Weight-management practices are receiving more questions about GLP-1 medications: when can tirzepatide be compounded, what patient-specific documentation matters, and what should a practice ask a compounding pharmacy?

This guide addresses those workflow and regulatory questions for med spa owners and the NPs, PAs, and other prescribers who work with them.

Can tirzepatide still be compounded in 2026?

Compounded tirzepatide should not be treated as a standing substitute for a commercially available drug. Under section 503A, a state-licensed pharmacy compounds for an identified individual patient after receiving a valid prescription. FDA guidance restricts compounded drugs that are essentially copies of commercially available products unless the prescriber determines and documents that a change produces a significant difference for that individual patient.

FDA states that tirzepatide does not currently appear on the 503B bulks list or the FDA drug shortage list. A practice should therefore not assume that a shortage-based pathway supports a prescription. The prescriber and pharmacy must review the current legal and clinical basis for each patient-specific preparation.

Best practices for prescribing compounded GLP-1 preparations

A clear process begins with the prescriber’s evaluation and a patient-specific prescription. When a significant difference is the basis for compounding, the prescriber’s determination should be specific to that patient rather than a standardized or pre-populated statement. If the pharmacy needs clarification, it should contact the prescriber’s team before preparation rather than making an assumption.

Practice marketing should describe consultation, monitoring, education, and patient support. It should not position a compounded drug as a cheaper version of a brand-name drug, call it generic, or imply that it is FDA-approved. Compounded medications are patient-specific preparations and are not FDA-approved finished drug products.

Patient education should match the actual preparation and label. Questions about treatment selection, dose changes, or adverse effects belong with the prescriber or pharmacist. Prescription status, delivery, refill, and account questions should follow the practice and pharmacy’s approved workflows.

What to ask a GLP-1 compounding pharmacy

Before establishing a relationship, ask how the pharmacy handles state licensure and shipping requirements for the locations where patients live. Ask which applicable USP standards guide its work, what prescription documentation it requires, and how it labels, packages, assigns beyond-use dates to, and stores each patient-specific preparation.

It is also reasonable to ask how the pharmacy handles API sourcing and applicable quality testing, how patients and practice staff reach a pharmacist, how prescription clarifications are handled, and how regulatory or policy changes are communicated. A pharmacy partner should be able to explain its process in plain language without promising results or making unsupported claims about another product.

Beyond GLP-1s: topical anesthetics and peptides

Topical anesthetics

Med spas may ask about compounded topical anesthetics used with aesthetic procedures. Because topical anesthetics can be absorbed systemically, practices should use clear, product-specific protocols addressing the prescribed concentration, amount, treatment area, skin integrity, application time, and occlusion. FDA has warned that excessive application and use over large, irritated, or broken areas of skin can increase absorption and the risk of serious adverse effects. Prescribing, dispensing, application, counseling, and monitoring should follow the specific product, patient, and approved procedure.

Peptides

In 2026, FDA’s Pharmacy Compounding Advisory Committee considered whether several peptide substances, including BPC-157-related and TB-500-related bulk drug substances, should be included on the 503A Bulks List. Committee consideration or a recommendation does not itself authorize compounding. Before discussing a peptide service, confirm the current regulatory status of the specific substance and formulation with the pharmacy and appropriate regulatory counsel. Products labeled “research use only” are not intended for administration to patients.

This article is general education for medical practices and is not legal or medical advice. Compounded medications are patient-specific preparations and are not FDA-approved finished drug products. All formulations require a valid prescription from a licensed prescriber. Regulations change; confirm current requirements with your prescriber, pharmacist, and applicable regulatory authorities.