Few medicines have moved from clinical novelty to cultural phenomenon as quickly as GLP-1 receptor agonists. Semaglutide, liraglutide and tirzepatide have reshaped how the world treats diabetes and obesity, and demand has outrun supply almost everywhere they are sold. Into that gap has also grown a market for compounded and other non-approved GLP-1 formulations, alongside a more dangerous trade in falsified and counterfeit products.
A market that grew online
Much of this trade lives online. Telehealth platforms turned a prescription that once required a clinic visit into a few taps on a phone. That convenience carried real value for patients priced out of branded therapy, where list prices can cross a thousand dollars a month. It also created a frictionless channel for products that regulators never reviewed. In early 2026, Hims & Hers briefly offered a $49 compounded semaglutide pill. After the FDA announced plans to take enforcement action against mass-marketed, non-FDA-approved compounded GLP-1 products, the company said it would stop offering the compounded pill. The episode illustrated how quickly the boundary between digital convenience, affordability and regulatory oversight can become contested.
The episode was less an isolated misstep than a window into a wider ecosystem. In March 2026 the FDA issued warning letters to thirty telehealth companies over false or misleading claims about compounded GLP-1s, part of a broader push against direct-to-consumer drug advertising that has generated more letters in months than the agency sent across the previous decade. The pattern runs from a single high-profile brand to hundreds of smaller sellers, marketplaces and social accounts that promote weight-loss injections to audiences primed by algorithmic feeds.
A safety problem that is real, and global
Underneath the marketing sits a genuine clinical problem. Clinicians at Stanford Medicine have catalogued why these products worry them. Some compounders use salt forms of the active molecule that were never tested in the trials that earned the branded drugs their approval. A 2026 study found that tirzepatide mixed with vitamin B12 can chemically bond to form a new molecule; Eli Lilly subsequently replicated the finding, although the clinical consequences remain unknown.
Multidose vials that require patients to draw their own doses have led to people injecting ten to twenty times the intended amount. Peptides degrade when handled poorly, so a drug shipped without proper controls may arrive weaker than its label claims, or stronger. Poison-control data also point to a growing burden of GLP-1-related exposures, with dosing errors accounting for a substantial share of reported cases.
The concern reaches well beyond the United States. In September 2025 the European Medicines Agency and national regulators warned of a sharp rise in illegal medicines sold as GLP-1 therapies across the bloc, advertised through fraudulent websites and fake social profiles, many hosted well outside European jurisdiction. Some of these products contain no active substance at all. Others carry harmful levels of something else entirely.
Not every version is the same drug
Clarity matters here, because four very different categories are often lumped together. Approved medicines have passed regulatory review for safety, quality and effectiveness. Legitimately compounded medicines, prepared by a licensed pharmacy for a specific patient with a real clinical need, serve a narrow and valuable purpose. Non-approved formulations may fall outside the regulatory approval pathway, while falsified and counterfeit products are outright fakes, sold by criminals who mimic a trusted name. Treating all four as one blurs the very distinctions that keep patients safe.
The question India has to answer
This distinction is particularly important as India enters a new era of generic GLP-1 competition. A regulator-approved generic is fundamentally different from an unapproved compounded formulation, and both are fundamentally different from a falsified medicine. Rising demand, online prescribing, aggressive social-media promotion and price-sensitive consumers form exactly the conditions under which unapproved and counterfeit products can flourish.
India's opportunity is significant. As generic competition expands, more patients could gain access to GLP-1 therapies at lower costs. Protecting that opportunity will require the regulatory and supply-chain systems to keep pace with demand, while making clear to patients that lower price does not have to mean lower standards.
Building access that patients can trust
Patient safety, in that environment, can no longer stop at the counter of a physical pharmacy. It has to extend into the digital health platforms where prescriptions are written and the supply chains through which medicines travel. The right response is to widen access while closing the gaps that unsafe sellers exploit. That means stronger traceability from manufacturer to patient, active digital surveillance of online sellers and advertising, meaningful prescription controls, robust pharmacovigilance that captures adverse events wherever they occur, and sustained patient awareness so buyers can distinguish a licensed source from a convincing fake. Innovation and legitimate access deserve room to grow, and this is how that room stays safe.
The GLP-1 revolution has already proven that these medicines can change lives at scale. Its next test is different. The solution is not to slow legitimate innovation or restrict responsible access. It is to build the safety infrastructure around it, with stronger traceability from manufacturer to patient, active surveillance of online sellers and advertising, appropriate prescription controls, robust pharmacovigilance and clear public education on how to distinguish approved, legitimately compounded and falsified products. Access can expand only sustainably when patients can trust the medicine they receive.
(By Dr Sabine Kapasi, CEO at Enira Consulting Pvt Ltd, Founder of ROPAN Healthcare Pvt Ltd, and a UN Advisor)
Disclaimer: The opinions expressed within this article are the personal opinions of the author. NDTV is not responsible for the accuracy, completeness, suitability, or validity of any information on this article. All information is provided on an as-is basis. The information, facts or opinions appearing in the article do not reflect the views of NDTV and NDTV does not assume any responsibility or liability for the same.