Weight management is the most commonly added service line in this market and the one carrying the most exposure, because the ground moved underneath it in 2025.
What changed, and why your old model may not work
Tirzepatide came off the shortage list in October 2024 and semaglutide’s shortage was resolved in February 2025. The enforcement discretion that allowed widespread compounding ended in April and May 2025, and in April 2026 the FDA moved to exclude semaglutide, tirzepatide and liraglutide from the 503B bulks list. Narrow, patient-specific compounding may persist. Routine program-wide compounding does not, and a program still priced on it has a sourcing problem rather than a marketing one.
What a defensible program needs
- A licensed provider in the patient’s state performing and documenting a good faith exam before the first prescription — every patient, every time.
- A real clinical pathway: baseline assessment, contraindication screening, titration plan, follow-up intervals, and criteria for stopping.
- Lab work where the protocol calls for it, with an ordering provider and someone qualified to act on the result.
- Sourcing you can defend in writing — branded product, or a 503A or 503B relationship whose lawful basis you can state.
- Marketing that describes the program rather than promising an outcome.
Where it sits structurally
In most states the entity prescribing is not the entity selling the membership. A gym, med spa or online brand adding weight management is adding a clinical operation, and the structure question comes before the pharmacy question. In a fitness setting this is the single most common structural error we see.
What MDside provides
- Medical direction and, where the state requires it, the professional entity underneath.
- Licensed providers across the states you sell into, with capacity for volume rather than one physician doing favours.
- Good faith exams on a platform we built and run — intake, review, approve, decline or request more information, each one a documented clinical decision.
- Pharmacy routing and lab draws, with the sourcing basis stated up front.
- Protocol maintenance as the rules keep moving, which in this category they do.
Frequently asked questions
Can we still offer compounded semaglutide or tirzepatide?
Only on a narrow, patient-specific basis where a lawful pathway exists, and not as the default supply for a program. The shortage-era model has ended, and pricing built on it does not survive the change.
Do patients need labs before starting?
It depends on your protocol and the patient. Many programs draw a baseline panel; what matters is that the protocol says what is drawn, why, and who reviews it.
Can this run fully asynchronously?
For non-controlled weight-management drugs, generally yes, provided a licensed provider actually reviews the intake and documents a decision. An automated approval is not a clinical decision.
What about microdosing protocols?
Off-label dosing is lawful medical practice. Advertising a deliberately sub-therapeutic protocol for an unapproved purpose is a different question, and it is the advertising that creates the exposure.
General information, not legal or medical advice. Requirements differ by state and change often. Confirm your obligations with counsel licensed where you operate.