The Start-Ups Turning Ozempic Into the Next Botox

A month of Wegovy, one of the new class of remarkably effective GLP-1 weight-loss drugs, can cost over $1,300, if you can get it. Alchemy 43, an upscale medspa chain with 10 locations across California, New York and Texas, says it has an unlimited supply of a medicine that offers the same active ingredient, at less than a quarter of the price.

Alchemy 43 set up its new GLP-1 programme, which it began offering in October, with guidance from weight-loss specialist Dr. John Love. Customers won’t be getting the brand-name drug touted in the press or TikTok, but rather raw ingredients sourced via compounding pharmacies. Alchemy 43 sells semaglutide, the active ingredient in Wegovy and Ozempic, and tirzepatide, the active ingredient in Mounjaro and Zepbound.

The recent innovation in GLP-1 drugs – which stands for glucagon-like peptide 1 – has been considered to be a revolution in the treatment of obesity, shown in studies to reduce around 15 percent of body weight and decrease the risk of obesity-related health issues like cardiovascular and heart disease. But it has been the use for more aesthetically motivated weight loss that has captivated the public, as rumours swirled about celebrities paying upwards of $1,000 a month out of pocket to look slimmer for the red carpet.

GLP-1 drugs are opening Alchemy 43 to a whole new group of customers, said founder Nicci Levy, who takes tirzepatide herself, showing off her personal weight loss progress on social media. She estimates that the injections have helped her lose 20 pounds. (Prior to this, Levy took Ozempic soon after giving birth to her first daughter, but couldn’t handle some of its side effects like nausea.) Since launching its weight-loss product last fall, 25 percent of customers who received injections were new to Alchemy 43′s business, which also offers Botox, fillers and facial treatments, Levy said.

Medspas and telemedicine start-ups are also at the centre of an emerging debate over where the lines should be drawn around uses of GLP-1s. Some see weight-loss drugs following the same trajectory as Botox and other treatments, which migrated from the dermatologist office to spa-like settings. Others are wary of blurring the lines between a still-emerging field of medicine and cosmetic treatments.

Tight supplies of brand name medication have further complicated the situation. The US Food and Drug Administration has discouraged the use of compounded weight-loss drugs, noting it “does not review compounded versions of these drugs for safety, effectiveness, or quality.” The agency has shot off stern letters to telemedicine providers it said were making illegal claims about the drugs.

Supply chain fluctuation hasn’t stopped businesses as varied as WeightWatchers, Ro and Equinox from finding a way to connect themselves to GLP-1s.

Mixed Messages

Levy said that the prescription of semaglutide injections at Alchemy 43 includes an initial exam to see if someone qualifies – those with specific medical conditions or an underweight BMI do not – as well as weight monitoring and check-ins with each weekly shot.

“It really does require medical monitoring to make sure that you’re getting great results and that you’re minimising any side effects,” she said. Among her customers, she has noticed that people are looking for a broad range of weight loss amounts, which could be between 20 to 40 pounds or even smaller goals.

“Certainly, I’ve had plenty of people approach me and say, ‘Hey, I have this stubborn five pounds that I just can’t seem to get rid of … Would this medication be an option for me?’” said Riley.

For non-cosmetic providers, that request would be met with a firm no.

“I wouldn’t support it for cosmetic use. So if it’s to fit into a dress or to lose five or 10 pounds, I would say that the risk outweighs the benefit of taking the medicine,” said Dr. Rekha Kumar, an endocrinologist and the chief medical officer of weight-loss telemedicine start-up Found. “The medicine hasn’t been around long enough to probably just give it to totally healthy people.”

Found offers brand name GLP-1 medications when they’re available, though Kumar said supplies vary from “hard to get to impossible to get.” The company offers additional weight-loss treatments, including behavioural coaching and other medications associated with weight loss.

Hims and Hers, meanwhile, has not launched any GLP-1 prescriptions at all, citing supply chain instability. It opted to instead establish a weight-loss programme with other medications like Bupropion and Metformin that can be used off-label for weight loss in hope that GLP-1 drugs can be added in the future when more readily available. On the company’s recent first-quarter earnings call, CEO Andrew Dudum said that there is “probably more to come in the future” for compounded GLP-1 products.

Ozempic-Adjacent Wellness

Companies not in the injection business have also found ways to make the most of the GLP-1 opportunity.

Equinox, for example, recently launched a training programme for customers to stay toned as they see weight loss on GLP-1 drugs. Beauty and supplement brands like Veracity are positioning themselves as injection-free Ozempic alternatives. Brands such as Thorne sell products containing berberine, which has been dubbed “nature’s Ozempic” by some online wellness gurus.

Supplement brand Pendulum, founded by Colleen Cutcliffe, who has a PhD in biochemistry and molecular biology from Johns Hopkins, sells a supplement called “GLP-1 Probiotic” that promises to “increase GLP-1 naturally.”

“It could be for people who don’t really want to go on the drugs … and it could be for people who are coming off of them,” said Cutcliffe. The FDA does not evaluate claims made by supplement brands or regulate them as it does with drugs.

Not Going Away

While it’s unclear how and where people will get access to GLP-1 drugs, experts agree that demand isn’t going anywhere.

With an earlier generation of GLP-1 drugs that had similar, but much smaller results, “I would really have to twist people’s arm to get them to take it,” said Dr. Kumar of her obesity patients. “People were not excited to take it. They didn’t want to inject it.”

But the rise of marketing of the drugs for weight loss, including through progress videos made by influencers taking GLP-1s, has caused public interest to explode. A special report on Ozempic by Oprah, who has discussed her use of the drug for weight loss, has shed more light on their widespread use. After the 2021 introduction of Wegovy specifically for obesity, more people who met the medical qualifications had access through insurance coverage.

When that triggered a shortage of the drugs, compounding pharmacies jumped at the opportunity. While not considered generics, the off-brand injections function in a similar – albeit unregulated – way, with more affordable prices and wider availability.

GLP-1 drugs’ potential to become as entrenched as Botox in the world of medical aesthetics is unclear. The price point may jump dramatically in the future. While the brand-name drugs are still on the FDA shortage list for an indefinite period of time, their removal will mean the end of being able to legally supply the compounded semaglutide injections. Similar drugs are in the pipeline from other drug companies, but cheaper generic versions are years away.

“It’s going to continue to go up as we learn more benefits. We’ve shown a reduction in heart attack, stroke and cardiovascular death. We’re learning about an improvement in kidney function, fatty liver disease, potentially addiction and benefits to fertility. The more we learn about the benefits of these medicines, I think demand will increase,” said Dr. Kumar.