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Compounding pharmacies are making their own versions of blockbuster weight loss drugs

AILSA CHANG, HOST:

As more people turn to blockbuster drugs like Wegovy to lose weight, some are choosing to skip the name-brand drugs and go online for less expensive alternatives made by specialized pharmacies. NPR pharmaceuticals correspondent Sidney Lupkin reports on the surging demand for these custom-made weight loss medicines.

SIDNEY LUPKIN, BYLINE: Jennie Smith, a seamstress at a ballet school in Kent, Ohio, says she was about a hundred pounds overweight. A few years ago, she wrote down everything she ate, cut calories to the extreme and lost 60 pounds, but it didn't stick.

JENNIE SMITH: I would have such hunger pains that I couldn't sleep. You know, I could not cut my calories anymore. And I kind of gave up, and I gained 30 of it back.

LUPKIN: Then she heard about the new weight loss drugs like Wegovy. That sounded like what she'd been looking for, but they're expensive at more than a thousand dollars a month. So Smith did some research and found a cheaper version of the drug offered by one of dozens of online pharmacies that tout their own copies of these weight loss drugs. On the pharmacy's website, she did a virtual appointment with a healthcare provider to figure out the right dose. The price - around $300 a month. The pharmacy sent the drug to her a few weeks later on dry ice. She's lost 40 pounds since September.

SMITH: It was like a light switch. As soon as I started taking it, I noticed not only was I not eating, but I wasn't thinking about food.

LUPKIN: It isn't exactly Wegovy, however. Smith got what's called a compounded medicine. It's made with the same basic ingredient as Wegovy but by a specialized pharmacy, not a drug company. The compounded drugs are not generics, nor do they go through the Food and Drug Administration's approval process. Compounding pharmacies prepare the drugs to order rather than manufacturing them the way a pharmaceutical factory would. For instance, if a drug is only available as a pill but an elderly patient can't swallow one, a compounding pharmacist could prepare it in liquid form.

Sometimes compounding pharmacies can legally pitch in during a drug shortage. That's what's happening now. The blockbuster weight loss drug Wegovy is in short supply because the manufacturer, Novo Nordisk, can't keep up with demand. But semaglutide - the active pharmaceutical ingredient, or API, in Wegovy - is widely available, says Scott Brunner, CEO of the Alliance for Pharmacy Compounding. There are factories around the world producing semaglutide that compounding pharmacies can buy to produce their medicines.

SCOTT BRUNNER: Pharmacy compounders are required to source API from FDA-registered facilities, and interestingly, they use some of the same FDA-registered facilities that the drug manufacturers use.

LUPKIN: But quality can be an issue. Not everyone selling compounded semaglutide is in compliance with state and federal standards. And Novo Nordisk has taken legal action against several businesses for selling semaglutide that isn't up to snuff. It says it found impurities, the wrong concentration of the drug, even some products that contain no semaglutide at all in compounded versions of its drugs. Although it's safest to get FDA-approved, brand-name drugs through your regular doctor and pharmacy, the high prices, spotty insurance coverage and limited availability have driven many patients elsewhere. No matter what, it is crucial for patients to keep their doctors in the loop. Doctor Scott Isaacs is the president-elect of the American Association of Clinical Endocrinology. He says losing weight can affect the management of other health conditions.

SCOTT ISAACS: You don't want to hide this from your doctor. I mean, they need to know. I can tell you an example of a patient I saw yesterday that had lost significant weight, and they were taking other medications. And the dose had to be adjusted significantly because of their weight loss, and they didn't know that.

LUPKIN: Isaacs also says it's important to physically check a patient's thyroid because these obesity drugs, brand-name or compounded, have a rare side effect - thyroid cancer. He says he'd prefer patients to work with him to get a prescription, but he knows when there's a will, there's a way. Sidney Lupkin, NPR News. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Sydney Lupkin is the pharmaceuticals correspondent for NPR.