Most people recognize the brands selling GLP-1s, TRT, peptides, and hormone therapy. Household names like WeightWatchers, Ro, and Hims/Hers are commonplace. They know the telehealth company. They know the logo. They know the monthly subscription.
They usually have no idea who actually made the medication.
That feels backwards to us.
The pharmacy, not the brand, is the company manufacturing the drug that gets injected, and it’s also the piece of the puzzle that’s regulated by the Food & Drug Administration (FDA). The pharmacy has its own FDA inspection history, its own compliance record, and sometimes its own enforcement actions. Those records are all public, but they’re rarely part of the conversation, and definitely not part of the marketing.
We reviewed every compounding pharmacy currently tracked by Vial.
Surprisingly, nearly half carry an FDA enforcement action.
Specifically, 22 of the 47 pharmacies in our index have received an FDA enforcement action. Twenty are warning letters. Two are FMD-145 inspection classification letters. More than half of those actions were issued during 2025 or 2026, which seems to reflect the FDA paying much closer attention to the online GLP-1 and compounded injectable market than it was just a few years ago.
That number surprised us. Then it stopped being surprising...
Once you start reading inspection reports, the pattern becomes difficult to ignore.
What an FMD-145 letter is, and why it matters
Most people have heard of an FDA warning letter. Almost nobody has heard of an FMD-145.
They probably should get familiar with it.
An FMD-145 is issued after an FDA inspection and communicates the agency’s final classification of that inspection. Facilities are categorized as NAI (No Action Indicated), VAI (Voluntary Action Indicated), or OAI (Official Action Indicated). That last designation is the one nobody wants because it means inspectors found problems serious enough to warrant official regulatory action.
It’s one of the few documents that tells you, in fairly direct language, how FDA inspectors viewed the condition of a manufacturing facility.
For anyone trying to understand where a compounded medication came from, that matters.
Consumer brands frequently outsource production to third-party compounders. Patients see the brand. Regulators inspect the pharmacy. Those are often two different companies, and unless someone connects the dots, the inspection history stays buried in an FDA database that few patients will ever search.
The numbers
| Measure | Count |
|---|---|
| Compounding pharmacies in the Vial index | 47 |
| With a verified FDA enforcement action | 22 (47%) |
| Warning letters | 20 (18 active, 1 resolved, 1 closed) |
| Active FMD-145 letters | 2 |
| Actions dated 2025 or 2026 | 13 |
| Earliest to latest action | February 11, 2019 – April 7, 2026 |
| Also carrying an active OIG exclusion | 1 |
| Historical OIG name matches excluded as unverified | 2 |
Every enforcement action is linked directly from that pharmacy’s profile in the Vial Compounding Pharmacy Directory back to the original FDA source documentation.
Why is the percentage so high?
Part of it is probably selection bias.
Vial doesn’t attempt to index every neighborhood compounding pharmacy in America. We focus on pharmacies supplying the rapidly growing online market for GLP-1s, peptides, testosterone, and hormone therapies. That’s also the exact part of the industry receiving some of the FDA’s closest attention.
Large sterile compounding facilities shipping injectable medications nationwide naturally attract more inspections than a local pharmacy filling a handful of compounded prescriptions each week.
But 47% is still a remarkably large share of the supply chain.
It’s too large to dismiss as coincidence.
But it’s equally important not to overstate what these records mean. An FDA warning letter is not a shutdown order. It doesn’t automatically mean the medication sitting in your refrigerator is unsafe. It means inspectors documented conditions they believed required correction. Sometimes those issues are fixed quickly. Sometimes they aren’t.
The records are public. The hard part isn’t finding them.
The hard part is knowing which pharmacy to search for in the first place.
Our companion Pharmacy Disclosure Study found that roughly 94% of telehealth providers never identify the pharmacy filling their prescriptions. Without that one missing piece of information, patients can’t reasonably look up FDA warning letters, inspection classifications, OIG exclusions, or anything else. They can’t verify what they were never told.
Data: Vial provider index snapshot, reviewed 2026-07-08. Corrections: hello@getvial.com. How enforcement signals are matched and scored: Vial methodology.