By Dr. D. Patel, MD — board-certified internal medicine physician, Empathy Primary Care, Colleyville, TX
A patient recently asked me why the GLP-1 medication I prescribe costs more than what some other clinics advertise. It’s a fair question, and the answer comes down to one decision: I only prescribe brand-name medication that comes directly from the manufacturer, such as Eli Lilly. That way, you know you are getting 100% of the medication.
In September, a compounding pharmacy recalled its compounded tirzepatide. According to the FDA, its investigators had cited the company for serious deficiencies in its sterility practices.
The three problems I keep coming back to
1. Sterility. Even when I know the pharmacy I’m working with, I cannot confirm with 100% certainty that a compounded medication is sterile. And if something goes wrong, it is my patient who suffers the side effects. That is my number one concern. In medicine, we are taught from day one: first, do no harm. I will not give my patients a substandard medication, even if the chance of a problem is small.
2. Dosing errors. Every compounding pharmacy makes these medications in its own concentrations, which can make it hard for patients — and even some providers — to adjust the dose correctly. One vial may be more concentrated than the next. Say a patient’s dose has been increased and they receive a new, more concentrated vial: they now need fewer units to get the right dose. If they don’t realize that and inject the same number of units, or more, they can end up with an overdose, significant side effects, or even a hospital stay. As a practicing internal medicine physician, I have seen patients come into the hospital with severe side effects from GLP-1 medications.
3. What’s actually in the vial. Many compounders use salt forms such as semaglutide sodium and semaglutide acetate, which are chemically different active ingredients from the approved drug. In the FDA’s own words, it is “not aware of any lawful basis” for compounding with them, and there is no data showing they behave the same way in your body.
A research letter published in JAMA in October 2026 adds another layer: compounding pharmacies routinely mix additives such as vitamin B12 into these medications — combinations that exist in no FDA-approved product and that, in the authors’ words, “remain uncharacterized.” One published analysis has already identified an impurity that forms when tirzepatide is combined with B12. The authors’ advice to physicians was blunt: do not assume a patient taking “tirzepatide” or “semaglutide” is receiving an FDA-approved product.
Yes, compounded medication is cheaper
Overall, yes, compounded medications are cheaper. But I will not compromise my patients’ safety to save a couple hundred dollars. Your health should always come first, and it should never come at the cost of a substandard medication.
What I prescribe instead
The brand-name medications, Zepbound and Wegovy, are made by Eli Lilly and Novo Nordisk. Both manufacturers now offer discounted self-pay pricing, along with an insurance eligibility check that may lower the price further for some patients. Nothing in these medications is mixed, diluted, or repackaged along the way. They ship directly to your home.
The instructions are easy to follow. These medications come in pre-filled pens, and some are also available in vials, so each dose is simple to measure and inject. Newer oral pill options have also arrived. Some start at a lower price than the injections, and many patients find a daily pill easier to take.
How my practice is paid
I do not make any money from the medication itself. What I provide is the care. Patients can come to me in one of two ways: through their insurance, if their plan covers weight-management visits, or through a monthly subscription.
If you’d like to see what the program includes and what it costs, the details are on our medical weight loss page, or call us at 817-668-3472.
Sources: FDA: Concerns with Unapproved GLP-1 Drugs Used for Weight Loss · FDA alert: dosing errors with compounded injectable semaglutide · FDA enforcement report, compounded tirzepatide recall (September–October 2026) · Mattingly et al., Compounded GLP-1 Dispensing Patterns and Vitamin B12 Coformulation, JAMA, October 2026.
This article is general health information, not medical advice. Medication decisions should be made with a physician who knows your history. Dr. Patel is a board-certified internal medicine physician and the founder of Empathy Primary Care in Colleyville, Texas.