Cheap copycat Ozempic sounds too good to be true. It is, a scientist found.

Naturally, that’s spawned a wave of cheaper copycat drugs.

Researchers have watched nervously as the resulting gray market of so-called generic semaglutide has ballooned. Pharmacies are technically allowed to make their own versions of brand-name drugs under specific circumstances and with a prescription. But some websites are offering the drugs without a prescription, no questions asked.

It begs the question: What’s in the online versions of semaglutide, and how can consumers know what they’re getting or if it’s safe?

Cue Timothy Mackey, a professor at the University of California, San Diego, who has been studying the online market for counterfeit drugs for decades. He decided to buy some of these cheaper, more accessible weight-loss drugs himself and test them in a lab with a team of researchers.

Their results, published August 2 in JAMA Network Open, provide some of the clearest information we have to date on what is — and isn’t — in knock-off versions of Ozempic.

Some sites were scamming people out of money

Not all off-brands of semaglutide are illegal or necessarily dangerous. Popular telehealth companies typically make it easier for customers to obtain a prescription via online consultation and provide compounded semaglutide, which is cheaper than brand-name versions.

There are risks involved in this process, Mackey said. There’s less supervision than seeing a doctor in person, plus compounded medications are not FDA-approved and can have unpredictable additives. However, the pharmacies that fill these prescriptions are regulated and have some level of quality control.

Mackey’s team was specifically interested in what he called the highest-risk form of semaglutide — weight-loss drugs sold online without a prescription. They gathered samples of these products to test.

All the websites the researchers used to purchase and test the products appeared in the top results on mainstream search engines and have millions of visitors, according to an analysis of the site traffic, Mackey told Business Insider.

They found that half of the sites were advertising brand-name Ozempic, which cost between $190 and $360 for two pens plus delivery fees. Ozempic was in shortage when they conducted the study, and even doctors were struggling to get hold of the real drug via official means. Predictably, brand-name products never arrived. When the researchers followed up, they were asked to pay extra money — between $650 and $1,200 — to “clear customs,” but it was a fraud, the researchers found after contacting customs agencies.

Dangerous ingredients and concentrations

The other sites advertised generic semaglutide. They did deliver the product, albeit in a dubious form with inconsistent dosages.

For one thing, all the samples arrived in powdered form, requiring users to reconstitute it using special sterilized water before injecting it. (This practice is common for online sales of peptides, a popular category of fitness and antiaging supplements.) Only one of the products provided instructions on how to do this. Doing it wrong poses a serious risk of contamination, Mackey said.

All of the samples were advertised as 99% pure semaglutide. Testing revealed they were between 7% and 14% pure. The samples also provided higher doses of semaglutide than the label suggested — up to 39% more per batch — increasing the risk of overdose. Too much semaglutide can cause serious gastrointestinal side effects like vomiting, as well as dehydration, and acute pancreatitis, according to the FDA.

Mackey’s team also found that the products were likely research-grade semaglutide never intended for human use. The websites used creative marketing language and imagery to imply their products were intended for people, without saying it directly.

One of the products also contained high levels of endotoxin, a harmful substance found in bacterial cells (although no live bacteria were seen).

Poison-control centers saw a massive spike in semaglutide overdoses last year, CNN reported. Based on his team’s results, Mackey is not surprised. “That’s a clear sign of a product not intended for human use,” Mackey said. “The bottom line there is that there are discrepancies in their manufacturing process.”

Counterfeit Ozempic isn’t going away, so buyer beware

Mackey said a wave of telehealth services and online providers have made it easier than ever to get prescriptions and medications online. But it’s also harder to spot a scam now than when everything came from brick-and-mortar pharmacy after a face-to-face with a doctor.

“The average user is more confused about how to get this legitimately,” he said.

Illicit websites can be convincing, but if they emphasize their weight-loss medications don’t require a prescription, that’s a major red flag, according to Mackey.

Another warning sign is cost. Brand-name semaglutide can set you back more than $1,000 a month. If a product is listed online for significantly cheaper, you’re likely to get what you paid for — an inferior or counterfeit product.

“If providers are advertising at $200, that’s because they’re not real, but still they’re advertising at a lower price point and that’s going to be attractive to consumers,” Mackey said.

Despite the risks and the FDA’s efforts to crack down on scammers and shady products, the market for weight-loss drugs is just too big, too new, and too messy to expect counterfeiters will stop anytime soon.

“It’s going to be something endemic in our supply chain because of how popular the market is,” Mackey said. “It’s kind of an arms race here.”