The semaglutide and tirzepatide shortages are over, which removed the legal basis for compounding these drugs at scale. A 2026 study asked what the market looks like now [1]. Researchers posed as customers at 75 weight-loss clinics and medical spas in West Virginia and Oklahoma between August and October 2025, chosen for high obesity rates and insurance mix.
Start with what this is not. These were brick-and-mortar clinics and spas in two states, not the online telehealth sellers ranked on this desk, and none of its percentages can be moved across. This site has its own count of what sellers disclose, in one good disclosure, and the two should not be blended.
With that said, the findings are hard to read comfortably. Of 75 businesses, 42 (56.0%) sold a compounded GLP-1 combined with B vitamins. Twenty-three compounding facilities supplied them. Of the 21 whose licensing could be established, 4 (19.0%) were not licensed to perform sterile compounding — for an injectable product. Of 22, 3 (13.6%) had been subject to state disciplinary action since 2023, and 1 of 23 (4.3%) had received multiple FDA warning letters.
The denominators differ because the authors could not establish every attribute for every facility, and they report them that way rather than rounding to a single figure. That is the correct treatment and it is worth copying, and it is the same discipline applied to dose tiers in what nobody says about a higher dose.
The B-vitamin detail is the one that travels, because it is not confined to spas. Walking seller pages for this site turns up the same practice: one seller ranked here lists “Tirzepatide/B6” and “Tirzepatide/Glycine/B12” by name in its own price table. A combination product is a different thing from the molecule, and a price comparison that treats them as the same is comparing two different purchases. That is part of why two published prices so often turn out not to describe one product.
The practical reading for a buyer is narrow and worth stating plainly. Ask what is in the vial and which pharmacy prepared it. Most sellers on this desk name neither, which is why how old a price is and what stands behind it are separate questions, and why a seller that names its compounder — as a few do — is doing something the rest are not.