We combed Portland medical centers, clinics, and pharmacies looking for semaglutide, the active ingredient in the new, fabulously expensive, FDA-approved weight-loss shots that have reportedly fueled the swift slimmings of celebrities from Kardashians to Elon Musk. Is it easily available in Portland? Who's actually accessing it? Where? 

To be sure, it’s early days for semaglutide: long-term effects are unknown (side effects like gastroparesis and "adverse gastrointestinal reactions" have been reported, while the manufacturer claims that the drug can reverse serious cardiovascular illness). Originally approved as Ozempic for type 2 diabetes in 2017, the weekly injection makes patients feel satiated, and received FDA approval in 2021 as the anti-obesity drug Wegovy, after a study in which obese patients lost an average of 14.9 percent of their body weight in 68 weeks. It's a financial juggernaut: the stock price of manufacturer Novo Nordisk has more than tripled since 2020, and riches from the medications are reportedly fueling the economic growth of Denmark. 

The medication is officially intended for clinically obese patients (body mass index, or BMI, over 30), or with a BMI over 27 and a weight-related health condition. So far, diverse groups that arguably most need the medication have found their access curtailed. Yet strong demand is coming from people who do not meet those requirements and simply want to lose 10 to 50 pounds. As comedian Chelsea Handler recently explained, “My anti-aging doctor just hands it out to anybody.” 

How is this playing out in Portland, where losing weight for aesthetic purposes has long been a non-priority? Handouts are not forthcoming. Nonobese Oregonians seeking svelter figures are likely to hit dead ends at reputable medical centers, which are historically cautious and slow to adopt Hollywood and Manhattan’s trendier, FDA-approved, nonessential treatments. A visit to Oregon Health & Science University, for example, will probably net a responsible practitioner enforcing the medication’s BMI requirements, and unwilling to prescribe it “off label” to a patient who is not clinically obese. For the quarter of Oregonians who do qualify as obese, treatment is often not covered by insurance. Jonathan Purnell, an endocrinologist at OHSU, says that 90 percent of his patients who take the drug pay out of pocket. Wegovy’s list price is over $16,000 per year. 

The story OF SEMAGLUTIDE IN PORTLAND might end here: no prescribing doctor, no prescription, no medication. Yet a loophole has emerged: massive consumer demand pushed semaglutide onto the FDA’s shortage list, allowing state-regulated “compounding pharmacies”—7,500 pharmacies nationwide that mix their own medications—to produce chemical copies for far below brand price. As a result, compounding pharmacies nationwide began meeting much of the demand for semaglutide, though the FDA warns that some slightly different compounds “have not been shown to be safe and effective,” and are not evaluated by the FDA. 

This has opened the floodgates for prescribing practitioners at medispas and mail-order services to provide the medication. Purnell firmly advises against versions made by compounding pharmacies. “Bad idea; you don’t know what’s in them,” he says, though he is sympathetic to patients’ plight, noting that “bias in the medical community” prevents some doctors from prescribing proven drugs. Fat shaming may be “the last accepted form of discrimination in our society,” he says. 

Local compounding pharmacies reported receiving daily calls about semaglutide. “Nobody I know of compounds it in Oregon,” says Aaron Bohn, pharmacy director at Community Compounding Pharmacy in Lake Oswego. “Florida and Texas are the Wild West of compounding; I don’t know how they get away with it.” As of this writing, a handful of states have banned compounded semaglutide; Novo Nordisk has begun suing compounding pharmacies and clinics for infringement and unlawful sales. 

Portland medispas see a plus-sized market gap. These typically small, for-profit companies often provide beauty and wellness treatments, frequently under the supervision of prescribing naturopaths or nurse practitioners. BioLounge, a Slabtown health clinic that offers services like “30-day hormone detox,” sells a three- to six-month semaglutide program for a $250 consultation, $200–350 per bottle plus $175 follow-ups at six weeks and every three months. Aura Aesthetics, a Beaverton medispa offering injectables and beauty treatments by a nurse practitioner, advertises a four-month “weight-loss treatment program” geared toward losing 15–20 pounds, for $2,800, and $375 a month thereafter. 

Marcea Wiggins, a naturopathic doctor who owns Santé Aesthetics & Wellness, in Northwest Portland, co-runs a 68-week supervised weight-loss program, charging $400 for an initial consult, and depending on the dosage, $1,200–2,000 for three months of compounded weigh-loss drugs, including regular monitoring and check-ins. “It’s so refreshing to see a long-term treatment option, instead of just a quick drug fix to drop 20–30 pounds,” she says.

Go online, and the price drops more. A mail-order service called Henry, which offers a handful of medications like testosterone, ships semaglutide for $297 a month, which includes telehealth consultations, though users complain that appointments are booked weeks out, while payment starts immediately. 

The price tag may lower through mainstream medical providers: Oregon’s public employees’ benefit board, which oversees health insurance for 136,000 people, has recommended that its insurers cover weight-loss drugs by 2024, partially reasoning that obesity disproportionately impacts minorities, and to not cover treatment would be discriminatory. State Rep. Rob Nosse, who serves on the board, says that patients are “tired of paying the rapacious prices that these companies charge,” though notes that in this newfangled world of weight-loss drugs, he can’t predict the outcome.