If you shopped for GLP-1s online over the last couple of years, you probably noticed compounded semaglutide and tirzepatide everywhere — often much cheaper than the brand-name pens. That availability wasn’t a loophole so much as a consequence of how U.S. drug-compounding law interacts with shortages.
Here’s the mechanism, in plain terms.
Shortages open a door
When an FDA-approved drug is in official shortage, the law gives compounding pharmacies more room to prepare versions of it, because patients who need the medicine may not be able to get the approved product. Semaglutide and tirzepatide spent significant stretches on the FDA’s shortage list as demand outran supply. That’s the period when compounded GLP-1s proliferated across telehealth.
Resolved shortages narrow it again
When the FDA determines a shortage is resolved, the shortage-driven compounding rationale narrows. Products that were widely available under shortage conditions become harder to justify and to buy. This is why some telehealth providers changed their offerings, and why patients saw compounded options disappear or shift.
Compounding doesn’t vanish entirely — it can still happen in other, narrower circumstances defined by law — but the broad, shortage-fueled marketplace is a different thing from ordinary compounding.
What this means for you
- Compounded ≠ FDA-approved. Per the FDA’s compounding Q&A, compounded drugs are not evaluated by the FDA for safety, effectiveness, or quality.
- Status changes over time. Whether a given product can be legitimately compounded depends on current conditions. Don’t assume last year’s availability still applies.
- Pharmacy quality matters enormously. If you do use a compounded product, the licensing and reputation of the pharmacy is doing a lot of the work that FDA approval would otherwise do.
For the practical version of this — how to check whether a provider is offering something legitimate — see our access guides and Provider Watch.