For customers using a telehealth website to get cheaper versions of popular obesity drugs, the low prices turned out to be too good to be true.
Customers of Zappy Health tell NPR they were drawn to the online provider by its low prices, its lack of subscription fees and its handy smartphone app with a chat feature for patients to talk to one another during their weight-loss journeys.
The Zappy chat was ultimately how many customers first learned that Ousia Pharmacy — one of several pharmacies that supplied Zappy with compounded obesity drugs — didn't have a required license, one that ensured the drugs were produced in accordance with safety and potency standards.
Compounded drugs that Zappy and other telehealth sites sell aren't generics. Instead, they're essentially copies of the name-brand drugs, made by specialized pharmacies. The Food and Drug Administration allows this kind of compounding during drug shortages.
Compounding pharmacies are regulated at the state level. Ousia, in Spring Hill, Fla., didn't have what's called a sterile compounding license. The obesity drugs made by compounding pharmacies are given by injection, so attention to sterile production is critical to avoid contamination that could cause infections.
Zappy didn't find out about Ousia's licensing problem until December and it ceased its roughly three-month relationship with the pharmacy on Dec. 13, Zappy's founder, Dr. Michel Choueiri, told NPR in an email after a broadcast version of this story aired. He called Zappy "the biggest victims of this situation" and said that it has left the company in "severe financial and reputational ruin."
Some Zappy customers NPR spoke with found out about the problem on Reddit.
Laura Franzese, in Portland, Ore., learned about the licensing problem after spending $1,000 on a bulk order of tirzepatide from Zappy that arrived with Ousia labels. (Tirzepatide is the active ingredient in Eli Lilly's obesity drug Zepbound.) She'd been taking the drugs already, from a local provider, and called them "life-changing," but made the switch to Zappy hoping to save money.
"I bought three months' worth of medicine from this company," she says. Now she's afraid to use the drugs. "It was a big investment."
People active on Reddit told NPR that Zappy deleted the original user post in its app chat forum about Ousia's lack of the proper license. Choueiri says Zappy publicly apologized in the same forum and removed the post only while it was verifying the claim.
Ousia couldn't be reached for comment.
For many people who've turned to online telehealth companies to find compounded obesity drugs, they say they would prefer to take the brand-name drugs, but it isn't an option for them. They say Novo Nordisk's Wegovy and Eli Lilly's Zepbound aren't covered by their insurance. And paying the full sticker price — more than $1,000 a month — is too expensive.
Compounding pharmacies fill a gap for patients like this. They've been a part of the health care landscape for decades, preparing custom medicines for people who need them, but booming demand for weight-loss drugs — as well as resulting brand-name shortages — has brought them into new prominence.
Even some people who have health insurance coverage for obesity drugs say they turn to telehealth and compounding because they couldn't reliably find the brand-name drugs in local pharmacies.
But the situation with Ousia shows the pitfalls of navigating the world of online compounded obesity drugs, which includes legitimate businesses as well as some unlicensed or unregistered ones. It can be difficult for consumers to tell the difference or trust the quality of the obesity drugs they're buying.
Looking for a deal, finding confusion
For Zappy customers, the problems came as a surprise.
Eric Bishop, an IT professional in Salt Lake City, was looking for a way to buy more tirzepatide at once, fearing that the official end to the Zepbound shortage would mean the end of the compounded version. He had been filling his prescription at a local brick-and-mortar compounding pharmacy but turned to Zappy to buy a stockpile.
He didn't know which pharmacy would be fulfilling the order through Zappy until after he paid. "They didn't give me a choice," he says.
Bishop had just gotten his nine-month supply of tirzepatide, worth $2,700, from Zappy when users on the Zappy app blew the whistle on Ousia.
"That's when I started seeing things in the chat," he says of the app's patient forum feature. "So I bounced over to Reddit."
According to a complaint filed by the Florida Department of Health on Dec. 5, Ousia applied for a sterile compounding license in March 2024, but it was never granted. When state regulators inspected the facility later that year in August, they discovered that it was compounding medicines anyway. In addition, inspectors noted that Ousia was improperly storing drugs that needed to be refrigerated and not keeping proper records for drugs it dispensed.
The Florida Department of Health did not respond to requests for comment on this story. In an email to NPR, Zappy's founder, Choueiri, said the department failed to disclose Ousia's problem "in a timely manner."
Bishop couldn't believe what he was reading.
"I'm all of a sudden, you know, about ready to start taking my medication and I'm like, I now no longer have any confidence in what I have," Bishop says. "And I might either want my money back or I want a replacement for what I have."
Another Zappy patient, Nicole Drong, in Minneapolis, says she was surprised when vials marked "Ousia" arrived at her home. "I did not know the name of the pharmacy until I got a package. And I was like, 'Well, that's weird. I thought it was going to say 'Zappy' on it.'"
Then in December, she noticed the Zappy app was sending her a lot more notifications than usual from the patient forum. Word was out that Ousia didn't have a sterile compounding license.
"I kind of feel stupid, I guess," Drong says. She says she was " just blindly putting trust in this pharmacy. … How often do you ever have to double-check your medication? Like, if I go get my antidepressants from Walgreens, do I have to double-check to make sure there's not anything extra in my bottle of pills?"
Choueiri, Zappy's founder, says patients have the opportunity to cancel once they learn which pharmacy is fulfilling their order, and it has responded to patient feedback to be more transparent with customers up front.
Confusion and no refunds
The bureaucratic details of licensing can be opaque to consumers. But these licenses matter, says Scott Brunner, who leads the trade group of compounding pharmacists, the Alliance for Pharmacy Compounding. Ousia pharmacy wasn't a member, he says.
He called not having a sterile compounding license where one is required "egregious."
"I would not take a drug that has been dispensed to that patient from a pharmacy that has been found to be in violation of its state license law," he says.
Choueiri did a TikTok live on Jan. 15, where he said Zappy was "made aware of the complaint" and wanted to let the process play out. He added that his family members were taking the Ousia medications too and that he was also fielding questions from them.
"It's not counterfeit?" he said, reading questions as they came in. "Yeah, no. No, it's not counterfeit. Um no, no. The short answer is no, but I'm not going to go down the legal litigation here."
At first, Zappy told people they could fill out a Google form to get a refund or replacement vials, but customers tell NPR that nothing has come of it yet. For a time, Zappy also told customers to ask Ousia for a refund instead.
On Jan. 31, 2025, Ousia voluntarily relinquished its regular pharmacy license, Florida records show. Now, the pharmacy's phone number goes to voicemail and its website is down.
Asked what Zappy is now advising its patients to do with their Ousia vials, Choueiri wrote to NPR: "As always, Zappy is a platform that connects patients to affordable care but does not replace the role of medical providers or pharmacists. Decisions about medication use should always be made in consultation with a licensed healthcare professional, and defer these conversations to the providers of care."
Choueiri is a medical doctor. On its website, Zappy touts that its weight-loss plans "are personalized by doctors."
According to Zappy's terms of service, the doctor-patient relationship isn't between Zappy and its users. It's between the providers who do virtual appointments and prescribing on Zappy and the Zappy customers. And the company "disclaims any liability for the medical or pharmaceutical services provided through its platform."
Spotting red flags
While the Ousia situation is unfortunate for the patients involved, it's an example of the regulatory system working the way it's supposed to, says Brunner.
The National Association of Boards of Pharmacy says it's hard to know how many online retailers are offering compounded obesity drugs that are made without the proper license or registration. State pharmacy boards oversee most compounding pharmacies around the U.S., but if a pharmacy isn't registered or licensed in a state where it's shipping products, it can be hard to track.
Betty Jones, compliance senior manager of the accreditation and inspection programs at NABP, says consumers can protect themselves by looking out for red flags. For instance, you should always know which pharmacy is filling your prescription, and they're required to provide counseling.
"If they're not providing you that offer of patient counseling or you're calling into that pharmacy and they don't allow you to, you know, be progressed to a pharmacist where you can ask questions, that would be something that I would call a red flag."
She says prices that are too low and pharmacies that don't ask for a prescription should also trigger alarm bells.
Potential customers should also be able to verify that a pharmacy is licensed, since these are public records available online in most states. And to dispense to you, that means the pharmacy needs to be licensed in your state, too — not just the one where it's located.
Bishop, the Zappy customer in Salt Lake City, says he helped organize a Facebook group for people to help them figure out how to get their money back. Customers say they haven't been able to get refunds.
Choueiri says Zappy's low prices mean it doesn't have much money left over after paying pharmacies and providers, and "Zappy does not control the funds necessary to issue refunds."
The Facebook group has grown to more than 600 people. Its members have even helped report new information to the Florida Department of Health, Bishop says. "We're just a community just kind of helping each other out."
Many of the group members' banks initially declined to reverse their credit card transactions with Zappy. That has started to change since Ousia relinquished its license, Bishop says. "Actually, some banks are even opening disputes that they closed previously."
Zappy is still advertising to customers, but Bishop says he isn't buying from the company again. He's back on compounded tirzepatide from his local pharmacy.
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