Michael Futter was desperate to lose weight. In February 2022, the 46-year-old from New Jersey had prediabetes and high blood pressure when his doctor asked if he had considered trying a GLP-1 medication. She prescribed him Wegovy, the blockbuster anti-obesity drug made by Novo Nordisk.

At the time, Futter’s health insurance plan covered the drug, which costs $1,350 a month. He was only on the hook for a $25 copay. But when he changed jobs, none of the plans offered by his new employer covered Wegovy. He was crushed. He was losing weight fast and felt better than he had in years. He turned to an online telehealth provider, Henry Meds, to get a compounded GLP-1 instead. He switched to tirzepatide, the active ingredient in Eli Lilly’s Zepbound, at a dosage that cost $450 a month, then stepped up to a higher dosage at $550.

The injectable medications have become so popular that their manufacturers have had trouble keeping up with demand. The drugs went into shortage back in 2022 and remained in short supply until recently. When drugs are in shortage, pharmacies in the United States are legally allowed to create “compounded” versions—essentially, full-blown copies—so that people can still access the medications. In the years these drugs have been in shortage, a cottage industry of telehealth companies and medical spas has sprung up offering compounded GLP-1 products for a fraction of the cost of the brand-name counterparts. Now, that may be coming to an end.

At the end of 2024 the Food and Drug Administration announced that tirzepatide was no longer in shortage. Then, in February, the FDA determined that the shortage of semaglutide, the active ingredient in Ozempic and Wegovy, had also been resolved. It meant compounding pharmacies had to stop making copies of the drugs. The FDA gave small pharmacies until February 18 to stop making tirzepatide, while larger outsourcing facilities had until March 19. For semaglutide, small pharmacies had to stop production by April 22, while large compounders have until May 22.

The move has left many US patients scrambling for alternative options. GLP-1s are so effective at helping people lose weight and improve their health that many patients fear going off of them. Some have stockpiled compounded versions before losing access. Others are relying on telehealth companies that are continuing to sell compounded versions after adding extra ingredients or changing the format from injectable to oral. And then some people are turning to more dubious sources for the drugs rather than shelling out full price for the branded versions.

“I don’t know if I’m going to be able to absorb the full cost of over-the-counter. I’m really worried,” Futter says. “I don’t want to gain the weight back.” He’s lost about 90 pounds since he started taking GLP-1s in March 2022 and is no longer prediabetic. While Novo Nordisk and Eli Lilly have started offering certain doses of their products for $500, that’s still higher than those offered by compounders. The dose Futter is on, 12.5 mg, isn’t available under Lilly’s self-pay program, and he worries that a lower dose will be less effective.

Futter’s provider, Henry Meds, no longer offers compounded tirzepatide injections, but allowed patients to place bulk orders before phasing it out. He went ahead and ordered several months’ worth of vials but doesn’t know what he’s going to do when he runs out. “I’m extremely nervous about what’s going to happen,” he says. “I’m eking every drop I can out of every vial to make it stretch a little bit longer.” (As of publication, Henry Meds is offering new and current patients the ability to bulk order 40 weeks of semaglutide injections. Henry Meds did not respond to a request for comment.)

Jim Bertel, a 41-year-old who lives in Colorado and credits tirzepatide for changing his life, was also able to stockpile his compounded GLP-1 medication before his provider stopped selling it. He’s unsure of what he’s going to do when he runs out later this month, and he is spending time scouring Reddit and Facebook forums to find which telehealth companies are still offering versions of the drugs. “Right now my plan is to take it month by month,” he says. “Hopping from provider to provider.”

Jessie, 40, who asked to be identified by her first name only, turned to a medical spa to get compounded medications when she couldn’t get consistent access through her insurance or primary care provider. Her provider initially wrote her a prescription for Wegovy, but she says it was “touch and go” getting it filled. She was able to supplement with a compounded version from the med spa when it wasn’t available. But at the end of last year, Jessie received a letter from her insurance company saying it would no longer cover Wegovy. Then her primary care provider stopped writing prescriptions for weight loss medications, saying they were too much of a hassle. She went back to the med spa and was able to get compounded semaglutide as recently as April, but the facility said it couldn’t guarantee supply moving forward. She’s now considering buying the drug from Mexico since she travels often to San Diego for work. “It’s the same meds, you don’t need a prescription, and it’s cheaper,” she says. In Mexico, brand-name Wegovy can be purchased for around $200 a month.

Spotty insurance coverage has helped drive demand for compounded GLP-1 products. Despite Wegovy and Zepbound being approved for patients with a body mass index of 30 or greater, and 27 or greater for those with at least one weight-related ailment, some insurance plans require a higher BMI or additional criteria for coverage—if they cover medications for obesity at all. “The whole underlying theme here is this stigma and bias of not recognizing obesity as a disease like we do cancer and diabetes and everything else,” says Florencia Halperin, an endocrinologist and chief medical officer at Form Health, an online medical weight loss clinic, “For cancer, you would never have an employer who says, ‘We’re not covering this.’”

Amanda Bonello, founder and CEO of the GLP-1 Collective, a nonprofit organization aiming to help patients access these medications, is not surprised at the lengths patients are going to. Bonello, who herself has taken compounded GLP-1 products, says for many patients she’s spoken to, the impact of these medications is not just about the weight itself.

“It’s about the freedom of mind,” she says. “It’s absolutely like having a second chance at life, one that you never thought that you could have. These are people who gave up hope. They spent their entire lives being treated like a punchline, being neglected, treated like the ‘other,’ even from sometimes their own doctors, their own family members.”

Bonello founded the GLP-1 Collective in January, shortly after the FDA first removed tirzepatide from the shortage list, signaling that the national supply had stabilized. The organization recently sent a letter to the FDA requesting to meet with the agency about the impact that the end of compounding is having on patients. In the meantime, the GLP-1 Collective is raising money to help people pay for their prescriptions. It has an initial fundraising goal of $20,000. “These people need access. They need affordable access and sustained access,” she says.

Some former compounding patients are turning to questionable online sellers operating on shaky legal footing. Dustin Olsen, a nutritionist and personal trainer who works with clients taking GLP-1 medications, says he’s already seen people on compounded meds seek out cheaper and more dubiously sourced alternatives online, rather than switching to name brands. “It’s all about the gray market,” he says. Even prior to the crackdown on compounded medications, there was a robust online ecosystem of unlicensed pharmacies selling counterfeit drugs or “research-grade” ingredients meant to be used in a lab rather than taken by humans—and as compounded semaglutide and tirzepatide get harder to find, people who were previously taking legal copycats are considering more extreme options. Olsen understands the economic factors driving people “gray” but worries about the health risks. “You just don’t know what you’re taking at all,” he says. “It could be sugar water.”

Bonello says she’s hearing from more and more patients who are turning to the gray market. “I can’t imagine that the FDA would rather people use completely unregulated sources than at the very least, state-regulated ones,” she says. “Yes, there are some bad apples out there, but you find them and go after them.” While compounding pharmacies are primarily regulated at the state level, the FDA has the authority to conduct inspections of compounding facilities to monitor ongoing compliance or investigate a specific problem or product complaint that the agency has received.

Although FDA’s rules require that compounders stop making exact copies of Eli Lilly and Novo Nordisk’s drugs, that doesn’t mean compounding is going to go away altogether. There’s a loophole for companies to continue selling compounded versions. It’s still legal to create custom compounds for people who need them, whether they need a special ingredient or a dosage not offered by pharmaceutical companies—and some telehealth companies are leaning into selling these not-quite-copies. While some telehealth companies have completely ceased offering tirzepatide and semaglutide, others have adjusted their offerings so that they are either in oral formats (like dissolving tablets) that are different than injectables, in custom dosages, or sold with additives like vitamin B. “There will be lots of options,” says Sabina Hemmi, who runs a startup called GLP Winner that allows patients to compare telehealth providers. “I think we’ll see a lot more versions of the drugs that are taken by mouth, either dissolving or sublingual.”

Some of these companies have already run into legal issues as they’ve continued to sell the compounds; Eli Lilly recently sued four major telehealth outfits, alleging that they were illegally selling compounds with added ingredients and different formats and dosages. In a highly litigious atmosphere, with several major compounding players opting not to test the limits of what’s legally permissible, there will indeed be a significant subset of patients who struggle to find accessible, affordable meds. As Hemmi notes: “Some people will lose access.”

In an emailed statement to WIRED, a spokesperson for Novo Nordisk says, “Moving forward, any compounder that mass produces or sells knockoff drugs is breaking the law and compromising patient safety.” A spokesperson for Eli Lilly echoed that sentiment, saying via email that the “FDA and a federal court have both made clear that compounders ‘must cease production’ of compounded tirzepatide knockoffs.”

Anthony Comuzzie, CEO of the Obesity Society, recognizes that there are legitimate access issues to GLP-1 medications, but he worries that some people who have sought out compounded versions may not meet the medical definition of obesity and are using them more casually for weight loss. “Obesity in and of itself is a legitimate, serious chronic disease, but people often confuse the accumulation of excess adipose tissue as a disease. In reality, it’s the physical symptom of the underlying metabolic problem, and that’s what these drugs address,” he says.

A WIRED investigation last year showed that it was shockingly easy to purchase compounded GLP-1 drugs online, with some telehealth outfits doing little vetting before issuing a prescription.

Halperin understands that people might be tempted to seek out lower-cost alternatives, but she recommends that patients work with a healthcare provider who has experience in treating obesity, even if they can’t get access to a specific medication at the moment. “Taking the risk of using a compounded medication, I don’t think that’s the right approach,” she says. But for many Americans who feel like they’ve tried everything else to lose weight, compounded medications seemed to offer a solution. Now access to those medications is anything but certain.