EXCLUSIVE: Doctor Threatened With Financial Blackout Over Compounded GLP-1

A doctor, speaking on the condition of anonymity with On The Pen, recently received a letter that should send a chill down the spine of every patient and provider in this country. It did not come from the FDA. It did not come from a state medical board. It came from the company that manages their electronic medical records, on behalf of her payment processing partner.

The message was direct. Please confirm whether you are prescribing compounded GLP-1 medications, or offering compounded versions of the name brand products. If so, there could be a pause in payment processing.

This was not about safety. It was not about regulation. It was a threat, issued through financial channels, with the clear intent of influencing a doctor’s medical decisions by putting their entire practice at risk.

And here is what makes it even more outrageous: the letter made no distinction whatsoever between 503A and 503B compounding.

That matters.

503A pharmacies are legally allowed to create custom formulations based on a patient’s individual needs. These are not mass produced drugs. They are prescriptions written by a licensed provider, filled by a licensed pharmacist, under a structure that has been legal and protected for decades.

503B pharmacies, on the other hand, are outsourcing facilities that can only produce compounded versions of a commercially available drug when there is an FDA-declared shortage. That shortage, in the case of tirzepatide, was declared over in December 2024.

But this doctor’s practice is not a 503B manufacturer. She is not a pharmacy. She is a provider. She writes prescriptions. What this letter does is effectively punish her for writing prescriptions that are still legal under federal law.

And it is all being enforced not through legal action, but through billing pressure. Through financial arm-twisting. Through veiled threats sent by faceless corporate entities who are now deciding what a doctor can and cannot prescribe.

We do not yet know who is pulling the strings here. Is this the FDA quietly pressuring intermediaries to enforce their stance without having to fight more lawsuits? Is this Eli Lilly or Novo Nordisk leveraging their partnerships and market dominance to wipe out the last remaining competition to branded drugs? Or is this just the inevitable result of a system where medical decisions are now made in boardrooms?

Either way, this cannot be allowed to continue.

This doctor is not ready to go public. And we respect that. The blowback could be immense. The disruption could be career altering. But this provider is not alone. If this is happening to them, it is likely happening to others.

So we are putting out the call.

If you are a provider and have received a letter like this, or know someone who has, reach out to On The Pen. If you are a patient, know that your options are being stripped away not because of science, not because of policy, but because of pressure. Invisible, well funded pressure.

If you would like to reach out to me confidentially to share your experience, please send an email to dave@onthepen.com

You’ve heard it said, democracy dies in darkness. So does medical freedom. The only way this ends is if we shine a light on it.

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