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Key takeaways
Compounded semaglutide isn’t approved by the FDA, so most insurance companies won’t pay for it.
Compounded versions may have inconsistent formulations and could pose safety risks.
FDA-approved medications like Wegovy may be more reliable and might be covered by some insurance plans.
Cost-saving options like patient assistance programs or discount cards may help manage the costs of FDA-approved semaglutide.
Semaglutide is a drug that’s gotten a lot of attention lately. It was first approved under the brand name Ozempic to manage blood sugar in people with Type 2 diabetes. Because of its weight-loss effects, it has also been approved for chronic weight management under the brand name Wegovy. As Ozempic and Wegovy have become more popular, not everyone has been able to access or afford these branded medications.
Some people may be drawn to the affordability of compounded semaglutide, hoping to manage costs through insurance. However, most insurance companies don’t cover compounded semaglutide, especially for weight loss, leaving many to pay potentially high out-of-pocket costs. Compounded drugs are not approved by the Food and Drug Administration (FDA), and they’re often intended only for use during drug shortages. Read on to learn more about whether insurance covers compounded semaglutide.
What is compounded semaglutide?
Compounded drugs are typically produced by state-licensed pharmacies or outsourcing facilities. The process involves mixing ingredients to create a medication that’s not commercially available. A healthcare provider might recommend a compounded medication when a person can’t use the regular version of a drug due to allergies or other reasons.
Compounded semaglutide, in particular, is a custom-made version of brand-name drugs that contain the same active ingredient. Those drugs are Ozempic, Wegovy, and Rybelsus. It’s meant to work the same since it contains the same GLP-1 agonist. As a result, compounded semaglutide may be able to help manage blood sugar and weight by controlling appetite and increasing insulin release. However, compounded semaglutide might contain different inactive ingredients, such as fillers and binders.
Compounding pharmacies may also make different forms of semaglutide that aren’t officially approved, such as orally disintegrating tablets and nasal sprays. The effectiveness of these versions hasn’t been studied for safety or efficacy. Only Ozempic, Wegovy, and Rybelsus have been studied as effective medications containing semaglutide.
Compounded semaglutide medications might not work as well as the real thing. They might have different:
- Strengths
- Formulations
- Ingredients
The FDA is starting to crack down on online pharmacies selling compounded semaglutide, and as drug shortages end, it might become harder to find. It’s important to be careful when considering compounded semaglutide. Consult a healthcare provider about the risks and benefits of using compounded drugs.
RELATED: Is compounded semaglutide the same as Ozempic?
Does insurance cover compounded semaglutide?
Most insurance companies won’t cover compounded semaglutide. Therefore, it’s not uncommon to have to pay full out-of-pocket costs for this medication. That’s because insurance providers usually wait for FDA approval before covering a drug. Since compounded semaglutide isn’t FDA-approved for diabetes or obesity, it’s not on most insurers’ drug formularies.
In addition, health insurance plans, including private plans and government-funded ones like Medicare and Medicaid, don’t typically cover weight loss medications. Insurance companies generally consider these treatments as cosmetic rather than medical necessities. However, in limited cases, some people may be able to get reimbursed for weight loss drugs.
When it comes to semaglutide, some insurance plans may cover compounded semaglutide in the following cases:
- The compounded version is medically necessary
- There are no suitable alternatives
- The compounding pharmacy meets certain standards of quality
Contact your health insurance company to determine whether they’ll cover weight loss treatments, especially those that are compounded. You can also check whether you’ll need prior authorization and what the potential deductible or copay amounts might be.
For FDA-approved semaglutide, insurance coverage varies. Some plans may cover it for Type 2 diabetes. But for weight loss, many don’t. Patients often face potentially high costs even with partial coverage for the branded semaglutide versions. Out-of-pocket expenses can be over $1,000 per month without coupons or savings cards.
It’s best to talk to a healthcare provider or pharmacist about safe, approved options for weight loss or diabetes treatments. They may be able to recommend patient assistance programs, savings cards, and coupons to help lower the cost.
RELATED: How to save on Ozempic │ How to save on Wegovy
Compounded semaglutide safety concerns
Compounded semaglutide has raised some safety concerns among health experts. Just because compounded semaglutide contains the same active ingredient as the brand-name versions doesn’t mean it’s safe to use. Side effects of compounded semaglutide may be different or more severe than those of the approved drug because the ingredients and doses can vary.
The FDA has even warned about potential risks with compounded semaglutide, which include problems with online pharmacies, unsafe ingredients, and even fake versions of the drug.
Quality of compounding pharmacies
The quality of the compounding pharmacy can affect the medication’s safety. Unlike regular medications that go through strict testing and approval by the FDA, compounded drugs are often made in smaller pharmacies with less oversight. This means there might be less control over how clean and safe the environment is where these drugs are prepared. Getting compounded drugs from a local, trusted pharmacy is often safer than ordering from unknown online sources.
Some pharmacies might make compounded semaglutide that could be contaminated or made with poor-quality ingredients. For example, if a pharmacy does not follow proper cleanliness procedures, patients could receive a product that contains harmful bacteria or other unsafe substances. The FDA has reported cases where compounded medications did not meet safety standards, leading to infections and other health issues.
Unsafe or incorrect ingredients
Another concern with compounded semaglutide is the possibility of unsafe or incorrect ingredients being used. Some pharmacies might switch out ingredients without proper testing, which can lead to medications that do not work as intended or could even be harmful. Therefore, you might not know what is actually in the medication you’re taking.
In addition, there have been reports of compounded products containing hidden additives or impurities that could interact negatively with other medications or worsen existing health conditions. This may be especially relevant if you have allergies or sensitivities, as you might not be aware of all the components in compounded semaglutide.
Dosing errors
One major concern with compounded semaglutide involves dosing errors. Some people have reported serious health events, including hospitalizations, due to taking too much of the drug. Many individuals are new to self-injections and may be confused by different ways to measure the doses, which may lead to mistakes.
Compounded semaglutide products have various strengths and packaging, making it easy to miscalculate doses. For example, some people have accidentally taken five to twenty times more than what was prescribed. The FDA stresses that compounded drugs should only be used when approved alternatives are not suitable.
Brand-name vs. compounded semaglutide cost and coverage
Brand-name semaglutide drugs like Wegovy and Ozempic can come with relatively high costs for some people without insurance. The list price for Ozempic and Wegovy can exceed $1,000 or more per month, although there are ways to pay less.
Many people have turned to compounded semaglutide as a cheaper option than FDA-approved Wegovy for weight loss. Some online pharmacies offer it for $100–$500 per month. However, the price you pay will depend on the compounding pharmacy you use. Although prices might seem like a good deal, you could be sacrificing safety and effectiveness to save.
Keep in mind that Wegovy may be covered by some insurance plans. Therefore, you could save more on Wegovy than compounded semaglutide if you have insurance.
Compounded vs. brand-name semaglutide: Cost & coverage comparison |
||
|---|---|---|
| Compounded semaglutide cost (not FDA-approved) | Brand-name Wegovy (FDA-approved for weight loss) | |
| Average cost without insurance (varies by telehealth provider) | $100–$500 per month | $1,850 for 4, 0.75 mL pens (a one-month supply)* |
| Average cost with insurance (varies by plan) | Varies depending on the insurance plan | $25 per month for 4, 0.75 mL pens (a one-month supply) |
*Average cost at the time of publication. Drug prices fluctuate and vary by pharmacy and location.
While the cost of Wegovy may be a limiting factor for some, there may be ways to save on the retail cost of the medication if you don’t have insurance. For example, you can try comparing prices at different pharmacies because they can charge different amounts for the same medicine.
You can also use a prescription discount card, such as the SingleCare prescription discount card, which may help lower costs. You can also look for coupons from Novo Nordisk, the manufacturer, or patient assistance programs that help people afford their medications.
Alternatives to compounded semaglutide
You might want to look for other weight loss options besides compounded semaglutide, especially if your insurance won’t cover it. Other medications that work like semaglutide may be able to help manage weight. GLP-1 agonists like semaglutide include Saxenda (liraglutide) and Zepbound (tirzepatide).
Phentermine is a prescription drug that can help control appetite. It may be found alone or combined with other active ingredients under the brand names Adipex-P (phentermine) and Qsymia (phentermine and topiramate). There are also medications like Alli and Xenical, which both contain orlistat, that work by blocking the absorption of fats to manage weight.
In addition, some people might want to explore natural products that can support weight loss, like green tea and fiber supplements. However, it’s important to talk to a healthcare provider before starting any new treatment to make sure it’s safe and right for you.
Bottom line
Insurance usually doesn’t pay for compounded semaglutide because it isn’t approved by the FDA and is mostly used when there are drug shortages. While these compounded versions might look like a cheaper option than well-known medications like Wegovy or Ozempic, they can be risky. They might come with the wrong amount of active ingredients, unusual dosing instructions, or unsafe ingredients.
If cost is a concern, you may want to explore FDA-approved options with insurance, discounts, or assistance programs, as they may be safer and more effective in the long run. Always consult a healthcare provider to determine the best and safest approach to managing weight with prescription medication.
Sources
- FDA’s concerns with unapproved GLP-1 drugs used for weight loss, Food and Drug Administration (2024)
- Description of outbreaks of healthcare associated infections related to compounding pharmacies, 2000-2012, American Journal of Health-System Pharmacy (2014)
- Compounding and the FDA: Questions and answers, Food and Drug Administration (2024)
- FDA alerts health care providers, compounders and patients of dosing errors associated with compounded injectable semaglutide products, U.S. Food and Drug Administration (2024)