Online prescribing and pharmacy services offer genuine convenience advantages over traditional healthcare, but they also create new risks. The two primary concerns are counterfeit medications (products that do not contain what they claim) and substandard medications (products that contain the correct active ingredient but at incorrect concentrations, with inadequate sterility, or with contamination). Understanding how to verify what you receive reduces exposure to both risks.
The Counterfeit Medication Problem
Counterfeit medications are most prevalent in markets where supply chains are poorly controlled and where high-cost medications create strong financial incentives for fraud. GLP-1 medications, with brand-name prices above $1,000 per month, have become a counterfeit target in the post-shortage environment.
The FDA maintains an active counterfeit alert database that includes alerts about specific counterfeit medications identified in the market. Reviewing this database before purchasing any medication from an unfamiliar source is a straightforward safety check.
The most common entry points for counterfeit medications in the US:
Offshore websites posing as US pharmacies: Sites that appear to be US pharmacies but fulfill prescriptions from overseas facilities without DEA registration or US pharmacy licensure. These are unambiguously illegal and the products have no regulatory oversight.
Social media sales: Semaglutide, tirzepatide, and testosterone are now sold through Instagram, Telegram, and other social platforms outside any medical or pharmacy context. These products have no chain of custody verification and pose the highest risk.
Unlicensed compounders: Compounding pharmacies that are not licensed in any state or that operate outside regulatory bounds. These are distinct from licensed 503A and 503B pharmacies.
Verifying Your Pharmacy
State pharmacy license: Verify the pharmacy’s license at the state board’s online lookup tool for the state where it is physically located. An unlicensed pharmacy is not a legitimate source.
NABP verification: The National Association of Boards of Pharmacy (NABP) maintains the Verified Internet Pharmacy Practice Sites (VIPPS) program. VIPPS-accredited pharmacies have been audited against federal and state requirements. Checking nabp.pharmacy confirms whether an online pharmacy holds this verification.
FDA outsourcing facility list: For 503B compounding pharmacies, the FDA registered outsourcing facilities list is the authoritative source. A pharmacy claiming 503B status that is not on this list is making a false claim.
DEA registration: Any pharmacy dispensing controlled substances (testosterone is Schedule III) must hold a DEA registration. DEA registrations can be verified through the DEA’s online registration lookup.
What to Check When Medication Arrives
For injectable compounded medications (semaglutide, tirzepatide, testosterone):
Appearance: Clarity of the solution. Injectable medications should be clear and colorless (testosterone in oil suspension is the exception, it is clear to slightly yellow, oily). Cloudiness, particles, or unusual color are red flags.
Labeling: Proper labeling includes the patient name, prescriber name, pharmacy name and address, drug name and concentration, lot number, beyond-use date, and storage instructions. Missing or incomplete labeling is a concern.
Packaging integrity: Vials should be sealed with no evidence of tampering. Syringes and pens should arrive in intact, sealed packaging.
Certificate of analysis (CoA): Reputable 503B facilities provide batch-specific certificates of analysis showing testing results for potency, purity, and sterility. Ask your pharmacy for the CoA for your batch. This document confirms third-party testing of the actual product you received.
What to Do With Suspected Counterfeit Medication
If you suspect the medication you received is counterfeit or substandard:
- Stop using it immediately
- Report to the FDA’s MedWatch program (fda.gov/medwatch)
- Report to the pharmacy that dispensed it and to the prescribing platform
- If health effects have occurred, seek medical care
For the regulatory framework governing compounding pharmacies, see The FDA and Compounding Pharmacies: A Plain-English Guide.
