How we evaluate compounding pharmacies
The pharmacy matters more than the brand on the front of the website. What we check, what we can verify, and what we refuse to assert.
Entities that are not the same thing
| Term | What it actually means |
|---|---|
| FDA-approved drug | Reviewed by the FDA for safety, effectiveness and quality before marketing |
| Compounded preparation | Not FDA-approved as a finished product. No premarket review of safety, effectiveness or quality |
| 503A pharmacy | State-licensed. Compounds for an individual patient against a prescription |
| 503B outsourcing facility | FDA-registered. May compound in bulk. Subject to current good manufacturing practice requirements |
| Telehealth company | Arranges the consultation. Usually neither the pharmacy nor the manufacturer |
| Manufacturer | Makes the FDA-approved product. Eli Lilly and Novo Nordisk, in this category |
What we check
- Is the specific pharmacy named? Not 'our network of licensed pharmacies' — the facility.
- Is it 503A or 503B, and can we verify that for that specific facility? Registration is per-facility, not per-company. A company can operate both, and we do not assume every location it runs has the same status.
- Is the licence verifiable in a state board of pharmacy database?
- Is the salt form and concentration disclosed? Semaglutide sodium and semaglutide acetate are not the same active ingredient as the semaglutide base in approved products.
- Single-dose or multi-dose vial?
- Any FDA warning letter or state board action — precisely attributed, dated and linked?
What we will not assert
We do not state that a pharmacy is 503A or 503B without verifying that specific facility. A provider's statement about its pharmacy relationship is a provider-reported relationship until independently supported, and we label it that way.
Where a warning letter exists, we attribute it precisely, date it, link it, and describe it as an agency communication rather than a final adjudication. We update it when a response or close-out letter appears. We do not use one letter to imply unrelated violations.
Why the vial format is the clearest safety difference
The FDA has received hundreds of adverse-event reports involving compounded GLP-1 products, and a recurring cause is dosing error — a patient or clinician drawing the wrong volume from a multi-dose vial, sometimes by a factor of ten, occasionally requiring hospitalisation.
A brand pen or single-dose vial removes that failure mode entirely. This is the clearest concrete safety difference between compounded and brand products, and notably it has nothing to do with the molecule — it is the delivery format. Ask which one you are getting.
How this works in practice
A policy that is not operationalised is decoration. Here is what ours actually changes about the pages you read.
Every price carries a status. Verified means we hold a dated capture of the provider's own page. Reported — pending verification means a provider or third party reports it and we have not captured it ourselves. Evaluation in progress means we are not asserting it. We do not upgrade a price to Verified because a comparison site published it — sites in this category contradict each other routinely, and a number repeated by three affiliate blogs is still one unverified number.
Every medical claim traces to a primary source. FDA labels and guidance for regulatory status; PubMed-indexed randomised trials for efficacy; ClinicalTrials.gov for trial design. Reddit and patient forums are never used as evidence of price, safety, efficacy or legitimacy — they may be described as anecdotal sentiment, labelled as such. Animal research is never presented as proof of a human clinical effect.
Every ranking shows its arithmetic. Where a provider we have a commercial relationship with ranks well, the calculation that produced that result is printed on the page. If the arithmetic is wrong, you can see that it is wrong, and tell us.
Commercial relationships and what they do not buy
The publisher and certain principals have financial relationships with some of the telehealth providers listed on this site, and we may earn a commission when readers use certain links. That is how this publication is funded, and we state it in the footer of every page rather than burying it.
What compensation does not do: it does not change a score, a rank, an inclusion decision, or a negative finding. Providers cannot pay for placement, cannot suppress an accurate criticism, and cannot review their own page before publication. Where a commercially-related provider loses a category, we say so — a comparison in which one provider wins everything is an advertisement, and the fastest way to tell the difference is to look for the losses.
Corrections
We publish prices in a market that changes them frequently, and we will get things wrong. When we do, we correct the page, date the correction, and say what changed — we do not quietly edit a number and pretend it was always right. Both readers and providers can submit corrections with evidence, through the same process and to the same standard.
Our own record so far includes removing a set of provider prices we had sourced from a third-party comparison site and could not substantiate, and correcting brand-pricing figures that had gone stale after a manufacturer price cut. Both corrections made the site less flattering to conclusions we had already published. That is the point.
Jastreboff AM et al., N Engl J Med 2022 (NCT04184622), n=2,539. Dose-response is real: the effect rises with dose. These are FDA-APPROVED SUBCUTANEOUS INJECTION doses — they do not transfer to compounded, microdose or ODT products. Trial means are not individual promises.