sterile conditions or had less semaglutide than promised. Recently, a Hims & Hers compounder was cited for having a potential insect infestation in its facilities.
In a statement, Hims wrote that “Patient safety and regulatory compliance are foundational to how we operate.”
Compounded drugs can sometimes lead to serious complications, like GLP-1 overdoses. But these issues seem to be rare. For many patients, the biggest risk is more mundane — wasted money and stalled weight loss because of a poorly made or fake drug, said Dr. Goutham Rao, chair of the family medicine and community health department at University Hospitals Cleveland Medical Center.
That risk can be reduced by using an established pharmacy or telehealth company with a reputation to uphold, he added, rather than going through online marketplaces. In a 2024 study, researchers purchased GLP-1s over social media and from illegal pharmacies, and they received mislabeled, contaminated and incorrectly dosed medications — when the products were delivered at all.
Can obesity be managed by a single drug?
In a typical medical practice, patients take GLP-1 medications as part of a larger treatment plan, said Dr. Juliana Simonetti, director of the obesity medicine program at University of Utah Health. For example, doctors use laboratory tests to assess for weight-related complications and offer dietary and exercise guidance to avoid issues like malnourishment. Regular follow-up visits are also important to manage side effects and to increase doses over time.
This close monitoring can be important because, in rare cases, GLP-1 medications can cause serious gallbladder and pancreatic issues, said Dr. Emily Hill Bowman, a primary care physician at Nebraska Medicine. As patients lose weight, doctors might also need to recalibrate other prescriptions to prevent, for example, thyroid levels from spiking or blood pressure from dropping too low.
By contrast, getting GLP-1s from websites or medical spas might leave patients managing these risks on their own, Dr. Sheer said, because they might be bounced between different providers or have otherwise spotty follow-up care. Some telehealth companies also operate like subscription services. This model can create conflicts of interest, she added, where the same company both evaluates patients and sells them drugs, when another treatment option might be more appropriate.
Telehealth can widen access, Dr. Simonetti said, but when care is mostly hands-off and follow-up is limited, it could lead to inappropriate prescribing, insufficient patient support and slower responses to warning signs.
GLP-1 drugs are a tool, but not a substitute for proper obesity care, Dr. Simonetti said. “This is not just about the weight,” she added. “It’s about improvement of health.”
What should you do if you’re taking compounded GLP-1 drugs?
If you’re going to get GLP-1s from a telehealth service or medical spa, ask where the drugs come from, who helps manage side effects and how quickly you can reach a provider, Dr. Sheer said. Vague answers to these basic questions could signal trouble.
Make sure the clinician knows what other medications you’re taking, and set up a real follow-up plan to adjust these medications and your GLP-1 dose, she added. Also, seek ongoing guidance on diet and exercise, since rapid weight loss without other lifestyle changes can erode strength and overall health.
Most important, loop in your primary care doctor and bring your compounded drug to your next visit. Even if the online provider or medical spa offers follow-up services, your doctor can still monitor your labs, offer lifestyle support, manage side effects and keep an eye out for serious complications, Dr. Simonetti said. Furthermore, your doctor might be able to steer you toward a more reputable compounding pharmacy or tell you if you’re paying too much.
“Let your doctor know,” Dr. Bowman said. “We’re just happy to help any way we can.”
Simar Bajaj covers health and wellness for The Times.
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