Short Answer: Nothing. It is business as usual at the providers I recommend and will be indefinitely. Compounding pharmacies are meant to offer custom medications. The providers I recommend are offering customized medications at a fraction of the cost of Big Pharma.

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What I know.... for those who want to deep dive.

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In October 2024, the manufacturers of the branded versions of semaglutide and tirzepatide began a months-long legal battle with the compounding pharmacies to assert that the medications were no longer in a national shortage. It ended this year with the courts agreeing that straight semaglutide and tirzepatide could no longer be compounded as a one-to-one substitute for the branded medications.

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GLP-1 users have historically found they've benefited from adding things to their regimen such as B12 for energy, glycine to retain muscle mass during weight loss, etc. This was known all along. So rather than prescribing or recommending these supplements separately, compounding pharmacies are offering them together. This allows patients to have a better experience, and without Big Pharma's markup, you can continue to source the active ingredient semaglutide and tirzepatide at a huge cost savings.

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Big Pharma is indeed actively trying to prevent this from happening. Scott Brunner, the President of the Alliance for Pharmacy Compounding (APC) and his right-hand associate, Tenille Davis, are leading the charge to straighten out the dialogue in the media regarding many, many things. First and foremost was to clear up the incredible safety profile of compounded medications.  I have corresponded with both of them, zoomed with Tenille, and they have been the only ones brave enough to challenge the narrative in the media. The next thing Scott and Tenille did is to address the legitimacy of the shortage back in November, when Big Pharma claimed there was no longer a shortage. After some time in court, the FDA agreed that normal pharmacies were still not properly stocked and the compounding pharmacies won. Now it is indeed, off the shortage list. It has caused another big stir in the media. Big Pharma is still coming after the compounding industry. The thing is, these medications are HUGE. They are blockbuster medications. There is a precedent for medications being in shortage historically in the US, many times, and the FDA enlisted the help of compounding pharmacies to fill the gap. That's their somewhat heroic, historical role. 

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This situation, however, with a huge money-maker being in shortage, and now being approved for things like sleep apnea, researched for treatment of dementia and Alzheimers, proven to lower inflammation which helps with things like joint pain and cardiovascular issues, even being used to curb alcohol cravings, treat alcoholism and other compulsive behaviors like shopping and gambling - the amazing things this medication may be used for goes on. As these benefits become more widely known, demand spikes. The branded manufacturers have had trouble keeping up. From 2022 to this year, the pharmacies were stretched to their limits and compounding pharmacies saved lives.

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Now they are pivoting back to doing what they've always done. Compounding pharmacies mainly offer customized medicine. That's their job. From cancer meds to adding cherry flavor for your kiddo with sensitive taste buds. You can easily get GLP-1s through compounding pharmacies on an ongoing basis, and the telehealth providers are saying, business as usual. Orderly is doing something especially amazing now. They are changing their whole format for prescribing to customize the medication just for you. That means in-depth free consults with GLP-1 specialists. Customized medication means no worries about interruptions, because that's what compounding pharmacies have always been there to do.

 

I also spoke with a large pharmacy owner who called me on the weekend and spoke to me for an hour. He is himself, an attorney. There are people who understand that if the telehealth companies were to release all of their patient base built up while the compounding pharmacies were helping with the national shortage since 2022 -- there would immediately be another national shortage at regular pharmacies. Compounding pharmacies play an important role. Being knowledgeable about what they do can offer us a great cost savings for GLP-1s.

 

The other big perk is, these telehealth medical professionals prescribing them specialize in GLP-1s. You won't get that going to a PCP. I speak to a GLP-1 physician trainer who is busy headlining national conferences. She believes, and hopes, that more and more PCPs will become willing to prescribe them over time. The media has done a number on the reputation of these medications, fomenting a crazy stigma for a peptide that is a naturally occurring substance in the body. The telehealth providers are happy to help, have been doing this for years, and will continue indefinitely with their compounding pharmacy partners.