For TikTok beauty influencer Ashley Raibick (@ashley.raibick), 27, trying semaglutide was a no-brainer. That’s the active ingredient in Ozempic (an injectable type 2 diabetes drug) and Wegovy (for people with obesity), and it’s become internet-and-beyond famous for how much weight people can lose while taking it. Raibick doesn’t have type 2 diabetes and admits that she might not initially appear to fit the drug’s indication for obesity or weight loss (a body mass index, BMI, of 27 or greater), but, “When something bothers me, I fix it,” she said. “I believe in doing whatever it is to make yourself feel and look your best in the beauty industry.”
Ozempic and Wegovy both require a prescription, so you might expect someone to get them at a doctor’s office. However, like many people who may not have clinical obesity (a BMI of 30 or greater) or are not a type-2 diabetic, curiosity led Raibick, who was looking to lose weight, to take a course of semaglutide prescribed by an M.D. at a medical center and spa hybrid, known as a med spa.
Ozempic, Wegovy, and compounded semaglutide (often a mixture of semaglutide and vitamins), are rapidly gaining popularity as wellness treatments. But is the miracle product people are getting from some med spas or telehealth companies really the same thing, is it safe and legal to use it in ways that are not FDA-approved, and could its rapid gain in popularity potentially be creating a drug shortage for those with type 2 diabetes? Here’s what’s most important to know.
How did Ozempic, Wegovy, and semaglutide get so popular?
Some of today’s most influential celebrities focus their messaging on whole-body health (mind, body, spirit) over weight loss and thinness—take Ashley Graham, Jamie Lee Curtis, and Selena Gomez, for example. However, public interest in weight loss, at least from the privacy of one’s personal laptop, appears to remain as strong as ever.
Fans first speculated, without evidence, that Kim Kardashian may have taken Ozempic to lose weight in 2022 when she went to the Met Gala. (According to The New York Times, she has denied these rumors.) Coincidentally, or perhaps not so much, Google search interest for “Ozempic” has increased 509%, “Wegovy” 235%, and “semaglutide” a massive 648% year over year. Despite increased searches, these drugs are not new. Ozempic was FDA-approved for type 2 diabetes in 2017, and Wegovy (a higher dose of semaglutide approved for weight loss) in 2021.
Back in 2022, Prevention’s sister site Good Housekeeping conducted a survey on diet culture that found that 87% of people polled have been on a diet with the purpose to change their weight or shape. Meanwhile, 60% said that the way they feel about themselves is largely influenced by their weight, shape, or size. All things considered, when a weekly injection marketed as a quick fix for losing weight became readily available, it was no surprise that people ran to find a prescription.
It’s relatively simple to get one too. Raibick, who was interested in losing weight, had a consultation at a med spa in New Jersey and received a prescription for semaglutide after meeting with a doctor and undergoing routine blood work. Raibick feels great about her experience: She lost 30 lbs in four months and documented her journey on TikTok to more than 45k followers.
“This opportunity presented itself and I have been doing research,” she said. She felt it was something she should try. “You know, you’re hearing all those celebrities doing it, so it felt to me only right to try it and to be able to give my feedback to people who really need it,” Raibick explains.
Who typically gets prescribed Ozempic and Wegovy?
People with type 2 diabetes take Ozempic, which is injected, for its main ingredient, semaglutide. According to Novo Nordisk and the FDA website, Novo Nordisk is the only company in the U.S. with FDA-approved products containing semaglutide, identified under the names Wegovy, Ozempic, and Rybelsus: “Semaglutide acts as a satiety hormone, so it makes you feel full. When we give it in a pharmacologic dose, it accentuates the satiety effects, lowers blood glucose in those who have high blood glucose, and promotes weight loss. Therefore, semaglutide is an effective treatment for type 2 diabetes,” explains Jacqueline Yuey Lonier, M.D., assistant professor of medicine at Columbia University Irving Medical Center and an adult endocrinologist at the Naomi Berrie Diabetes Center in NYC. Novo Nordisk says Ozempic is FDA-approved for those with type 2 diabetes to improve blood sugar and to reduce the risk of major cardiovascular events like heart attack and stroke in adults. Novo Nordisk notes that the medication should be used in tandem with diet and exercise. A similar drug, Rybelsus, is also made by Novo Nordisk for people with diabetes; it is taken orally, instead of injected.
Wegovy, on the other hand, is specifically for people who are considered overweight or obese. Novo Nordisk’s product information states that semaglutide in its Wegovy form is FDA-approved for chronic weight management in adults with a BMI of 30 or greater—and it can also be prescribed to those with a BMI of 27 or greater who also have weight-related medical problems. (Prevention no longer uses BMI as an indicator of health, but in the case of these drugs, it’s a crucial part of the FDA guidelines). The drug’s manufacturer says that semaglutide should be used alongside a reduced-calorie diet and increased physical activity.
Ozempic and Wegovy both list semaglutide as the main active ingredient. The differences between the two drugs, aside from each drug’s intended use, is the dosing, method for increasing dosage, inactive ingredients, and prescribing information. Though the FDA and Novo Nordisk have made these specifications, it is legal and in fact commonplace for a doctor or nurse practitioner to prescribe them to people who don’t fit the criteria, known as “off-label” use.
How easy is it to get your hands on semaglutide?
Prescribers (anyone with an M.D., D.O., or N.P.) at med spas and telehealth companies prescribe weight loss drugs on and off-label. Anyone searching Google would find pages of med spas and telehealth companies with weight loss programs that include semaglutide. Two examples are one in Eastern NJ (a different one than the one Raibick went to), as well as a telemedicine company that prescribes the weight loss drug in New York and Florida. Prevention spoke to representatives from both companies.
At the telemedicine company that offers online medically-supervised programs for weight loss, prescribers offer an “out-of-pocket version that caters to individuals that wouldn’t normally qualify, hypothetically, [for the drugs] and may not fall into traditional BMI guidelines,” one of their pharmacists, who asked to remain anonymous, explains.
The only prescription likely to be covered by insurance is Ozempic for type 2 diabetes, so any form of semaglutide outside of Ozempic would likely be considered “out of pocket”—though the Wegovy website says some insurers do cover it for obesity.
The patients who get semaglutide from prescribers at this telemedicine company, as at others, don’t always fit the drug company’s criteria. “As someone with 30 years of pharmaceutical experience, I screen [the patients] and know what I’m looking for. On an anatomical level I know what questions to ask. We’re not even going to waste [the patients’] time,” the pharmacist explains. “Everything is very thorough.”
He shares that weight-loss plans are not always “black and white.” A weight one person might aspire to could be the starting point for another—and both could be considered healthy. “Everyone wants to be at a certain weight. They know what weight they want to be at intuitively because they know what they were like 10-15 lbs lighter, he says.”
Taking semaglutide without a prescription is pricey: Again, insurance companies generally only cover semaglutide for those with type 2 diabetes (usually in its Ozempic form). Without insurance covering costs, these drugs can add up. An eight-week weight loss program that uses semaglutide at the med spa in NJ costs approximately $575 to $1000, which covers the medication, supplies, and regular check-ins with the prescriber. The NJ med spa owner and medical director, D.O., said he has been prescribing semaglutide for just over a year and has seen a steady uptick in patients seeking the weight loss drug. “I have been starting six to 10 new patients a week on the weight loss program with semaglutide. The demand is growing here in New Jersey as the summer months are approaching,” he said. He follows up with these patients every four weeks.
What’s the deal with “compounded” semaglutide?
The ongoing debate
In addition to Ozempic and Wegovy, many med spas and telehealth companies offer something called “compounded semaglutide”—which is neither Ozempic nor Wegovy, but rather a combination of semaglutide and often other ingredients like vitamins, according to prescribers.
But there’s some debate between Novo Nordisk, med spas, and compounding pharmacies about the use of semaglutide, especially “compounded semaglutide.”
Novo Nordisk says it is the only company in the U.S. with FDA-approved products containing semaglutide (Ozempic, Wegovy, and Rybelsus, for which it claims to hold various trademarks and patents). Novo Nordisk also says that it generally sells these three drugs to wholesalers, who then sell the drugs directly to retail pharmacies. But, “which specific pharmacies or retailers receive semaglutide is determined by wholesaler distribution and order fulfillment practice, and not controlled by Novo Nordisk,” Novo Nordisk says. “Practices involving the sale and advertising of compounded ‘semaglutide’ are not affiliated with the brands for which Novo Nordisk holds the FDA approval and marketing rights.”
Novo Nordisk says that it does not sell semaglutide to med spas, compounding pharmacies, or telehealth providers for purposes of manufacturing compounded products and that it is not directly supplying semaglutide to any telehealth providers. So where are compounding pharmacies, med spas, and telehealth companies that offer compounded semaglutide getting it from? Is the use of compounded semaglutide legal? And are the products some compounding pharmacies, med spas, and telehealth companies market even semaglutide?
“Compounding pharmacies, med spas, and other entities that are claiming to offer or sell compounded products purporting to contain ‘semaglutide’ are sourcing their ingredients from entities other than Novo Nordisk,” the Novo Nordisk spokesperson says. “Novo Nordisk is actively monitoring and taking action (including but not limited to issuing cease-and-desist letters) against those entities that are engaging in the unlawful sale of compounded semaglutide, disseminating false advertising, and infringing its trademarks.”
Scott Brunner, CEO of the Alliance for Pharmacy Compounding (A4PC), says that, “based on reports from some compounding pharmacies,” compounding pharmacies have been able to access semaglutide from legitimate FDA-registered facilities. He also emphasizes, “While [Novo Nordisk] surely may exercise control over the supply of the active pharmaceutical ingredient [semaglutide] via its contracts with manufacturers, it has not (yet) completely locked down the supply chain.”
The question of legality
Brunner states that FDA guidance “indicates that if an ‘FDA-approved drug is listed as currently in shortage’ on the FDA shortage list—as the FDA-approved semaglutide drugs currently are,” the drug may be compounded. Brunner’s A4PC statement acknowledges that Novo Nordisk holds patents to the drugs, and states that “while we aren’t qualified to offer a legal opinion on the matter, we do note that an exception to the FDA guidance for patented drugs ‘would contradict the very reason the law allows compounding of FDA-approved drugs in shortage in the first place.’”
According to the FDA website, “When a drug is in shortage, compounders may be able to prepare a compounded version of that drug if they meet certain requirements in the Federal Food, Drug, and Cosmetic (FD&C) Act. As of May 2023, Ozempic and Wegovy are both listed on FDA’s Drug Shortages list.”
When reached for comment on the matter, Novo Nordisk pointed to this press release concerning its recent filing of trademark infringement and false advertising suits against “certain medical spas, weight loss or wellness clinics, and compounding pharmacies,” that it alleges are unlawfully using its trademarked brand names Ozempic or Wegovy when marketing and/or selling compounded products purporting to contain semaglutide that are not genuine Ozempic or Wegovy products. The suit also alleges that the FDA has not approved any generic versions of semaglutide. The press release notes that Novo Nordisk has launched semaglutide.com to provide tools on how to spot a counterfeit injectable product. (The lawsuits, which were just filed, are pending.)
There isn’t a law against the practice of compounding drugs in general, but rather a debate over who holds the rights to sell compounded semaglutide; from where exactly compounding pharmacies, med spas, and telehealth companies are sourcing the drug; and whether some compounding pharmacies are even using semaglutide in their products.
For the patient, it’s not always clear from a company’s website—often the consumer’s first step in decision-making—whether prescribers are providing semaglutide compounded with something else. One surefire way to determine if you’re receiving Ozempic or Wegovy in its original form is to head to a specialist. Dr. Lonier, an endocrinologist, recommends getting a prescription for one of these drugs “from physicians who have the appropriate training in their use.”
As for the legality of compounding medication, in general, the FDA does not regulate the practice of medicine, adds Chanapa Tantibanchachai, M.S. press officer for the FDA. “With few exceptions, health care professionals generally may choose to prescribe or use a legally marketed human drug or medical device for an unapproved or uncleared use when they judge that the unapproved use is medically appropriate for an individual patient,” Tantibanchachai said. So those with the power to prescribe medication can do so on or off-label.
The question of safety
“Compounded drugs pose a higher risk to patients than FDA-approved drugs because they do not undergo FDA premarket review for safety, effectiveness, or quality,” Tantibanchachai says.
“Some weight loss clinics, pharmacies, and other companies claim to have availability of compounded ‘semaglutide’ products, including products that purport to offer ‘semaglutide’ in combination with other ingredients,” a Novo Nordisk spokesperson explains. “These compounded products do not have the same safety, quality, and effectiveness assurances as FDA-approved drugs, and may expose patients to potentially serious health risks.”
Of course, the fact that compounded drugs (or any drugs) are not FDA-approved does not mean that they are necessarily unsafe; it only means that those drugs have not gone through the FDA review process.
Is Wegovy and Ozempic’s new popularity creating a shortage for people who really need the drugs?
Some prescribers prefer compounds because they are created in different pharmacies (compounding pharmacies) than Wegovy and Ozempic. But, it would seem to us, since compounding pharmacies are still using semaglutide to create compounded versions, there may be a connection between increased use of semaglutide and Ozempic and Wegovy shortages.
There were shortages of Ozempic and Wegovy in late 2022 and early 2023, which were due to high demand, according to a Reuters report. on May 25, before the FDA announced the latest Ozempic and Wegovy shortage at the end of May, Novo Nordisk said that all doses of Ozempic were available to pharmacies “for appropriate patients with type 2 diabetes,” and that pharmacies may experience “normal delays given the time required to order the product from their local distribution center, and geographical variabilities.” While reporting this story, Novo Nordisk said, with respect to Wegovy, that “prescribing trends continue to increase at a substantial rate and indicate that demand for Wegovy in the U.S. will exceed our current supply capacity,” so the company does “anticipate that many patients will have difficulty filling Wegovy prescriptions” at certain doses “through September 2023.”
Raibick understands that some could question her (or anyone’s) reasoning for taking semaglutide outside the realm of its FDA-approved or manufacturer-recommended use. “Was I someone who really needed it? Some will say no. But am I somebody who is overweight; that I couldn’t get [the weight] off and was unhappy and unhealthy and didn’t feel good in my own skin? Absolutely. So to me I’m doing something that’s bettering my health,” she said.
As buzz continues to build around using Ozempic for weight loss, Dr. Lonier says that many of her type 2 diabetes patients have had to skip doses and generally go without their medications due to a shortage. Dr. Lonier remains concerned about how the drug’s popularity will continue to affect her patients. “It’s horrible. It’s a real problem because the supply is very inconsistent. Patients have had a lot of trouble in the last few months, even with our prescriptions and prior authorization, getting their hands on the meds. The only answer for them is calling different pharmacies to check availability. I’ve had patients unable to get their meds and their blood sugars are getting high and they don’t feel well. It’s a big medical problem—a big, big medical problem.”
Zee Krstic, a health editor for Good Housekeeping who has type 2 diabetes, scrambled to fill his Ozempic prescription in 2022. “Finding Ozempic at the pharmacy has felt like a full-time job,” Krstic says. “In 2022, I was on a monthly hunt for Ozempic that felt never-ending.” But Krstic said things are looking up. “I will say that as of March 2023, I am surprised to find that most availability has seemingly done a 180 from where it was for most of last year.”
The bottom line
“From the FDA perspective, with few exceptions, health care professionals generally may choose to prescribe or use a legally marketed human drug or medical device for an unapproved or uncleared use when they judge that the unapproved use is medically appropriate for an individual patient,” says Tantibanchachai. The FDA urges people to take caution when taking off-label drugs.
While the surging popularity of semaglutide for general weight loss has the potential to spur a long-term shortage for people who need the drug for its intended purposes (like for type 2 diabetes), raising a murky conversation about ethics, those looking to lose weight can take the drugs should they get a prescription.
The demand for weight loss drugs remains so prominent that more are in development. Eli Lilly’s Tirzepatide, approved for treatment of type 2 diabetes under the drug name Mounjaro, will reportedly be presented to the FDA as a weight loss option beyond those with type 2 diabetes. Novo Nordisk’s Saxenda is another injectable weight loss drug on the market, and more are coming.
In reporting this story over the past six months, we found it challenging to reveal the answer to one of our biggest questions. Is the product people are getting from some med spas and telehealth companies the same drug as Novo Nordisk’s FDA-approved products containing semaglutide? It depends on the med spa and telehealth company and what your healthcare provider prescribes—and is the subject of ongoing debate.
There’s a bigger conversation to be had about long-term effectiveness of semaglutide-driven drugs. Anecdotally, when you stop semaglutide you may gain the weight back, said Dr. Lonier. “So for people who are looking for a quick fix it’s not necessarily the answer.” In her professional opinion, “There are people that want to lose weight and don’t need to, so to put those people on the meds is not the right approach,” she said.
While Raibick said her initial use of semaglutide helped her gain the confidence she needed to hit the gym and adjust her diet, she was worried about titrating, or weaning off of the drug, and subsequently gaining back the weight she’s lost. TikTok is saturated with stories of people gaining weight back after their final shot and entering another weight loss cycle. She weaned off of the drug, only to go back on a short time later, per her TikTok at press time.
This is a developing reported story. All information is accurate as of press time.
Emily Goldman is the senior editor at Prevention. She’s spent her career editing and writing about health, wellness, beauty, fashion, and food for Martha Stewart Living, Martha Stewart Weddings, Bridal Guide, Good Housekeeping, and more. She’s loved all things health and wellness since starting her bi-weekly podcast Pancreas Pals—a series all about the highs and lows of living life with type 1 diabetes. When not podcasting, she spends most of her time curled up with a good book or watching a period piece on BBC.
Sonya Maynard is the Research Director for Prevention Magazine. She has more than 15 years of experience in fact-checking, with a specialty in health and wellness content.