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Weight Limit is a series that examines the rise of weight loss drugs like Wegovy and how they impact young people. This story digs into cheaper Ozempic “dupes” and what they actually are.
After a patient’s insurance wouldn’t cover the weight loss medicine Dr. Nancy Crimmins, MD, a pediatric endocrinologist at Cincinnati Children’s, had prescribed, the patient asked her if she would send the prescription to a compounding pharmacy, where it would be cheaper. Dr. Crimmins hadn’t heard of the pharmacy, and wanted to understand why they could provide medications like semaglutide — the active ingredient in Ozempic and Wegovy — at a fraction of its typical cost, which can range from $900 to $1300 per month. So, she called up a compounding pharmacy and asked.
The reason the drugs can be sold at a cheaper price is because “this is not medical grade product,” she said. “I absolutely, hands down, will never write this prescription to a compounding pharmacy because of this.”
Ozempic hit the markets in 2017 as a drug designed to help people with Type 2 diabetes lower their blood sugar, noting the drug might also result in weight loss. In 2021, Wegovy, a drug made of the same active ingredient as Ozempic (semaglutide) but in a higher dose, was approved specifically for weight loss. The drugs took the market by storm. According to NBC News, Wegovy was so popular that it went into shortage, prompting doctors to prescribe Ozempic off-label for weight loss. That triggered a shortage of both drugs, which still exists today.
When drugs go into shortage, the U.S. Food and Drug Administration (FDA) allows compounding pharmacies to compound those drugs — or mix or alter certain drugs to create a separate product. In the case of Ozempic and Wegovy, the demand for these drugs has triggered a gray area, one in which compounds of the drugs are sold at lower prices through various sources like certain clinics and specialized telehealth services. But as Dr. Crimmins learned, these compounds aren’t necessarily safe, and we don’t always know what exactly is in them.
Compounded drugs can be crucial for some patients, like those who are allergic to an ingredient in a needed medication. Compounding pharmacies can mix a version of that drug that doesn’t include the ingredient, allowing the patient to take it safely. But, compounded drugs aren’t FDA approved, meaning the federal agency “does not verify the safety or effectiveness of compounded drugs,” nor does it verify manufacturing quality, according to the FDA website.
This has resulted in issues. “FDA has observed troubling conditions during many of its inspections of compounding facilities including toaster ovens used for sterilization, pet beds near sterile compounding areas, and operators handling sterile drug products with exposed skin, which sheds particles and bacteria, among many others,” the FDA website says. In 2012, a pharmacy in Massachusetts shipped an injectable compounded drug that was contaminated with fungus, reaching more than 14,000 patients across the country and resulting in what the FDA called the “most serious outbreak associated with contaminated compounded drugs in recent history.” More than 750 people across 20 states developed infections, and more than 60 died. This incident was not an isolated one, according to the FDA, and has been one in a long line of hazardous issues arising from compounding pharmacies.
Because compounded drugs aren’t FDA approved, we don’t always know what they contain — which is also true for semaglutide. In their October 10 episode examining Ozempic, the podcast Maintenance Phase, hosted by Aubrey Gordon and Michael Hobbes, noted that Novo Nordisk, the manufacturer of Ozempic and Wegovy, holds the patent on semaglutide through 2032. This, they said, means that other companies cannot produce a medication containing semaglutide. Because the drug was placed on the FDA’s shortage list, this opens the door to compounding despite the patent. Still, the New York Times reports that there is currently no generic version of Ozempic or Wegovy, and Novo Nordisk does not sell semaglutide for compounding purposes. And, according to a Responsible Use letter from Novo Nordisk, the company does not sell semaglutide products to telehealth providers.
“These compounding pharmacies are prescribing something, they're calling it semaglutide. It's not Ozempic and it's not Wegovy. It might be a watered-down dose of those things. It could be something called semaglutide sodium. It's called semaglutide, but it's … not cleared for use in humans,” Gordon said on the show. “And the third option is that it's something else entirely. Because this is in shortage and because there is less FDA oversight, these compounding pharmacies are not required to tell anyone what's in the drugs that they are giving people.”
Gordon goes on to point out that, while this might sound like a niche problem, it’s actually quite widespread. The online pharmacies promising next-day Ozempic prescriptions or offering discounted deals on semaglutides are “powered by compounding pharmacies,” she said.
While some online pharmacies seem to offer prescriptions for Ozempic, Wegovy, and other similar medications, many offer compounds (some aimed specifically at children and teens), and there isn’t always information on what, exactly, is in that compound. The Times reports that compounding pharmacies may buy semaglutide from pharmaceutical ingredient manufacturers and mix it with things like B vitamins and more. Others, they report, use the ingredient Gordon referenced, semaglutide sodium, which the FDA has raised a red flag on.
“FDA has received reports that in some cases, compounders may be using salt forms of semaglutide, including semaglutide sodium and semaglutide acetate,” the website reads. “The salt forms are different active ingredients than is used [in] the approved drugs, which contain the base form of semaglutide. The agency is not aware of any basis for compounding using the salt forms that would meet the FD&C requirements for types of active ingredients that can be compounded.” The organization also sent letters to three regulatory boards warning that semaglutide sodium and acetate are not safe for compounding use.
As a result, Novo Nordisk is suing some medical spas, weight loss or wellness clinics, and compounding pharmacies that it’s alleging have sold “non-FDA approved counterfeit and compounded semaglutide products claiming to contain semaglutide.” Eli Lilly, which produces another injectable weight loss drug called Mounjaro, has initiated similar lawsuits.
Dr. Melissa Crocker, MD, MBA, a pediatric endocrinologist at Boston Children’s Hospital, said the demand for semaglutide is so high that she understands why people are seeking alternatives when the drug is in shortage. But, she warns people against getting semaglutide from a compounding pharmacy.
“I would only buy a medicine made by the manufacturer and used in the way the manufacturer intended it to be used. I would encourage people to seek out medications through their established providers,” she told Teen Vogue. “We want to make sure that a full assessment is being done, that people are being given good nutritional support, mental health support, and are being examined by a healthcare provider before being given medications. That they’re being monitored for any underlying issues.”
Dr. Crimmins stressed that proper evaluation is crucial prior to prescribing semaglutide or other weight loss medications, but she too understands why it’s attractive to get semaglutide from these telehealth services or through compounding pharmacies. They offer a weight loss solution in a world where thinness is prioritized, and they offer a cheaper product in an inequitable healthcare system. But instead of accepting that people will turn to potentially unsafe alternatives because of barriers to healthcare access (she strongly cautioned against getting medications from these pharmacies), she said it’s worth investigating the gap between the people who most need semaglutide, and the people who can afford to get it. Most private insurers don’t cover the drug for weight loss and Medicare doesn’t cover any weight loss medication, meaning many patients have to pay out of pocket.
“There is a health disparity in who can get these medications. A rich family, if they can get a provider to write this prescription, they can pay for it out of pocket,” she said. “Even if I have kids with genetic conditions that [lead to obesity], I can’t get those medications for them if they’re on public insurance. It’s not even [a question of] why people want it, but how do we get it in the hands of people who really need it when there’s this whole other group of people who can access it cosmetically.”
Read the rest of the series here:
Teens Are Taking Wegovy, and Experts Wonder What That Means for Mental Health
Ozempic Is Highlighting How We Link Our Worth to Our Body Size
Nearly 1 in 10 Teenagers Have Turned to Pills for Weight Loss, Research Shows
Diet Culture History: From Ancient Greece to Ozempic
Young People Are Struggling to Get Ozempic for Diabetes Because of the Drug's Popularity
