What to Do If You Can't Get Compounded Semaglutide or Tirzepatide with Joe Zucchi
Navigating the world of obesity treatment can be tricky, especially when things take an unexpected turn. Lately, compounded versions of medications like Semaglutide and Tirzepatide have been harder to find, leaving many patients feeling a bit lost. So, what happens now?
In this episode, we’re chatting with Joe Zucchi, a physician assistant, personal trainer, and clinical supervisor at Transition Medical Weight Loss in Salem, New Hampshire. Joe gives us the lowdown on what’s really going on with compounded medications and why it's more important than ever to focus on safe, FDA-approved options. His clinic takes a well-rounded approach to weight management, blending fitness, nutrition, medical treatments, and even an on-site marketplace stocked with healthy, portion-controlled foods.
Joe’s here to share his expert insights on what to do when compounded meds are hard to come by, how to navigate your options, and why having a solid plan for long-term success is crucial.
Why Obesity Isn’t Just About Willpower
Explaining obesity as a chronic disease can be tricky, especially when patients have tried countless diets and exercise routines without lasting success. Obesity isn’t just about willpower; it’s a complex, relapsing condition influenced by biological mechanisms. When people cut calories and exercise more, the body often fights back with increased hunger, reduced fullness, and a slower metabolism. Understanding this helps patients realize their struggles aren’t their fault.
Diet culture complicates things further, promoting extreme approaches like keto, intermittent fasting, or low-carb diets. While some methods work short-term, they rarely last because they aren’t sustainable. Instead of promoting drastic measures, it’s better to focus on balanced, realistic changes that patients can stick with.
Medications can be a valuable tool in this process. Just like someone with high blood pressure wouldn’t be told to “try harder” without medication, it’s unfair to dismiss medications for obesity. They’re not a crutch; they’re a way to make healthy habits more effective. Ultimately, it’s about providing patients with options that help them achieve lasting progress.
The Issue with Compounded GLP-1 Medications
For a while, compounded versions of medications like semaglutide and tirzepatide became widely available. This happened when FDA-approved drugs such as Wegovy, Ozempic, and Mounjaro experienced shortages, leaving patients scrambling for alternatives. During that time, a loophole allowed compounding pharmacies to produce these medications since they were officially listed as “in shortage” by the FDA.
However, the situation quickly spiraled out of control. Many facilities began producing and selling compounded medications under the guise of generic versions, which do not exist for these drugs. They were also making oral versions of medications that had never been properly tested and mixing them with other drugs in varying dosages and potencies.
Patients were left in a risky position. The FDA found cases where these compounded medications were contaminated or contained incorrect doses. Some even had sugar alcohols instead of the actual drug. People were unknowingly taking medications incorrectly—using what they thought were daily injections as weekly doses, or vice versa.
This chaotic environment prompted organizations like the Obesity Medicine Association and the Obesity Society to issue joint statements warning against the use of compounded versions of these medications. The fundamental concern was patient safety. When people resort to these cheaper alternatives, they’re often unaware of the risks involved.
Thankfully, the shortage that initially justified compounding these medications has now ended. That also means the loophole allowing these compounds to be sold is closing. Pharmacies are running out of time to legally produce these versions under the FDA’s 503A and 503B guidelines.
On a positive note, official FDA-approved options have become slightly more affordable. For example, Eli Lilly’s Zepbound is available at $349 per month for the lowest dose and $499 for higher doses. Similarly, Wegovy can be accessed through NovoCare at $499 per month. Although these prices remain high for many, at least patients can be sure they are receiving properly manufactured and approved medications.
The problem with the compounded versions wasn’t just their questionable quality; it was also the way they were marketed. Companies took advantage of the situation, promoting these compounds on a large scale instead of as a temporary fix. What was supposed to be a short-term solution during a shortage turned into a lucrative business model.
Patients who relied on compounded medications are now left in a difficult position. Their prescriptions are no longer available, and some were never told this option was temporary. Doctors and companies offering these compounds without a clear plan for transitioning patients back to approved medications acted irresponsibly.
Now, as compounded options disappear, many patients are left wondering what to do next. It’s a frustrating and unfortunate situation, especially for those who found some relief in the compounded medications. But moving forward, the focus should be on ensuring access to safe, FDA-approved medications that come with proper guidance on dosing, titration, and lifestyle adjustments.
What to Do When Access Runs Out
For those who've been using compounded Semaglutide but suddenly find it's unavailable, it's natural to feel frustrated or lost. But it’s important not to just stop treatment and hope for the best. Research shows that stopping medications like Wegovy often leads to weight regain. Clinical trials, including one that monitored patients for 176 weeks, found that maintaining weight loss of 20 to 25% over three years was achievable—until the medication was discontinued. Once treatment stops, the body's natural tendency is to return to its previous weight, making continued support essential.
The first step is understanding your options. Branded medications are still available, with more affordable choices now offered through programs like Eli Lilly Direct and NovoCare. Tirzepatide has shown greater efficacy than Semaglutide, but both medications are effective. While NovoCare’s discount program doesn’t apply to Medicare patients, Eli Lilly’s Zepbound direct option does, making it accessible to more people.
A surprising number of patients are unaware they even have coverage for these medications. In some cases, prescriptions could be available for as low as $25 a month. About half of patients may have coverage for these medications if the prior authorization process is handled properly. Unfortunately, many clinics default to prescribing compounded medications without checking insurance coverage, simply because that’s the business model they follow.
Out-of-pocket costs for branded medications hover around $500. But there are also more affordable options, like Qsymia and Contrave, which cost around $100 per month. While these medications generally don’t provide the same level of effectiveness as GLP-1 medications, they can still be helpful for weight maintenance. Some studies suggest that patients who transition from GLP-1 medications to these alternatives can still maintain their weight loss reasonably well.
Lifestyle changes are also part of the equation. While many patients struggle to maintain weight loss without medication, about 15 to 20% can succeed through consistent lifestyle modifications. The National Weight Control Registry offers some insight: people who maintain their weight loss long-term are typically those who stay physically active, track their food intake, and stick with healthy habits.
It’s worth noting that clinical trials demonstrating weight regain after stopping medications don’t reflect real-world care. In studies, patients are given placebo injections without adjusting their lifestyle or medical care. But in real-life situations, a clinician can tailor a plan to help patients transition off medication successfully, whether that involves modifying nutrition, adjusting exercise routines, or focusing on behavioral changes.
Bariatric surgery is also an option worth considering, especially for those seeking substantial weight loss of 20% or more. While it’s not the right choice for everyone, it remains the most reliable way to achieve significant, lasting weight loss.
Ultimately, the goal is to help patients find the right care, whether that means continuing medication, transitioning to a more affordable option, or exploring surgery. It's about making sure people receive the support they need to achieve and maintain their health goals.
Making Exercise Work for You
Exercise is crucial for health, but building a consistent routine can be tough, especially for those who aren’t used to it. The key is finding activities that feel enjoyable and sustainable. Whether it’s sports, dancing, weightlifting, or simply going for walks, starting with something you like makes all the difference. For beginners or those with mobility issues, even small steps like using mini ellipticals or doing air squats throughout the day can be effective.
Consistency matters more than intensity. Studies have shown that breaking up sedentary time with short bursts of activity can improve blood sugar control and boost energy better than a single long workout. The important part is to start small, gradually build up, and find ways to keep moving throughout the day.
Strength training is particularly valuable since building muscle boosts metabolism, preserves muscle mass during weight loss, and provides long-term health benefits. Whether it’s through CrossFit, home workouts, or personalized gym plans, the goal is progress over perfection. Making fitness enjoyable and part of daily life is what leads to lasting results.
Thanks for reading! Navigating weight loss and treatment options can be complex, but with the right approach, you can find a path that works for you. Whether it’s through medication, lifestyle changes, or exercise, consistency and support are key. For more insights on managing weight loss and the challenges around compounded medications, be sure to listen to the full podcast episode. Stay focused on your health goals, and we'll catch you in the next one!
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