Pharmacists’ Look at the Future of GLP-1 Compounding

Last week, Drug Topics® explored how 2026 became a turning point for compounded GLP-1 medications, tracing the FDA’s shift from scattered warning letters to a proposed exclusion of semaglutide, tirzepatide, and liraglutide from the 503B Bulks List.

But regulatory headlines don’t answer the questions pharmacists field at the counter every day: Is this product legitimate? Is it safe? How should compounding fit into a market increasingly driven by direct-to-consumer telehealth?

To dig deeper, we reconnected with 3 pharmacy practice educators from the Massachusetts College of Pharmacy and Health Sciences (MCPHS) for a follow-up conversation. In this interview, the experts unpack how patient concerns have shifted, whether the regulatory scrutiny has changed their confidence in the GLP-1 class itself, and what pharmacists should watch for as the FDA finalizes its compounding decisions.

READ MORE: The 2026 GLP-1 Compounding Crackdown: A Pharmacist’s Guide

The experts featured in this discussion include:

• Hailey Choi, PharmD, BCAC, CDCES, associate professor of pharmacy practice at MCPHS
• Jana Murry, PharmD, RPh, assistant professor of pharmacy practice at MCPHS
• Spencer Casella, PharmD, RPh, assistant professor of pharmacy practice at MCPHS

Patient Concerns, Pharmacist Confidence in the GLP-1 Class

Drug Topics: How would you explain the current situation regarding compounded GLP-1s and what types of new patient concerns do you think pharmacists have faced as these developments evolve?

Hailey Choi: Reputable compounding pharmacies may have extensive quality-control procedures, including appropriate API sourcing, certificates of analysis, potency and sterility testing, and lot tracking. However, compounded medications are not FDA-approved and do not undergo the same premarket review. Patients are also asking more questions about where their medication comes from, whether the pharmacy is legitimate, how to measure the correct dose, and whether the medication was shipped and stored appropriately. Pharmacists are increasingly helping patients evaluate not only the medication itself, but also its source, concentration, quality, and handling.

Spencer Casella: The current situation is evolving rapidly. GLP-1s are one of the revolutions in medicine of the last 5 years, delivering outcomes and patient benefits not seen before regarding obesity. Their status of being a biological product and all currently branded have led to high costs to insurers and consumers. Many patients have been concerned about coverage and access, leading them to seek alternative pathways to get GLP products. The door opened with the product shortages, leading patients to access them through compounding pharmacies. Demand grew so rapidly that even today, with the product shortages ending, patients still regularly use these alternative pathways. Patients have concerns with knowing if their product is authentic and if it is made safely. Patients also have huge concerns due to cost and are often directed away from insurance utilization due to lack of coverage. Pharmacists play a critical role in being able to appropriately address these concerns and know how to get patients answers if they do not have one readily available.

Jana Murry: The current landscape with GLP-1s is intense. Counterfeit medications and medication safety have always been one of the forefront concerns for pharmacists. The demand for GLP-1s has amplified these concerns. As pharmacists, we are accustomed to navigating complexity under strenuous scenarios. When demand grows quickly, patient safety must remain the priority; not profit, not convenience, and not speed. GLP-1s can be an important tool for weight management, but not a magic solution. We must ensure that patients have resources, monitoring, and a health care team supporting them; not just providing a prescription. We must also recognize the increased pressure on compounding pharmacies to move quickly and ramp up production. Appropriate training, staffing, quality control, and safety standards must stay in place. The goal shouldn’t be helping someone lose weight, it should be helping them achieve sustainable, long-term health. GLP-1s may be a piece of the puzzle, but they work best as part of a comprehensive, holistic plan of clinical support, healthy habits, and ongoing follow-up.

Drug Topics: With policymakers working around the clock to regulate GLP-1s, as their popularity rises to record highs, how have these developments changed the pharmacist’s opinion of the GLP-1 medication class as a whole?

Hailey Choi: These developments have not changed my confidence in the GLP-1 class itself. FDA-approved GLP-1–based therapies have strong evidence across diabetes, obesity, cardiovascular disease, and other cardiometabolic conditions. What has changed is my awareness of how important the medication delivery system has become. A highly effective medication still requires appropriate prescribing, titration, monitoring, patient education, and reliable product quality. I separate concerns about compounded products or certain distribution models from the clinical value of FDA-approved GLP-1 therapies.

Spencer Casella: GLP-1s are regulated; they are approved drug products from the FDA. The issue that has arisen involves compounding drugs with GLP-1 active pharmaceutical ingredients (APIs) to open new avenues of patient access to the drug outside of the current FDA-approved and marketed products. Pharmacist’s may have varying opinions on these products; who should qualify for them, how readily accessible APIs should be, etc. Pharmacists need to take an objective mindset when approaching these medications as you would any other and keep patient safety at the forefront.

READ MORE: Pharmacist Involvement Speeds Prior Authorization for GLP-1s

Distribution, Regulation, and What Pharmacists Should Watch For

Drug Topics: Many of the proprietors of compounded GLP-1s come from potentially shady entities such as online pharmacies and grey-market businesses. With telehealth and mail-order platforms on the rise, how has the recent transformation of drug distribution in the US affected the safety of and access to GLP-1s?

Hailey Choi: Telehealth has greatly improved access to obesity treatment, particularly for patients who may have difficulty finding local providers. However, it has also made it harder for some patients to know exactly who is prescribing, compounding, and dispensing their medication. The concern is not telehealth itself, but whether convenience replaces appropriate clinical evaluation, transparent pharmacy sourcing, quality assurance, and follow-up. Patients may recognize the telehealth company but know very little about the pharmacy actually producing their medication. Pharmacists can help patients verify that the pharmacy is appropriately licensed, that they have a valid prescription, and that a qualified health care professional is available to manage dosing, adverse effects, and other concerns.

Jana Murry: There will never be a time where untested entities are in short supply. As soon as people put weight loss in a search engine, there is a mix of useful, useless, malicious, and well-intentioned inaccurate information. It can be hard to know the unknown or understand fact from fiction. The best defense is to do research, ask questions, and validate sources.

Drug Topics: The public comment period on the FDA’s proposed GLP-1 exclusion from the bulk compounding list is set to expire on July 30. Whether these drugs are excluded or not, what do you think GLP-1 access will evolve into following the FDA’s decision?

Hailey Choi: FDA's proposal specifically concerns whether semaglutide, tirzepatide, and liraglutide should be included on the 503B Bulks List; it is not a blanket prohibition on all individualized compounding. If FDA finalizes the exclusion, I expect the market to shift further toward FDA-approved products, manufacturer self-pay programs, expanded insurance coverage, and new competitors entering the obesity treatment market. Patient-specific compounding may still have a role when there is a documented clinical need. The larger issue will continue to be affordability. If compounded access becomes more limited without improvements in coverage and cost, some patients may seek less regulated alternatives. Improving access to affordable FDA-approved therapies therefore remains extremely important.

Spencer Casella: It’s almost impossible to imagine if it wouldn’t. The proposed GLP-1 exception is evidence of the large demand from the public, and it seems the agency has responded to such demand, albeit in a strange manner, considering they are the regulatory body and know these are marketed drugs. I think avenues of access will evolve regardless of an exception being placed or not.

Drug Topics: Finally, what future developments within the GLP-1 compounding space should pharmacists keep on the lookout for?

Hailey Choi: Pharmacists should watch FDA's final decision regarding the 503B Bulks List, continued enforcement involving telehealth marketing, and increasing scrutiny of API sourcing and product quality. We should also watch the growing online market for investigational products such as retatrutide and cagrilintide. These products are already being marketed to consumers despite not being FDA-approved, which creates another important patient-safety concern. Overall, pharmacists will continue to play an important role in helping patients determine whether a product is legitimate, appropriately prepared, correctly dosed, properly stored, and being used safely.

Jana Murry: Pharmacists will need to be vigilant with their suppliers, ensuring that these products are being made, shipped, and delivered safely.

READ MORE: Obesity Management Resource Center