![](\"https:\/\/fortune.com\/img-assets\/wp-content\/uploads\/2026\/09\/AdonisSaremi.jpeg?w=2048\")
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I run a medical practice built almost entirely around treating obesity by video. Labs, history, follow-up \u2014 all possible through a screen.\u00a0<\/p>\n
And yet I\u2019ve never written a prescription for a compounded GLP-1.\u00a0<\/p>\n
Both of those things are true because good telemedicine doesn\u2019t cut corners. It\u2019s past time for the FDA to enforce that by cracking down on the online sellers, stand-in prescribers, and bad actors exploiting compounding regulations.<\/p>\n
The agency should issue guidance stating that cost is not a medical justification for compounding a drug, that a compounded GLP-1 is not a like-for-like substitute for an approved one, and that prescribing one without genuine medical necessity puts patients at risk and physicians\u2019 licenses on the line.<\/p>\n
And the prescribers fueling this compounding craze should stop. If you can\u2019t name the medical reason your patient needs a knockoff GLP-1, you don\u2019t have one.<\/p>\n
Earlier this year, the FDA sent warning letters to 30 telehealth companies that blurred the line between approved and compounded GLP-1s in their ads. But vague admonishment doesn\u2019t move the bottom line.<\/p>\n
As demand for GLP-1s has surged, so has the market for compounded versions sold as quick, easy, lower-cost alternatives. To a patient, they can look nearly identical: similar names, similar claims, even similar injector pens. But they\u2019re far from it.<\/p>\n
Compounded drugs aren\u2019t subject to the inspections and reviews that commercially manufactured medicines undergo. Some compounding pharmacies are excellent, following proper practices, issuing a certificate of analysis, running third-party testing. Others aren\u2019t, and a patient ordering online through these quick-hit conglomerates has no way to know what version they\u2019re injecting \u2014 if they\u2019re even made aware of the difference first.<\/p>\n
If a patient calls me about side effects a few weeks in, I need to know whether it\u2019s the drug, the amount, or something that got added along the way. Without that gold-standard oversight, what\u2019s in the vial may not match what\u2019s on the label. Sterility failures and dosing errors have become reality.<\/p>\n
Patients\u2019 medical supervision shouldn\u2019t stop at the first visit, either. Before I prescribe, I want to know about their history of diabetes, sleep apnea, an eating disorder, or any medications that might cause negative interactions. I track body composition over the course of treatment, because losing weight quickly without enough protein compromises muscle and bone.<\/p>\n
Almost none of that is happening in these flashy online portals. A recent study of compounded GLP-1 sellers found next to no clinician involvement, and some orders cleared in under five minutes. That\u2019s nothing more than commercial fulfillment.<\/p>\n
Federal law lets pharmacies compound for an individual medical need \u2014 like an ingredient allergy or an inability to swallow a pill \u2014 and to fill temporary gaps during a shortage. When the GLP-1 shortages ended more than a year ago, sellers pivoted: Add a substance, usually vitamin B12, and market the product as personalized. No researcher has studied these combinations in people, and no reasonable person would consider that type of mass workaround a medical necessity.<\/p>\n
I understand why this market exists. These medications are expensive, insurance coverage is inconsistent, and economic strain across the country feels unrelenting. I take that seriously, and I discuss every option with my patients.<\/p>\n
We usually arrive at the same place: There\u2019s no bargain for medicine when you can\u2019t be sure what you\u2019re getting.<\/p>\n
Without official intervention, I\u2019m worried the issue will soon worsen. An FDA advisory panel last month recommended adding six unapproved peptides to the list of substances that can be compounded in bulk \u2014 on almost no human evidence.\u00a0<\/p>\n
Until I see proof that a substance is safe and that it works, I won\u2019t prescribe it. But without federal requirements, some companies won\u2019t adhere to the same promise.<\/p>\n
Telemedicine is tremendous for expanding patients\u2019 access to experts, especially for chronic care, but a questionnaire is not a physician, and untested, unauthorized lookalikes are not medicines.<\/p>\n
Doctors have a responsibility to hold that line. Regulators must, too.<\/p>\n
The opinions expressed in Fortune.com commentary pieces are solely the views of their authors and do not necessarily reflect the opinions and beliefs of <\/em>Fortune.<\/em><\/p>\n<\/div>\n #obesity #expert #wait #compounding #craze #stop<\/p>\n","protected":false},"excerpt":{"rendered":" I run a medical practice built… <\/p>\n","protected":false},"author":1,"featured_media":5923,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[9010,1830,240,3635,4216,42,3825],"class_list":["post-5922","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-finance-news","tag-compounding","tag-craze","tag-expert","tag-glp-1s","tag-obesity","tag-stop","tag-wait"],"yoast_head":"\n