Are compounding pharmacies safe?
The rules tightened in 2025, so 503B on its own is not the green light it used to be. Ask about base versus salt form and mean it.
Here is what changed. The FDA declared the semaglutide shortage resolved in February 2025, and the enforcement discretion that let pharmacies compound it ended that spring. On May 1, 2026 the FDA went further and proposed leaving semaglutide, tirzepatide and liraglutide off the 503B Bulks List entirely. That proposal was still open as of September 2026, so this is a moving target and we treat it like one.
What that means for us: “Is it a 503B?” used to be the whole test and it is not any more. A facility being FDA-registered tells us about the facility, not about whether what they are selling us is legal to compound today.
The base versus salt question still holds and it is still the fastest way to catch a bad actor. The FDA has warned against salt forms (sodium or acetate). Legitimate compounding uses the base form.
So be blunt on the phone: “Do you use the base form or a salt form, sodium or acetate?” If they say salt, hang up.
Then do the rest of the Pharmacy Recon. Ask what their source is and whether they will send a Certificate of Analysis. Start with Google reviews, ask your besties, and if the price looks too good to be true it probably is. The cheapest service is not always the best one.
Ask your prescriber where they want you filling this. Ask today, not after the vial arrives.
None of this is medical advice. It is educational material drawn from FAT BITCH: Killing the Willpower Myth by Cat Clark, and it does not replace your prescriber, your pharmacist, or your actual doctor. If something here does not match what your care team told you, go with your care team and bring this along to the conversation.