Documentation of Compounded GLP-1 Receptor Agonists in a Large Primary Care Dataset

Area of Science:

• Pharmacology
• Health Services Research

Background:

• Compounded semaglutide and tirzepatide formulations were used by telehealth and aesthetic providers during drug shortages.
• Patient demand for these medications outstripped supply of brand-name versions.

Purpose of the Study:

• To estimate the documentation rate of compounded semaglutide and tirzepatide in US primary care.
• To characterize differences between users of compounded versus brand-name formulations.

Main Methods:

• Retrospective cohort study using the American Family Cohort electronic health records (2021-2024).
• Included patients with documented semaglutide and/or tirzepatide use.
• Identified brand-name prescriptions from structured data and compounded use from clinical notes.

Main Results:

• 8.2% of 153,044 patients used compounded formulations, with increasing use over time.
• Compounded formulation users had longer therapy durations (10.0 vs. 7.8 months).
• Compounded users were more likely female, non-Hispanic White, nondiabetic, and from areas of lower socioeconomic deprivation.

Conclusions:

• Documented compounded semaglutide/tirzepatide use in primary care (8.3%) was lower than expected (est. 23%).
• This suggests significant patient access outside coordinated care.
• Gaps in documentation may pose safety risks due to lack of clinician oversight.