Why we chose compounded GLP-1s — and how we source them responsibly

The GLP-1 telehealth space has a sourcing problem. In February 2026, the FDA issued warning letters to 30 telehealth companies for making false or misleading claims about compounded semaglutide and tirzepatide products — implying FDA approval that doesn't exist, hiding the identity of their compounding sources, and approving prescriptions without meaningful clinical review.

LiveRounded prescribes compounded semaglutide and tirzepatide. This article explains what that means, why we chose this approach, and exactly how we source our medications.

Required disclosure first

Compounded semaglutide and tirzepatide are not FDA-approved drugs. The FDA has not reviewed these medications for safety or effectiveness. The clinical trials showing 15–22% weight loss were conducted with FDA-approved branded formulations — not compounded versions. You deserve to know this upfront.

What compounded medications are

Compounding pharmacies create medications by mixing, combining, or altering pharmaceutical ingredients. Compounded GLP-1s use the same active ingredients as Wegovy (semaglutide) and Zepbound (tirzepatide) but are manufactured outside the FDA drug approval process. They are not bioequivalence-tested against the branded products.

Why we chose this approach

Our flat-rate pricing model — one price regardless of dose — only works with compounded medications. Branded semaglutide and tirzepatide cost $349–$550/month at manufacturer-direct pricing before any retail markup. You cannot bundle that into a flat-rate subscription without bankrupting the practice or gouging patients.

The business model that lets us include labs, unlimited NP messaging, AI monitoring, and all-dose pricing at $249–$329/month requires compounded sourcing. We'd rather be honest about that than pretend branded medications are financially viable in this model.

Why not all compounded GLP-1s are equal

The companies getting FDA warning letters were not necessarily doing compounded medications — they were doing compounded medications badly. Key problems the FDA identified: sourcing from unverified facilities, making claims of equivalence to branded products, and using salt forms (like semaglutide sodium) that differ from the molecule used in clinical trials.

We take a different approach. Our in-house pharmacist audits every compounding facility we use before we work with them, reviewing: FDA 503B registration status, cGMP (current Good Manufacturing Practice) compliance records, sterility testing protocols, potency verification methods, and beyond-use dating practices. We source exclusively from 503B outsourcing facilities, which are subject to more stringent manufacturing oversight than traditional 503A pharmacies.

How we document clinical necessity

Since the national semaglutide shortage ended in 2025, compounders cannot simply produce bulk copies of branded products — they must document clinical necessity for each patient's specific formulation. Our NP reviews every patient's complete health history before any prescription is written, documents the clinical rationale for the specific compound prescribed (custom dosing schedules, preservative-free formulations for patients with sensitivities, etc.), and maintains this documentation in the patient record.

This is exactly what the FDA requires. It is also what distinguishes a real clinical practice from a prescription mill.

What patients should ask any telehealth provider

Whether you choose LiveRounded or another provider, here are the questions that matter: What 503B facility fills your prescriptions? Can you name them? Has a pharmacist independently audited that facility? Does your NP document clinical necessity per patient, or is there an algorithm approving prescriptions in bulk? Does your website say 'not FDA-approved' prominently, or is it buried in the footer?

We can answer every one of those questions. We think you should hold every compounding telehealth provider to the same standard.

This article was reviewed by John McIntosh, NP. It is intended for informational purposes and does not constitute medical advice. Consult your healthcare provider before starting any medication. Compounded medications are not FDA-approved.