Semaglutide

The best-documented incretin medicine in current use. Large randomized trials support clinically meaningful weight loss and glycemic improvement, with a well-characterized gastrointestinal adverse-effect profile and a boxed warning related to thyroid C-cell tumors in rodents.

A long-acting GLP-1 receptor agonist. It slows gastric emptying, increases glucose-dependent insulin secretion, suppresses glucagon, and reduces appetite via central GLP-1 pathways.

STEP trials established weight-loss efficacy in adults with overweight or obesity. SELECT reported a reduction in major adverse cardiovascular events in people with established cardiovascular disease and overweight. Oral and injectable forms are both approved for specified indications. Real-world muscle loss and GI intolerance remain practical limits, not footnotes.

FDA-approved (injectable and oral) for type 2 diabetes and, at a higher-dose brand, chronic weight management. Prescription only. Compounded versions have been a shortage-era workaround with quality and dosing risk.

A licensed clinician writes a prescription for a specific approved product — Ozempic or Rybelsus for type 2 diabetes, Wegovy for chronic weight management — filled by a pharmacy. Compounded copies were a shortage-era workaround. After FDA declared the shortages resolved, compounding copies of these approved GLP-1s is generally not permitted except in narrow 503A/503B cases (a documented clinical difference that the approved product cannot meet).

Same four pathways as the Sourcing guide.

Ozempic is commonly covered for type 2 diabetes with prior authorization. Wegovy for obesity is a commercial-plan lottery: many require BMI thresholds plus a comorbidity, step therapy, or both. Medicare Part D has long covered incretins for diabetes and, for Wegovy, certain cardiovascular indications. Starting 1 July 2026, the Medicare GLP-1 Bridge covers Wegovy (injection or tablet) at $50 per month for eligible Part D members through 31 December 2027. Manufacturer savings cards may apply if you have commercial insurance; they usually do not stack with Medicare.

Counterfeit pens, compounded 'semaglutide sodium' or acetate, and research vials labeled not for human use. FDA has warned that some compounded products used salt forms that are not the approved drug, and that falsified Ozempic-like pens have entered the US supply. A Telegram listing is not a pharmacy.

Strand does not list vendors. See the grey market.

Common: nausea, vomiting, diarrhea, constipation. Less common: gallbladder disease, pancreatitis signal (monitor). Boxed warning: rodent C-cell tumors; contraindicated with personal/family MTC or MEN2. Not for pregnancy. Dose titration is clinician-directed; compounding copies are not equivalent to the approved product.

• Gastrointestinal effects are common and sometimes treatment-limiting.
• Gallbladder disease and a pancreatitis caution are on the labels.
• Boxed warning: rodent thyroid C-cell tumors; contraindicated in personal or family MTC or MEN2.
• Not for pregnancy. Lean-mass loss travels with fat-mass loss.
• Weight typically returns when the drug is stopped.
• Unregulated or compounded copies add identity, sterility, and dosing risk that the trials never measured.

• STEP 1 · 2021 · N Engl J Med

  Wilding et al. Once-weekly semaglutide in adults with overweight or obesity. PMID 33567185.

• SELECT · 2023 · N Engl J Med

  Lincoff et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. PMID 37952131.

• FDA labels

  Prescribing information for Ozempic, Wegovy, and Rybelsus.