Seventy-five weight-loss clinics and medical spas in West Virginia and Oklahoma were still selling compounded copies of Ozempic and Mounjaro in late 2025, months after the drug shortages that made those copies legal had ended.
That count comes from a secret-shopper study in JAMA Health Forum ↗, in which investigators posed as prospective customers at storefront clinics between August and October 2025. The two states were picked on purpose, for high obesity rates and an insurance mix that leaves many patients paying cash.
Compounding is the practice of a pharmacy mixing a drug to order rather than buying it from the manufacturer. Federal law lets compounders make near-copies of a brand-name drug only while that drug is in official shortage. Semaglutide ↗, the molecule in Ozempic and Wegovy, came off the FDA shortage list in February 2025. Tirzepatide ↗, the molecule in Mounjaro and Zepbound, cleared its shortage in late 2024. Once a drug is off the list, making what the law calls an essentially identical copy is no longer allowed.
The clinics found a way to keep selling anyway. Forty-two of the 75 businesses, about 56 percent, offered a GLP-1 mixed with B vitamins rather than the drug on its own. Adding an ingredient is the standard route compounders use to argue their product is not the same thing as the approved drug, and therefore not a banned copy. Seven clinics, about 9 percent, sold an oral version, a formulation neither Ozempic nor Mounjaro comes in.
The sourcing is where the study gets uncomfortable. The 75 clinics were supplied by 23 compounding facilities. Of the 21 the investigators could check, 4 (about 19 percent, or roughly one in five) were not licensed to do sterile compounding at all. Sterility is not a paperwork detail for these products. A GLP-1 shot is injected, and a contaminated injectable can seed a bloodstream infection in a way a contaminated pill usually cannot. One supplier had drawn multiple FDA warning letters since 2023. Three others had been hit with state-level disciplinary action.
None of this describes the licensed, inspected compounding pharmacies that operated cleanly during the shortage. The point of the study is narrower and sharper: the market that grew up around a genuine supply gap did not fold when the gap closed. It adapted, kept the same storefronts, and in a meaningful slice of cases now runs on suppliers that regulators have already flagged.
For a patient, the label rarely says any of this. A compounded semaglutide-plus-B12 vial from an unlicensed mixer and an FDA-approved Wegovy pen both present as a weekly shot for weight loss. The two peptides are the same molecule on paper. What differs is who made it, under what oversight, and whether anyone verified it was sterile before it went into an arm.
The active ingredients trace back to the same two receptor targets the branded drugs hit. Both semaglutide and tirzepatide act on the GLP-1 receptor ↗; tirzepatide also hits GIP. The molecule a compounder starts from may be identical to the one in the approved pen. The manufacturing around it is the variable, and this study is a reminder that the variable did not disappear when the shortage did.