Postshortage Compounded GLP-1 RA Market in 2 States With Potentially High Demand

Importance: Supply-side challenges combined with high costs and limited insurance coverage led to a robust market for compounded glucagon-like peptide-1 receptor agonists (GLP-1 RAs). However, assessment of this market since the end of the semaglutide and tirzepatide shortages is needed. Objective: To characterize available compounded GLP-1 RA products, describe aspects of patient care and monitoring, and identify source pharmacies of available compounded products. Design, Setting, and Participants: From August to October 2025, a cross-sectional secret shopper study was conducted of brick-and-mortar weight-loss clinics and medical spas advertising GLP-1 RAs for weight loss and offering compounded GLP-1 RAs. These businesses were identified in January 2025 using a web mapping application to perform location-based searches that were supplemented with a review of business websites and publicly available data regarding compounding facilities. The businesses were located in 2 states (West Virginia and Oklahoma) with potentially high demand for compounded GLP-1 RAs that were purposively selected based on obesity rate and insurance mix. Main Outcomes and Measures: Compounded GLP-1 RAs offered by weight-loss clinics and medical spas; aspects of patient care and monitoring; and characteristics of compounding suppliers, including facility type, licensing status, objectionable conditions noted by investigators, and disciplinary actions. Results: A total of 75 weight-loss clinics and medical spas offering compounded GLP-1 RAs were identified and included in the analysis. Of these businesses, 7 (9.3%) reported offering oral compounded GLP-1 RA formulations and 42 (56.0%) reported offering compounded GLP-1 RA products combined with B vitamins. Twenty-three compounding facilities were identified as suppliers, 4 (of 21; 19.0%) of which were not licensed to perform sterile compounding. Since 2023, 1 facility (4.3%) had received multiple US Food and Drug Administration warning letters and 3 of 22 (13.6%) had been subject to state-level disciplinary action. Conclusions and Relevance: Findings of this study show that, after the end of the semaglutide and tirzepatide shortages, compounding facilities have continued to manufacture GLP-1 RAs with added ingredients. Compounded GLP-1 RA sourcing is diverse but includes facilities without licenses to perform sterile compounding or that have been subject to recent disciplinary action, posing clinical and regulatory challenges.