47% of the compounding pharmacies in our index have an FDA enforcement action

Most people are familiar with brands such as WeightWatchers, Medvi, Hims/Hers, etc. But what most people aren’t familiar with are the companies behind the scenes who actually manufacture the compounds you’re prescribed. We decided to take a deep dive into Vial’s pharmacy index, the companies responsible for physically compounding the semaglutide, peptides, and testosterone, and found some surprising facts.

Nearly half of the pharmacies we track have a federal enforcement action by the Food & Drug Administration (FDA). An FDA federal enforcement action against a pharmacy is an official penalty or legal step taken when a pharmacy breaks the Federal Food, Drug, and Cosmetic Act (FD&C Act). These actions attempt to protect you from unsafe or incorrectly made drugs.

Specifically, 22 out of 47 tracked pharmacies carry warnings. Most are just that, warning letters, although two are FMD-145 compliance forms issued after inspections. An FMD-145 letter is a formal notification issued by the U.S. Food and Drug Administration (FDA) that informs a manufacturer or facility of the final classification of an FDA inspection. As more and more people turn to online providers, the FDA enforcement momentum appears to be speeding up. More than half of these actions are dated 2025 or 2026.

Why you should care about an FMD-145 letter

Early Warning System for Risks

• Exposes the severity of violations: The letter explicitly labels the facility as NAI (safe/compliant), VAI (minor violations), or OAI (severe violations).
• Predicts future product quality: If a company receives an OAI (Official Action Indicated) classification via an FMD-145 letter, it alerts consumer advocacy groups and the public that the company’s products carry a higher risk of contamination, defects, or future recalls.

Empowers Informed Buying Choices

• Helps to bridge the gap between brand and factory: Many consumer brands outsource their manufacturing to third-party facilities. The FMD-145 data allows investigative journalists and consumer groups (and companies like Vial) to trace exactly whereproducts are made and report on those specific facilities’ sanitation and safety standards.
• Holds companies accountable:When consumers, retailers, and supply chain buyers can see a facility’s official compliance status, it forces manufacturers to maintain high safety standards to protect their market reputation.

The numbers

Each counted action is linked from that pharmacy’s profile in the compounding pharmacy directory to its FDA source page.

Why is the percentage so high?

Part of it is just the nature of the business. Vial’s index targets pharmacies focused on the exploding online GLP-1 and peptide space. It’s the exact market the FDA has been coming down hardest on with inspections. Plus, a massive facility shipping sterile injectables nationwide simply draws more heat than a quiet local shop. But 47% is a massive chunk of the supply chain. It is definitely not a rounding error.

To be completely fair, a warning letter isn’t a factory shutdown. It does not automatically mean the specific vial in your fridge is bad. It just means inspectors found problems that required fixing. But while the records are sitting right there in the open, FDA letters, OIG exclusions, DEA actions, they are easily overlooked since there is no incentive for the actual brands to offer this transparency.

The real headache is actually upstream. A patient can’t even check these records if they want to. Our companion study showed that roughly 94% of telehealth provider sites refuse to name their partner pharmacy... which makes tracking anything virtually impossible.

Data: Vial provider index snapshot, reviewed 2026-07-08. Corrections: hello@getvial.com. How enforcement signals are matched and scored: Vial methodology.