A reader sent me a denial letter from her US insurer. They covered Wegovy. They didn't cover Mounjaro. Same patient, same diagnosis, same prescriber. The reason isn't medical. It's a contract that nobody mentions.
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.
Pure Rawz, Limitless Life Nootropics, Amino Asylum, Empower Pharmacy, and Strive Pharmacy scored on Panya's public 11-signal rubric. The headline finding: Amino Asylum is offline after a June 2025 FDA enforcement action. The compounders carry active regulatory weight. The research-chem channel has structural ceilings that the COA cannot fix.