- Online pharmacies offering Ozempic and Wegovy at significantly reduced prices may not be what they appear to be.
- Health experts warn there’s no guarantee that you’ll receive an FDA-approved version of the medication you order from some e-retailers.
- Some online pharmacies may not use the proper ingredients or they may dilute the medication, which can raise health risks.
Over the past few months, prescription drugs like Ozempic and Wegovy (brand names for different versions of semaglutide) have become hot topics due to their purported weight loss benefits.
While Wegovy is currently the only semaglutide to be FDA-approved for treating obesity, many people have begun taking Ozempic (typically prescribed to help treat people with type 2 diabetes) off-label for the same purpose.
Celebrity endorsements and social media buzz surrounding these medications have also caused their popularity to skyrocket.
Last fall, Novo Nordisk, the company behind Ozempic, Wegovy, and Rybelsus (an oral version of semaglutide), began reporting shortages of the medications.
The nationwide shortage, as well as the high cost of these prescription drugs, has led many people to seek alternative versions online from compounding pharmacies and international e-retailers.
However, obtaining prescription medications this way can come with significant risks, and as more people are turning to alternative methods of obtaining semaglutide, healthcare providers are raising concerns.
“Compounding pharmacies are pharmacies that can take ingredients of certain medications and tailor them for specific needs,” says Mir Ali, MD, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA. “The pharmacy typically takes FDA-approved ingredients and creates a new medication that may not be FDA-compliant.”
It may sound like a bad idea 100% of the time, but not necessarily.
“Hospitals use this type of compounding to create specific medications for patient needs,” Ali says.
For example, a patient may not be able to take a medication with certain dyes because of allergies or they may need a customized, lower dose of medication to reduce side effects, says Darragh Herlihy, NP, an adult nurse practitioner at the Stony Brook Bariatric and Metabolic Weight Loss Center.
In these cases, working with a trusted and reputable healthcare provider and trusted and reputable compounding pharmacy can be beneficial — and even necessary.
However, Sue Decotiis, MD, a New York City-based physician, says she has seen the pitfalls of veering from using FDA-approved weight loss drugs as prescribed by a qualified medical provider first-hand.
“Patients of mine have told stories of being ripped off by online companies who promised to provide the drugs and were unable to and kept a large upfront charge,” Decotiis says. “Later, they gave the patients other easy-to-obtain medications that were not what the patient needed or expected.”
And that’s the problem. There’s a level of faith involved with going a non-traditional route to obtain pharmaceuticals, even from compounding pharmacies that appear reputable.
“Some pharmacies may not use the proper ingredients, mix other ingredients or dilute the medication,” says Ali. “This could result in unpredictable reactions, unknown side effects, or decreased efficacy. Therefore, there is some risk in going to a compounding pharmacy for a cheaper version of semaglutide.”
It’s also not a guarantee that a patient is actually getting semaglutide at all.
“I do not think they can [be sure it’s semaglutide] — certainly not the version approved based on efficacy and safety,” says Jamie Kane, MD, the director of the Northwell Health Center for Weight Management and chief of the section of obesity medicine.
Compounding pharmacies require prescriptions for drugs like Wegovy. Other e-retailers may not.
Herlihy says she looked online and found a retailer located in India that would ship it for under $150 without prior authorization required. Except the drug would arrive as a powder, turning the patient into a pharmacist.
“Do people know the difference between normal saline, bacteriostatic water, and tap water?” Herlihy says. “And then there’s the dosing component because you’re talking about 0.5 milliliters, and you have to get the syringes and needles.”
Truly, what could go wrong?
“There’s an endless list of things,” Herlihy says. “It raises the question of quality control, safety, infection, and misuse. Nobody is monitoring the patient. Is it appropriate for the patient? Are they worried about the side effects? Are there contradictions?”
“The only benefits I see going to a compounding pharmacy is reduced cost and perhaps availability,” Ali says. “There is still risk associated with using these types of pharmacies.”
Herlihy agrees. Working with a reputable licensed provider with good reviews and experience with specific, reputable compounding pharmacies can make the process safer.
So can being a discerning patient.
“[People] used to say, ‘The doctor said so,’ and they don’t ask the why,” Herlihy says. “I suggest we start asking the why, especially if we are going off the beaten path. The why is important. So is the who.
Still, as Ali said, there are no guarantees.
“If they source it out through a compound pharmacy, it is probably safer than doing it yourself because they have a business dependent on the integrity of the end product,” Herlihy says. “It’s safer, but it’s still not an FDA-approved product at that point, and there’s no third-party monitoring on the quality of the product.”
And that may cause some people to call patients who are going this route irresponsible. But providers empathize with patients who have struggled with chronic obesity for years and are stuck between a rock and a hard palace attempting to obtain these drugs.
Several studies, including this one, suggest semaglutide can help people lose weight when combined with lifestyle changes.
The research offers potentially positive news for individuals who have overweight or obesity, which more than 70% of U.S. adults ages 20 and over are,
But providers note their patients run into roadblocks when trying to get insurance companies to cover all or part of the costs of the drug, which carries an out-of-pocket listed price tag of $1,349.02, according to Novo Nordisk’s website.
“There has been widespread press about the improved outcomes with newer anti-obesity medications, and yet the majority of insurance companies do not cover them,” says Kane.
Why is this?
Despite how commonplace having overweight or obesity is in the United States, misconceptions still exist.
“Weight stigma is a major player in all aspects of obesity treatment and is inherently assumed in the choice not to cover breakthrough treatments,” says Kane.
Having overweight or obesity is often considered a choice that can be rendered with lifestyle tweaks like diet and exercise.
Providers say that both play a role, even for individuals who do qualify and find success with weight loss drugs.
But for many people, lifestyle changes alone aren’t always enough. Yet, insurance companies often require individuals who have overweight or obesity to have another weight-related risk factor, such as heart disease, before they can qualify for medications like Wegovy.
Herlihy also notes that these weight-loss drugs are meant for long-term use.
But the need for long-term use compounds the price issue. It’s not a simple one-time fee of more than $1,300. It’s an ongoing expense with no end in sight, limiting accessibility.
The prohibitive cost and difficulties being able to qualify for coverage of semaglutide are two of the biggest reasons experts say people are turning to compounding pharmacies and other foreign retailers who claim they get medication from reputable pharmacies — despite the risks.
But health experts say it doesn’t have to be this way.
“The $1,300 price for semaglutide is uniquely American,” Kane says.