It began as a supply problem and evolved into a legal, regulatory, and political battle that touched hundreds of thousands of patients, a multibillion-dollar compounding pharmacy industry, two pharmaceutical giants, and the FDA itself. The story of GLP-1 drug shortages is still unfolding — and understanding it helps explain why access to these medications remains so complicated.

2021–2022: The Demand Surge Begins

Ozempic (semaglutide) was approved for type 2 diabetes in 2017 and had been growing steadily. But in late 2022, something shifted. Social media — particularly TikTok and Twitter — began amplifying stories of significant weight loss among people taking Ozempic off-label. Celebrities, influencers, and public figures were reported to be using it. Prescriptions exploded.

Novo Nordisk, Ozempic’s manufacturer, simply could not keep up. Demand had grown faster than the global supply chain for a drug that requires sophisticated biologics manufacturing. By early 2023, Ozempic was in short supply across the United States.

2023: The FDA Shortage Designation and the Compounding Window Opens

In 2023, the FDA officially added semaglutide to its drug shortage database. This was a pivotal regulatory moment. Under federal law, when a drug is on the shortage list, compounding pharmacies — which produce customized or alternative versions of medications — are allowed to compound copies of that drug for patients, even without the branded manufacturer’s approval.

Almost immediately, a wave of compounding pharmacies began producing their own semaglutide formulations. Telehealth platforms — many of them newly founded specifically to exploit this window — began offering GLP-1 subscriptions, connecting patients with compounded semaglutide at $200–$400/month, far below brand-name prices.

Tirzepatide (Mounjaro and Zepbound) followed a similar trajectory. By 2023 and into 2024, both semaglutide and tirzepatide were on the shortage list, and the compounding market for both was booming.

The Scale of the Compounding Market

Estimates suggest that by 2024, millions of Americans were receiving compounded GLP-1 medications through telehealth platforms and direct-to-consumer pharmacies. Companies like Hims & Hers, Ro, and numerous smaller startups had built substantial businesses around this model.

The compounded versions were not identical to the brand-name products. Some included:

• Different salt forms of the active molecule
• Added ingredients like vitamin B12, L-carnitine, or other compounds
• Variable dosing presentations

Manufacturers and some patient advocates raised concerns about safety, quality control, and the lack of standardization. Compounding advocates countered that licensed, accredited pharmacies were producing these medications safely and providing access to patients priced out of the branded market.

2024: The Crackdown Begins

As Novo Nordisk and Eli Lilly ramped up manufacturing capacity, the FDA began re-evaluating the shortage status of these medications.

March 2024: The FDA determined that the tirzepatide shortage was resolved and moved to remove it from the shortage list. This was immediately contested by compounders and some telehealth companies, who argued the drug was still not adequately available.

October 2024: After legal challenges, the FDA reaffirmed its position on tirzepatide, setting a deadline for compounders to stop producing it.

Early 2025: Similar action began with semaglutide. The FDA took steps toward removing semaglutide from the shortage database, which would close the legal window for most compounding of Ozempic and Wegovy equivalents.

The Legal Battles

The transition did not happen quietly.

Compounders and telehealth companies filed lawsuits challenging the FDA’s determination that the shortage had ended, arguing the agency had not adequately assessed real-world patient access before acting. Several suits sought injunctions to delay the ban on compounded tirzepatide.

Eli Lilly filed its own lawsuit against specific telehealth companies and compounders, alleging they were producing illegal copies of Zepbound and Mounjaro, including versions with unapproved additives that could mislead patients.

Congress was not silent either. Lawmakers from both parties held hearings examining access, affordability, and whether the FDA’s shortage resolution process adequately considered patients who relied on compounded versions for affordability reasons.

What Happened to Patients

The regulatory whipsaw created real hardship for patients who had built their treatment plans around compounded medications.

Telehealth companies began notifying customers that compounded GLP-1 medications would no longer be available, offering transitions to brand-name products — often at dramatically higher prices that many patients could not afford. Patient advocates documented cases of people abruptly unable to afford to continue treatment.

Some platforms shifted strategies: offering services to help patients access manufacturer savings programs, prior authorization support, or pivot to whatever compounded alternatives remained legally permissible.

The Salt Form Loophole

One notable wrinkle: while the FDA’s restrictions targeted “semaglutide base” and “tirzepatide base” (the active molecule as used in brand-name products), some compounders argued that products using different salt forms (chemical variants) of these molecules were distinct compounds and therefore still permissible.

This argument remained legally contested throughout 2025. Regulators argued these were functionally equivalent to the restricted compounds; compounders argued they were meaningfully different. Courts issued mixed rulings at various levels.

Where Things Stand Today

The GLP-1 compounding landscape has contracted significantly from its 2023–2024 peak, but has not disappeared entirely. Key points as of 2026:

• Most large-scale telehealth compounding of standard semaglutide and tirzepatide has ended or is winding down
• 503B outsourcing facilities (large-scale compounders operating under stricter FDA oversight) may retain more options than smaller 503A pharmacies under certain circumstances
• Legal battles over specific salt forms and specific compounder classifications continue in courts
• Manufacturer savings programs and prior authorization support have become more important access tools as compounded alternatives have shrunk

The Bigger Picture

The GLP-1 shortage saga illuminates fundamental tensions in the American healthcare system: between innovation and access, between intellectual property protection and affordability, between regulatory caution and patient desperation. These medications have the potential to transform health outcomes for millions of people — but only for those who can get and afford them.

The compounding window, whatever one thinks of it ethically or legally, functioned for two years as an unplanned affordability valve for a health system that hadn’t built one. As that valve has closed, the pressure on payers, policymakers, and manufacturers to find other solutions has only grown.

Disclaimer: The regulatory and legal landscape around GLP-1 compounding is evolving rapidly. This article reflects the situation as understood at the time of writing and may not reflect the current legal status. Consult a healthcare provider and pharmacist for current, personalized guidance.