What to know about buying meds online

In March, the Food and Drug Administration added semaglutide to its drug shortages list. That means the pricey popular prescription drug—sold as Ozempic for type 2 diabetes and Wegovy for weight loss—could be purchased from compounding pharmacies. Here’s what to know about buying any medicines from compounding pharmacies...or from websites you find online.

“GLP-1 Weight Management,” says HenryMeds.com. “Only $297 per month...No insurance needed.” 

How can Henry sell a month’s supply of semaglutide for $297, when Wegovy—Novo Nordisk’s brand-name semaglutide that was approved by the FDA for weight loss in 2021—costs (an outrageous) $1,350 a month?

For starters, with Henry, you work up to a lower peak dose (1 milligram per week) than researchers reached in clinical trials (2.4 mg per week). While Henry charges an extra $100 per month to get “up to” 2 mg per week, $397 a month is still far cheaper than Wegovy.

The big savings: “The medication you may be prescribed is a generic compounded medication and is not associated with the Novo Nordisk company,” says Henry.

Not exactly. When it comes to semaglutide, “there are no approved generic versions,” says the FDA’s website.

But when the FDA put semaglutide on its drug shortages list, compounding pharmacies got the go-ahead to make a non-branded version that is now being sold on a host of websites like Henry, Sesamecare.com, and Invigormedical.com. 

Compounding 101

“Drug compounding is the process of combining, mixing, or altering ingredients to create a medication tailored to the needs of an individual patient,” says the FDA.

Say you’re allergic to a prescription medicine’s dye or a child needs a liquid version because it’s easier to swallow. A licensed pharmacist at a state-licensed compounding pharmacy can help.

“Those facilities fill a need when somebody needs a highly customized product that just doesn’t exist,” says Allan Coukell, senior vice president for public policy at Civica Rx, a non-profit pharmaceutical company that makes FDA-approved (non-compounded) generic drugs.

“Outsourcing facilities” can also compound drugs in bulk if there’s a shortage or a “clinical need.”

The FDA inspects those facilities according to what it calls a “risk-based schedule.” “But it’s not the same level of oversight that an FDA-approved drug has,” says Coukell.

What’s more, “FDA does not verify the safety or effectiveness of compounded drugs,” says the agency’s website.

Nor do compounding pharmacies always include required cancer warnings, on “bioidentical” hormones, for example.

And the FDA can’t guarantee that compounded drugs are made properly.

“FDA has observed troubling conditions during many of its inspections of compounding facilities including toaster ovens used for sterilization, pet beds near sterile compounding areas, and operators handling sterile drug products with exposed skin, which sheds particles and bacteria,” says the agency.

In 2020, when Coukell was senior director for health programs at the Pew Charitable Trusts, his team collected data on 73 compounding errors linked to 1,562 adverse events.

The worst: In 2012, 793 people in 20 states were diagnosed with infections—usually fungal meningitis—and 76 died after the New England Compounding Center sold contaminated steroids that were later injected into patients.

“With an injected drug, sterility is of paramount importance,” says Coukell, “because you’re bypassing all of your body’s defenses and injecting it straight into your tissues.”

And patients have to inject semaglutide every week.

Adverse reactions

“FDA has received adverse event reports after patients used compounded semaglutide,” says the FDA’s website. What were they?

The website doesn’t say. (And none have been tied to websites like HenryMeds.com.) But some people have inadvertently injected far too much of the drug.

“We reported on three patients who received semaglutide from either compounding sources or a medical spa,” says Amberly Johnson, director of the Utah Poison Control Center in Salt Lake City.

“In two cases, patients administered about a 10-fold higher dose than prescribed.”

One vomited for two days and had nausea for a week. Another had a day of vomiting and three days of headache and weakness.

“The spa patient had to seek care at a hospital to receive IV fluids and anti-nausea medication,” notes Johnson.

Dosing errors are unlikely with brand-name Wegovy or Ozempic, she says, because the drug comes in pre-filled pens.

“It’s pre-set or you just dial in the number of milligrams that you’re prescribed,” says Johnson.

Not so with some compounded versions.

“They’re being dispensed in vials that are similar to insulin and administered with insulin syringes,” says Johnson. “The dosing on insulin syringes is in ‘units,’ not milligrams, so it’s easy for patients to get confused.”

And as semaglutide’s popularity has surged, so have the errors.

“As of July, we’ve seen as many adverse events with semaglutide as we saw all year in 2022,” says Johnson, “so these three cases are the tip of the iceberg.”

What’s more, some compounding pharmacies combine semaglutide with vitamin B-12 or B-6.

And while “the active pharmaceutical ingredient in Wegovy and Ozempic is semaglutide in its base form,” the FDA told the National Association of Boards of Pharmacy in April, “we are aware that in some cases compounders may be using salt forms of semaglutide, including semaglutide sodium and semaglutide acetate.”

Does that—or the added vitamins—matter? It’s hard to say.

What is clear: “They haven’t been through the same rigorous testing as the approved drug,” notes Johnson.

Beyond compounding

Compounded drugs come with risks. But they may be minor compared to buying medicine—any medicine—from illegal websites posing as pharmacies.

“Buying prescription drugs from rogue online pharmacies can be dangerous, or even deadly,” says the FDA’s website.

A red flag: the online pharmacy requires no prescriptions.

“There, you’re getting into very dangerous territory,” says Coukell. “The drugs could be coming from anywhere.”

Counterfeit Adderall, Oxycontin, Percocet, and Xanax may even contain a lethal dose of fentanyl, warns the Drug Enforcement Administration’s “One Pill Can Kill” campaign. Those pills are more likely to come from social media, but why take a chance?

Another danger: “What looks like an online pharmacy could be a front for a scammer or identity thief,” warns the Federal Trade Commission’s website.

The National Association of Boards of Pharmacy has a list of more than 40,000 unsafe websites. Many have “Canada” in their name but get their drugs elsewhere.

That said, many legit online pharmacies can save you money. You can use the NABP’s Buy Safely tool (safe.pharmacy/buy-safely) to see if a website is safe.

And if you have questions or problems with any drug, call your local poison control center at 1-800-222-1222.

“They’re open 24 hours a day, seven days a week,” says Johnson. “And they’re free.”