Semaglutide, tirzepatide, and compounded weight-loss telehealth.
The FDA lifted the semaglutide shortage in February 2025 and the tirzepatide shortage in December 2024, which pulled the 503A safe harbor out from under most compounded GLP-1 telehealth platforms. Stripe, Square, and PayPal issued blanket terminations across the vertical starting in Q1 2025. There are still direct acquirer paths for compounded and FDA-approved GLP-1 platforms when the clinical chain, LegitScript posture, and pharmacy fulfillment are documented at boarding.
Three overlapping reasons. FDA declared the semaglutide shortage resolved February 21, 2025 and tirzepatide December 19, 2024, removing the 503A safe harbor most compounded platforms operated under. Visa VAMP threshold tightened to 0.9 percent combined dispute-plus-fraud ratio in 2026, and weight-loss telehealth structurally runs 1.5 to 3 percent chargeback rates. Automated marketing-copy review flags GLP-1 platforms once landing pages surface therapeutic claims.
FDA-approved GLP-1 only (Wegovy, Zepbound, Ozempic, Mounjaro under label) with 5 to 8 percent rolling reserves. Compounded GLP-1 with individualized-prescription documentation and 8 to 15 percent rolling reserves. Hybrid FDA-approved plus documented-exception compounded, boarding at 6 to 10 percent.
MCC 5912 for pharmacy-of-record. MCC 8011 for medical-practice-of-record. MCC 8099 for consultation-billed models. MCC 5734 and 5967 are the misclassifications that flag accounts post-boarding.
2,150 dollars annually plus 975 dollars for the initial telemedicine review. Certification runs 4 to 8 weeks with a complete packet.
Tokens do not transfer. Re-tokenization at the new gateway with Visa Account Updater and Mastercard ABU recovers 65 to 80 percent of pre-termination MRR within 30 days, plus 5 to 10 percent recovered in months 2 and 3 via smart retry.