Cheaper Wegovy Copies Online: What Buyers Should Know About Compounding Pharmacies

Jennie Smith, a seamstress at a ballet school in Kent, Ohio, spent years trying to lose weight and keep it off. She dropped 60 pounds through dieting, then regained 30. When she decided to try a new weight-loss drug like Wegovy, she ran into a barrier: the medicine costs more than $1,000 a month, and she doubted her insurance would pay for it.

Her research led her to an online pharmacy offering its own version of the drug. After a virtual appointment with a health care provider to settle on a dose, the pharmacy shipped the medicine on dry ice a few weeks later. The cost was about $300 a month. Smith says she has lost 40 pounds since September. "It was like a light switch," she says, describing how she stopped thinking about food.

What Smith received was not Wegovy itself. It was a compounded medicine, made with the same basic ingredient, semaglutide, but prepared by a specialized pharmacy rather than a drug company. New online businesses offering telehealth prescriptions for cheaper compounded versions seem to appear constantly, giving some patients relief from high prices, insurance denials and shortages. The convenience carries risks, however.

Compounding pharmacies exist to serve patients whose needs are not met by approved drugs. Their products are not generics and do not go through the Food and Drug Administration's approval process. They are mostly regulated by state boards of pharmacy. A typical example is turning a pill into a liquid for an elderly patient who cannot swallow it. The FDA says compounders are not supposed to make "essentially" copies of approved drugs, but they can legally step in during a shortage. Wegovy is currently in short supply because manufacturer Novo Nordisk cannot keep up with demand. Scott Brunner, CEO of the Alliance for Pharmacy Compounding, says semaglutide itself is widely available and that compounders must source ingredients from FDA-registered facilities, some of which also supply drugmakers.

Not every seller meets standards. Novo Nordisk has taken legal action against several businesses, saying it found impurities, incorrect concentrations and even products with no semaglutide. The company says hundreds of problems tied to compounded semaglutide have been reported to the FDA's voluntary adverse event system, including 99 hospitalizations and seven deaths as of the end of March. Brand-name drugs also appear in that database with hospitalizations and deaths.

The National Association of Boards of Pharmacy has identified more than 40,000 online pharmacies operating illegally or in ways it does not recommend. Executive director Al Carter estimates that only about 5% of online pharmacies are legitimate. His group checks 200 new ones a week, but when one is taken down, two more appear. "It's kind of like you're on a hamster wheel," he says. Consumers can use the association's search tool to see whether a pharmacy meets its standards.

Buyers can do more on their own. Brunner advises confirming that the pharmacy is licensed in the buyer's state, using the FDA's state-by-state links. Patients can also ask where the semaglutide comes from and look up that facility in an FDA database of registered sites. Advertising compounded "Ozempic" or "Wegovy" is a red flag, because compounders may not legally use brand names in marketing. Brunner's blunt advice: never inject something without a prescription from a licensed prescriber and a state-licensed pharmacy.

The FDA and medical experts say the safest route is an approved brand-name drug through a regular doctor and an in-person pharmacy. Some people avoid that because of weight stigma. Smith's primary care doctor scolded her for using compounded semaglutide and said she should lose weight on her own. She says she has had no complications so far.

Still, Dr. Scott Isaacs, president-elect of the American Association of Clinical Endocrinology and a professor at Emory University Medical School, says patients should not hide the drug from their doctors. A primary care provider can monitor other conditions and medications. He described a recent patient whose other medication doses needed significant adjustment after weight loss. People on insulin may need less as they lose weight, since too much can cause seizures or death. Isaacs also notes that the drug, brand name or compounded, carries a rare risk of thyroid cancer, so a physical thyroid check matters. He would prefer patients avoid online pharmacies, but acknowledges that is not always realistic: "If there is a will, there's a way."