How we evaluate compounding pharmacies
The pharmacy matters more than the brand on the front of the website. What we check, what we can verify, and what we refuse to assert.
Entities that are not the same thing
| Term | What it actually means |
|---|---|
| FDA-approved drug | Reviewed by the FDA for safety, effectiveness and quality before marketing |
| Compounded preparation | Not FDA-approved as a finished product. No premarket review of safety, effectiveness or quality |
| 503A pharmacy | State-licensed. Compounds for an individual patient against a prescription |
| 503B outsourcing facility | FDA-registered. May compound in bulk. Subject to current good manufacturing practice requirements |
| Telehealth company | Arranges the consultation. Usually neither the pharmacy nor the manufacturer |
| Manufacturer | Makes the FDA-approved product. Eli Lilly and Novo Nordisk, in this category |
What we check
- Is the specific pharmacy named? Not 'our network of licensed pharmacies' — the facility.
- Is it 503A or 503B, and can we verify that for that specific facility? Registration is per-facility, not per-company. A company can operate both, and we do not assume every location it runs has the same status.
- Is the licence verifiable in a state board of pharmacy database?
- Is the salt form and concentration disclosed? Semaglutide sodium and semaglutide acetate are not the same active ingredient as the semaglutide base in approved products.
- Single-dose or multi-dose vial?
- Any FDA warning letter or state board action — precisely attributed, dated and linked?
What we will not assert
We do not state that a pharmacy is 503A or 503B without verifying that specific facility. A provider's statement about its pharmacy relationship is a provider-reported relationship until independently supported, and we label it that way.
Where a warning letter exists, we attribute it precisely, date it, link it, and describe it as an agency communication rather than a final adjudication. We update it when a response or close-out letter appears. We do not use one letter to imply unrelated violations.
Why the vial format is the clearest safety difference
The FDA has received hundreds of adverse-event reports involving compounded GLP-1 products, and a recurring cause is dosing error — a patient or clinician drawing the wrong volume from a multi-dose vial, sometimes by a factor of ten, occasionally requiring hospitalisation.
A brand pen or single-dose vial removes that failure mode entirely. This is the clearest concrete safety difference between compounded and brand products, and notably it has nothing to do with the molecule — it is the delivery format. Ask which one you are getting.
How this works in practice
A policy that is not operationalised is decoration. Here is what ours actually changes about the pages you read.
Every price carries a status. Verified means we hold a dated capture of the provider's own page. Reported — pending verification means a provider or third party reports it and we have not captured it ourselves. Evaluation in progress means we are not asserting it. We do not upgrade a price to Verified because a comparison site published it — sites in this category contradict each other routinely, and a number repeated by three affiliate blogs is still one unverified number.
Every medical claim traces to a primary source. FDA labels and guidance for regulatory status; PubMed-indexed randomised trials for efficacy; ClinicalTrials.gov for trial design. Reddit and patient forums are never used as evidence of price, safety, efficacy or legitimacy — they may be described as anecdotal sentiment, labelled as such. Animal research is never presented as proof of a human clinical effect.
Every ranking shows its arithmetic. Where a provider we have a commercial relationship with ranks well, the calculation that produced that result is printed on the page. If the arithmetic is wrong, you can see that it is wrong, and tell us.
Commercial relationships and what they do not buy
The publisher and certain principals have financial relationships with some of the telehealth providers listed on this site, and That is how this publication is funded, and we state it in the footer of every page rather than burying it.
What compensation does not do: it does not change a score, a rank, an inclusion decision, or a negative finding. Providers cannot pay for placement, cannot suppress an accurate criticism, and cannot review their own page before publication. Where a commercially-related provider loses a category, we say so — a comparison in which one provider wins everything is an advertisement, and the fastest way to tell the difference is to look for the losses.
Corrections
We publish prices in a market that changes them frequently, and we will get things wrong. When we do, we correct the page, date the correction, and say what changed — we do not quietly edit a number and pretend it was always right. Both readers and providers can submit corrections with evidence, through the same process and to the same standard.
Our own record so far includes removing a set of provider prices we had sourced from a third-party comparison site and could not substantiate, and correcting brand-pricing figures that had gone stale after a manufacturer price cut. Both corrections made the site less flattering to conclusions we had already published. That is the point.
Jastreboff AM et al., N Engl J Med 2022 (NCT04184622), n=2,539. Dose-response is real: the effect rises with dose. These are FDA-APPROVED SUBCUTANEOUS INJECTION doses — they do not transfer to compounded, microdose or ODT products. Trial means are not individual promises.
503A pharmacies versus 503B outsourcing facilities
The single most important pharmacy distinction for a compounded semaglutide buyer is whether the dispensing pharmacy is a 503A traditional compounding pharmacy or a 503B outsourcing facility. A 503A pharmacy prepares patient-specific preparations against individual prescriptions under state board of pharmacy licensure; it is not required to follow the FDA's current good manufacturing practice (cGMP) regulations, and the FDA does not inspect it on a routine manufacturing schedule. A 503B outsourcing facility registers with the FDA, must comply with cGMP, is inspected on a risk-based schedule, and reports adverse events to the FDA. Neither status makes a compounded drug FDA-approved, and neither status is "FDA-approved pharmacy," a phrase that does not exist.
We record which facility type applies to each provider's dispensing relationship, because it changes the manufacturing-assurance profile. A program dispensing through a 503B facility carries more federal oversight of the preparation process; a program using a 503A pharmacy relies on state licensure and the pharmacy's own quality systems. After the February 2025 shortage resolution, the lawful basis for compounding semaglutide narrowed to patient-specific 503A preparation with a documented clinical difference, which makes the 503A/503B question inseparable from the legality question covered in our compounding-rules analysis.
The pharmacy fields we verify and record
For each provider, we attempt to capture and record the dispensing pharmacy's legal name, physical facility location, state license number and status, 503A or 503B classification, FDA registration where the facility is a 503B outsourcing facility, and whether the pharmacy is disclosed to the patient before enrollment rather than only on the shipped label. We treat pre-enrollment disclosure as a positive transparency signal and undisclosed "network of licensed pharmacies" language as a negative one, because a patient cannot verify a pharmacy they cannot identify.
Each captured fact receives a verification status and a capture date in our central evidence ledger, not a page-level assertion. A pharmacy name a provider states on its own site is recorded as Provider Reported until we confirm the license on the relevant state board of pharmacy lookup, at which point the license fact becomes Verified with the date of the lookup. We do not convert provider-reported pharmacy claims to Verified without an independent state-board or FDA-registry check, and we do not present state licensure as equivalent to FDA approval.
Limitations of pharmacy verification
Pharmacy verification confirms licensure and registration status; it does not test the potency, sterility, or purity of any specific batch a patient receives, which only laboratory assay of that batch can establish. A pharmacy in good standing can still have a batch-level quality failure, and the FDA has documented adverse events and dosing errors associated with compounded semaglutide even from licensed sources. Verification also reflects a point in time: licenses lapse, facilities change, and provider-pharmacy relationships shift, which is why each pharmacy fact carries a recheck date. Readers should treat a positive verification as a necessary screen, not a guarantee of product quality, and should report suspected quality or adverse-event concerns to their clinician and to FDA MedWatch.