How to Get GLP-1 During a Shortage

Introduction

GLP-1 shortages were a defining feature of 2022-2024. Wegovy® launched in 2021, demand exploded, supply lagged, and patients waited 6+ months for prior authorization plus stock availability. The FDA officially listed semaglutide and tirzepatide as in shortage from 2022 through October 2024, which opened the door for 503A and 503B compounding under FDA enforcement discretion. By late 2024 the FDA declared the shortage resolved and began enforcing against compounding that simply copied the commercial products. The March 2025 FOAF v. FDA ruling upheld the FDA’s authority.

That doesn’t mean shortages can’t recur. New shortages could be declared if demand outpaces supply again, or if manufacturing disruptions hit. The 2026 status is “no official shortage” but the supply chain remains tight in some regions and doses. Pharmacy-level stockouts of specific Zepbound® or Wegovy doses still happen periodically.

This guide covers what to do when a shortage hits, both the legal compounding pathway (when the FDA reopens it) and the practical workarounds when local pharmacies just don’t have stock.

At TrimRx, we believe that understanding your options is the first step toward a more manageable health journey. You can take the free assessment quiz if you’re ready to see whether a personalized program is a fit for you.

Is GLP-1 Still in Shortage in 2026?

No, not officially. The FDA removed tirzepatide from the shortage list on October 2, 2024 and semaglutide shortly after. The court fight with the Outsourcing Facilities Association concluded in March 2025 with the FDA’s position upheld. Mass-market 503B compounding ended after the ruling.

Quick Answer: The FDA officially ended semaglutide and tirzepatide shortages in October 2024; no shortage is currently declared as of mid-2026

Local pharmacy stockouts still occur periodically, especially for specific high-demand doses (5 mg and 10 mg pens). These aren’t formal shortages but cause real-world delays in getting prescriptions filled.

If a new shortage gets declared in 2026 or 2027, the 503A and 503B compounding pathways open up again under FDA enforcement discretion. As of mid-2026, that’s not the current state.

What If My Local Pharmacy Doesn’t Have Wegovy or Zepbound?

The most common 2026 scenario isn’t an official shortage but a local stockout. Practical workarounds:

1. Call other pharmacies in your area. CVS, Walgreens, Costco, and independent pharmacies all stock these drugs at different levels.
2. Use a mail-order pharmacy through your insurance. CVS Caremark, Express Scripts, OptumRx all have mail-order options that often have better stock than retail.
3. Switch to LillyDirect (for Zepbound) or NovoCare (for Wegovy) direct shipping. The manufacturer specialty pharmacies have the most reliable supply.
4. Switch to compounded GLP-1 through telehealth. The pharmacy direct-ships overnight.

The fastest workaround is usually #3 or #4. Local pharmacy stockouts can drag on for weeks. Direct manufacturer or compounded telehealth bypass the retail supply chain entirely.

Can I Get Compounded GLP-1 in 2026 Without an Active Shortage?

Yes, but only for documented individualized clinical need. After the March 2025 FOAF ruling, 503A pharmacies can compound semaglutide or tirzepatide for individual patients when a prescriber documents a clinical reason the commercial product doesn’t meet. Reasons include:

• Allergy to a commercial product excipient
• Need for a non-standard titration dose (like 3.5 mg tirzepatide)
• Combination formula with B12, glycine, or niacinamide
• Documented inability to obtain commercial product (which during local stockouts can apply)

Mass-market compounding for any healthy patient who wants a cheaper option ended. The legal lane is narrower but real.

What Dose Strategies Work During Stockouts?

If you can’t get your current dose:

• Stretch the supply by going to an every-10-day schedule instead of weekly for 1-2 doses (only with clinician approval; this is a temporary measure)
• Step down to a lower dose temporarily if the lower dose is available
• Switch to a comparable dose of the other drug if your prescriber agrees (semaglutide 2.4 mg ↔ tirzepatide 10-15 mg, roughly comparable for weight loss based on SURMOUNT-1 vs STEP 1 data)
• Step up earlier than scheduled if a higher dose is available and you’ve tolerated current dose well

Don’t do any of this without clinician input. Dose changes that look small can have real effects on tolerability and effect.

Should I Switch Between Semaglutide and Tirzepatide During a Shortage?

Sometimes a useful strategy. Tirzepatide (SURMOUNT-1 showed 20.9% weight loss at 72 weeks at 15 mg) is generally more potent for weight loss than semaglutide (STEP 1 showed 14.9% at 68 weeks at 2.4 mg). Switching from semaglutide to tirzepatide if Wegovy is out usually maintains or improves the weight-loss trajectory.

Switching from tirzepatide to semaglutide if Zepbound is out is more of a step down in potency but can work to bridge a supply gap.

Dose conversion is approximate:

• Semaglutide 0.5 mg ≈ tirzepatide 2.5 mg
• Semaglutide 1.0 mg ≈ tirzepatide 5 mg
• Semaglutide 1.7 mg ≈ tirzepatide 7.5 mg
• Semaglutide 2.4 mg ≈ tirzepatide 10 mg

These are clinician-guided conversions based on observed weight-loss equivalence, not formal pharmacokinetic equivalents. Start at the conservative end and titrate up.

What If My Insurance Won’t Cover a Switch?

Insurance prior authorization for the new drug requires a fresh PA process. If you’ve been approved for Wegovy and now want Zepbound during a Wegovy shortage, your insurance may require new documentation. The fastest path is often to ask your prescriber to note the shortage as the clinical reason for the switch.

If insurance denies and the shortage continues, cash-pay through LillyDirect for Zepbound or NovoCare for Wegovy avoids the PA process entirely. Cost is higher but availability is more reliable.

Key Takeaway: During a real shortage, 503A pharmacies can compound the drug for patients with documented clinical need; mass-market 503B compounding requires an FDA shortage declaration

Do Compounded Shortages Have the Same FDA Backing?

Compounded shortages aren’t separately declared. The FDA shortage list tracks commercial products. During the 2022-2024 commercial shortage, compounded supply expanded under FDA enforcement discretion. After the shortage ended, mass-market compounding was wound down.

If a new commercial shortage gets declared, the compounded pathway expands again. Until then, compounded GLP-1 is only legal for individualized clinical need.

What About International Suppliers During a Shortage?

Don’t. Buying from Indian, Mexican, or Eastern European pharmacies has the same risks during a shortage as anytime: counterfeit risk, broken cold chain, customs seizure, no legal recourse, FDA warning letters against the sellers. The savings don’t justify the risks.

Several patients during 2022-2024 lost money to international “peptide” sellers shipping uncharacterized API powder labeled “research use only.” The FDA, FTC, and state attorneys general filed actions against several companies. Stay with US-licensed pharmacies.

How Can I Prepare for a Potential Future Shortage?

A few proactive moves:

1. Maintain insurance prior authorization (don’t let it lapse) so you have the brand-name option as a default
2. Keep a relationship with a telehealth platform that offers compounded GLP-1 (like TrimRx’s free assessment quiz) so you have an alternative if needed
3. Save medication documentation (dates, doses, prescribing platforms) so a new provider can verify your history quickly
4. Don’t stockpile beyond a 30-90 day supply. Cold-chain storage at home isn’t ideal for long durations.

The shortage cycle of 2022-2024 caught many patients off guard. Having multiple platforms set up doesn’t cost anything until you need them.

What If I’m Just Starting GLP-1 During a Stockout?

Start with whichever drug and platform has the best availability. The clinical data for semaglutide and tirzepatide are both strong. STEP 1 showed 14.9% weight loss at 68 weeks with semaglutide 2.4 mg. SURMOUNT-1 showed 20.9% with tirzepatide 15 mg. SURPASS-2 (Frias et al. 2021 NEJM) compared the two drugs in type 2 diabetes and showed tirzepatide produced greater A1C reduction across doses.

For pure weight loss, tirzepatide has stronger trial data. For cardiovascular risk reduction post-SELECT, semaglutide has FDA approval and Medicare Part D coverage in the right population. Start with what’s available and what fits your indication.

Bottom line: SURMOUNT-1 (Jastreboff et al. 2022 NEJM) and STEP 1 (Wilding et al. 2021 NEJM) data applies to both drugs at their respective FDA-approved doses

FAQ

Is There a GLP-1 Shortage in 2026?

No official shortage as of mid-2026. The FDA ended both semaglutide and tirzepatide shortages in late 2024. Local pharmacy stockouts of specific doses still occur periodically.

Can I Get Compounded GLP-1 Without an Active Shortage?

Yes for documented individualized clinical need (allergy, non-standard dose, combination formula, or inability to obtain commercial product locally). Mass-market compounding for any healthy patient ended in March 2025.

What’s the Fastest Workaround for a Local Stockout?

Direct manufacturer self-pay (LillyDirect for Zepbound, NovoCare for Wegovy) or compounded GLP-1 through telehealth. Both bypass the retail supply chain.

Can I Switch From Semaglutide to Tirzepatide During a Shortage?

Yes with clinician approval. The drugs are both effective; tirzepatide is slightly more potent for weight loss. Use approximate dose conversions and titrate carefully.

Will Future Shortages Reopen Compounding?

If the FDA declares a new shortage, 503A and 503B compounding pathways expand again under enforcement discretion. As of mid-2026, no new shortage is declared.

Is It Safe to Stretch Doses During a Shortage?

Only with clinician guidance and as a temporary measure. Stretching to every 10-14 days for 1-2 doses can bridge a gap. Longer-term stretching reduces clinical effect.

Where Can I Check the Official Shortage Status?

The FDA Drug Shortages database at fda.gov tracks the official shortage list. Search for semaglutide or tirzepatide.

Disclaimer: This content is for informational purposes only and does not constitute medical advice. It is not intended to diagnose, treat, cure, or prevent any disease or condition. Individual results may vary. Always consult a qualified healthcare professional before starting any weight loss program or medication.