Medication Supply and Shortages
You show up at the pharmacy. You’ve done everything right — had the doctor’s appointment, got the prescription, maybe even fought through a prior authorization. And the pharmacist looks at you and says, “We don’t have it in stock. I’m not sure when it’s coming back.”
If that’s happened to you, you’re not imagining things. GLP-1 medications have been in and out of shortage for the better part of three years. At one point, nearly every dose of every major GLP-1 was listed on the FDA’s drug shortage database. The situation rattled patients, frustrated providers, and created a vacuum that some very questionable actors rushed to fill.
The good news: the worst of the shortage is over. Both semaglutide and tirzepatide are officially off the FDA shortage list as of early 2025. But the story of how we got here — and what to do if it happens again — is worth understanding. Because supply disruptions aren’t just an inconvenience when you’re on a medication that requires consistent dosing to work.
How We Got Here: The Demand Surge
The GLP-1 shortage wasn’t caused by a manufacturing failure or a recall. It was caused by an explosion in demand that no one — including the manufacturers — predicted at this scale.
Here’s what happened: prescriptions for GLP-1 medications surged roughly 300% in under three years, reaching an estimated 9 million by September 2023.[1] Semaglutide specifically saw a 442% increase in prescriptions between January 2021 and December 2023.[1] And a huge chunk of that growth came from off-label weight loss prescribing — up an astonishing 2,082% between 2019 and 2022.[1]
What drove it? A combination of strong clinical trial data, FDA approvals for weight management (Wegovy in 2021, Zepbound in 2023), and then the wildfire effect of social media and celebrity attention. When high-profile figures started talking publicly about using these medications, demand accelerated beyond anything the traditional pharmaceutical supply chain was built to handle.
To be clear: the demand wasn’t wrong. These medications work, the clinical evidence is strong, and millions of people genuinely benefit from them. The problem was that pharmaceutical manufacturing — which involves complex biological processes, dedicated production facilities, and regulatory quality standards — can’t scale overnight. Building a new production line for injectable medications takes years, not months.
The Shortage Timeline
Here’s how it played out:
- March 2022 — Wegovy first appears on the FDA shortage list. Novo Nordisk paused new patient starts temporarily.
- 2022–2024 — Shortage expanded to most dose levels of Ozempic, Wegovy, Mounjaro, and Zepbound. Different doses cycled in and out of availability.
- October 2024 — FDA officially resolved the tirzepatide (Mounjaro/Zepbound) shortage.[3]
- February 2025 — FDA officially resolved the semaglutide (Ozempic/Wegovy) shortage.[3]
That resolution doesn’t mean every pharmacy has every dose on every shelf right now. It means the manufacturers have confirmed they can meet aggregate demand and the FDA is no longer listing these as shortage drugs. Spot shortages — individual pharmacies running out temporarily — can still happen. But the systemic, nationwide shortages are over.
One medication still affected: Liraglutide (Saxenda/Victoza) remains on the FDA drug shortage list as of early 2026. If you’re on liraglutide, check the FDA’s current shortage database for the latest status.
The Compounding Controversy
The shortage created a market. And into that market stepped compounding pharmacies — some legitimate, some not.
Here’s the background. When a brand-name drug is on the FDA shortage list, compounding pharmacies are legally permitted to make copies of that drug. Compounding is the practice of a pharmacy mixing or preparing a customized medication for a specific patient, and it’s a legitimate and long-standing part of pharmacy practice. There are two types:
- 503A pharmacies — traditional compounding pharmacies that prepare medications for individual patients based on a prescription. They’re regulated at the state level.
- 503B outsourcing facilities — larger-scale operations registered with the FDA that can produce compounded medications in bulk without individual prescriptions. They face more federal oversight, including FDA inspections.
During the semaglutide and tirzepatide shortages, both types of compounding pharmacies began producing versions of these medications. For many patients who couldn’t access the brand-name drugs, compounded versions were the only option available. Some were produced responsibly by reputable pharmacies following safety standards. Others were not.
The Safety Picture
The safety data on compounded GLP-1 medications is concerning. As of December 2024, the FDA had received 605 adverse event reports for compounded semaglutide and 545 for compounded tirzepatide — including 17 deaths.[2] Those numbers include hospitalizations, allergic reactions, dosing errors, and contamination issues.
This doesn’t mean every compounded GLP-1 product is dangerous. Many of those adverse events involved products from unlicensed or unregistered sellers — not legitimate compounding pharmacies. But the range of quality across the compounding landscape is wide, and there’s no way for patients to verify manufacturing standards on their own. If you’re currently using a compounded product, talk to your provider about transitioning to a brand-name version now that the shortages are resolved.
The Salt Form Problem
Here’s a detail that matters more than it sounds like it should. Legitimate semaglutide — the molecule in Ozempic and Wegovy — is semaglutide base. Many compounding pharmacies were producing semaglutide sodium or semaglutide acetate instead. These are different salt forms of the molecule, and the FDA has been clear: they are not the same drug.[2] The clinical trials that proved semaglutide works were conducted with semaglutide base. The safety and effectiveness of alternate salt forms haven’t been established through the same rigorous testing.
This isn’t a technicality. Different salt forms can affect how a drug is absorbed, how stable it is, and how it behaves in your body. The FDA specifically flagged this as a concern.
The Legal Battle
When the FDA resolved the semaglutide shortage in February 2025, compounding pharmacies were supposed to stop producing it — because the legal basis for compounding (the shortage) no longer existed. Several compounding companies and pharmacy organizations have filed lawsuits challenging the FDA’s decision, arguing the shortage isn’t truly resolved because patients still face access barriers due to cost.[3]
That legal fight is ongoing. In the meantime, the FDA sent warning letters to more than 50 compounders for violations ranging from producing semaglutide without a valid shortage basis to manufacturing quality failures.[5]
From my experience, the compounding situation is one of the most confusing things patients deal with. The messaging is all over the place — some providers still recommend compounded products, some pharmacies still sell them, and the legal status shifts every few months. My take: now that the brand-name medications are available again, the risk-benefit calculation for compounded versions has changed significantly. The access problem that justified the risk is largely resolved.
What to Do During a Shortage
If supply tightens again — or if you’re dealing with a spot shortage at your local pharmacy — here are the strategies people actually use:
The FDA maintains a real-time database tracking which medications and doses are affected. This tells you whether you're facing a nationwide issue or a local one.
Chain, independent, and specialty pharmacies all have different supply chains. Don't assume that because one is out, they all are — people regularly find stock at a pharmacy two miles away.
Eli Lilly's LillyDirect program ships Zepbound and Mounjaro directly to patients, bypassing the pharmacy supply chain entirely with home delivery.
Some providers work around gaps creatively — for example, prescribing two lower-dose pens instead of one higher-dose pen. This is a provider decision, not something to figure out on your own.
If one GLP-1 is consistently unavailable, your provider may recommend switching — semaglutide to tirzepatide or vice versa. It involves a new titration schedule, but it's better than going without treatment.
Never adjust your dosing, skip doses to stretch your supply, or switch medications on your own during a shortage. All of these decisions affect how the medication works in your body and need to be made with your prescriber. If you’re running low and can’t get a refill, call your provider’s office — they may have samples, alternative strategies, or connections to pharmacies with stock.
What NOT to Do
Shortages create desperation, and desperation creates opportunities for bad actors. A few things to watch out for:
If someone is selling GLP-1 medications through social media, an unregulated website, or a source that doesn't require a prescription — walk away. The FDA has documented counterfeit, contaminated, and mislabeled products circulating through these channels.[2]
If you use a compounding pharmacy, verify it's a licensed 503A or registered 503B facility. The FDA maintains a list of registered 503B outsourcing facilities. If a source can't provide licensing information, that's a red flag.
Hoarding extra pens reduces availability for other patients dealing with the same problem. The medication also has a shelf life and specific storage requirements — stockpiling creates waste and increases the risk of using expired product.
The Future of Supply
The supply picture is genuinely improving, and the investments behind it are massive.
Novo Nordisk has committed roughly $18 billion in manufacturing investment to expand production capacity across multiple continents.[4] Eli Lilly has made similarly large-scale investments. Both are building dedicated GLP-1 facilities to buffer against future demand surges.
The FDA approved the Wegovy pill (oral semaglutide for weight management) in December 2025. Oral medications don't require the specialized pen devices that created bottlenecks — as patients move to pills, that relieves pressure on the injectable supply chain.
Semaglutide and tirzepatide patents don't expire until the early 2030s, so don't expect biosimilar competition before roughly 2030–2032.[6] When they arrive, they'll bring competition, lower prices, and additional manufacturing capacity.
The Bottom Line
The GLP-1 shortage was real, it was disruptive, and it affected millions of people who were counting on consistent access to their medication. That part is worth acknowledging — if you went through it, the frustration was justified.
But the worst is behind us. Both semaglutide and tirzepatide are off the shortage list. Manufacturing investments measured in tens of billions of dollars are coming online. Oral formulations are expanding options. And the systems for navigating spot shortages — manufacturer programs, multiple pharmacy networks, provider flexibility — are better established than they were in 2022.
Stay informed. Keep the FDA shortage database bookmarked. Have a conversation with your provider about a backup plan before you need one. And if someone tries to sell you a shortcut — an unverified product, a too-good-to-be-true compounded version, a social media miracle — remember that the safest path is always through your provider and a licensed pharmacy.
The supply chain caught up. The infrastructure is being built. You shouldn’t have to worry about whether your medication will be there next month — and increasingly, you won’t have to.
Sources:
- AJMC. “An Ongoing Crisis: Semaglutide Shortage Raises Dual Concerns.” 2024.
- FDA. “FDA’s Concerns with Unapproved GLP-1 Drugs Used for Weight Loss.” 2024.
- Pharmacy Times. “FDA Ends Semaglutide Shortage Listing.” February 2025.
- Fierce Pharma. “2025 Forecast: After Novo, Lilly Expansion Sprees.” 2025.
- Wilson Sonsini. “FDA Sends Warning Letters to More Than 50 GLP-1 Compounders.” 2025.
- Chemical & Engineering News. “Looming GLP-1 Drug Patent Expirations Draw Generics Firms.” December 2025.
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