Five months after the FDA closed enforcement discretion on 503A and 503B compounded tirzepatide and semaglutide, the US compounded-GLP-1 landscape has consolidated, contracted, and fragmented. The April 30 scorecard recap captured the snapshot. This is what changed in the four weeks after.
What actually shifted in the last 60 days: Foundayo (orforglipron) approved early under the National Priority Voucher, oral Wegovy 25mg shipping, FDA proposes excluding tirzepatide from 503B bulks, RFK pulled 14 peptides off Category 2, survodutide phase 3 obesity readout. Routing impact for each.
Retatrutide, orforglipron, CagriSema, survodutide, MariTide, pemvidutide. Where each one sits in phase 3, the readout window, the mechanism, and what each approval would shift for routing decisions today. Bleeding edge of the science, conservative on the rating.
RFK and HHS moved most restricted peptides back to Category 1 in early 2026. Here is what that actually does, and what it does not.