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Eli Lilly and Novo Nordisk have recently taken legal action against companies that sell compounded versions of the drugs, often alleging trademark infringement. Novo Nordisk has filed 21 lawsuits since last summer. In June of this year, Eli Lilly filed six lawsuits, following 10 others that the drug company began last fall. One, filed against a company that sells compounded GLP-1 online, alleged that presenting compounded drugs as having the same lively ingredients as its products “is not just deceptive—it’s dangerous.”

“Telemedicine providers and prescription pharmacies that claim to offer or sell unapproved prescription products purporting to contain ‘semaglutide’ source their ingredients from entities other than Novo Nordisk,” Novo Nordisk spokesperson Jamie Bennett told WIRED. “As reported by the FDA, he warned“Unapproved semaglutide combination drugs do not have the same guarantees of safety, quality and effectiveness as Novo Nordisk’s FDA-approved semaglutide drugs, and patients should not use combination drugs if an approved drug is available.”

“There are huge safety implications,” Ryder says. In 2012, a compounding pharmacy caused an outbreak of fungal meningitis that killed at least 64 people, one of the worst pharmaceutical contamination disasters in the United States. A pharmacist who oversaw production of the drug was sentenced to prison, and the incident led to tighter oversight and licensing requirements for compounding manufacturers.

Some of the leading prescription pharmacies that manufacture GLP-1 drugs have run into trouble for their practices. Hallandale Pharmacy, a popular supplier—two of my four vials came in a sleek blue package—faced problems with regulators for past misconduct that included concerns about record-keeping and conditions at the facility. I received warning letters from the FDA, although the last one was closed in May 2022, meaning the FDA felt it had addressed the unresolved issues. (Hallandale declined requests for comment.)

The FDA has also found problems with pharmaceutical companies. In 2023, FDA inspectors found bacterial contamination at Novo Nordisk’s manufacturing facility in North Carolina. “Management made an immediate decision, and the facility received FDA approval for full production for the August 2023 market,” Novo Nordisk’s Bennett says.

Advocates of compounding say that while the drugs aren’t FDA-approved, they’re still subject to stringent quality controls, in part because of changes in regulations enacted after 2012. Carroll, for one, says that Hims did “due diligence” when choosing a pharmacy and that he’s pleased with the quality of the drugs. “We’ve seen an incredibly good response from our customers,” he says. “No adverse side effects that we weren’t expecting.” According to Carroll, Hims hasn’t had to report any adverse effects to the FDA.

What’s next?

As scientists continue to discover recent potential uses for GLP-1 drugs, and public interest and demand remain high, these drugs could remain on the FDA’s official shortage list for months or even years. If the shortage ends, one type of compounding pharmacy (called a 503a) would have to stop producing them immediately, while 503b pharmacies, which typically produce more in volume, I would have 60 daysEnding the shortage would require some significant changes in this burgeoning home-based industry. None of the telemedicine companies that sent compounded semaglutide to WIRED mentioned what might happen during the intake process in this scenario.

Many people taking combination medications may be surprised to find out within a few months that they have to switch to brand-name medications and therefore pay significantly more.

But even when the shortage officially ends, at least some telemedicine companies have no plans to move away from compounded drugs. “We think demand for the drugs will continue to grow, so that could actually extend the shortage list,” says Hims’ Pat Caroll. “We believe there’s a path, even after these drugs come off the shortage list, to provide these compounded drugs.”

Even skeptics suspect it won’t go away anytime soon. With demand so high, Ryder suspects pharmaceutical companies will need to ramp up production to serve “basically 40 percent of the U.S. population” before the shortage ends. Until then, Ryder suspects the telemedicine boom will continue unabated.

For now, the vials of semaglutide ordered by WIRED lie untouched at the bottom of the refrigerator.