This Works—So Why Are They Trying to Take It Away?

In my first post, I shared how I got started with a GLP-1 after insurance denied coverage. In the second, I explained what compounding pharmacies are and why they’re cheaper.

This post is about something different.

Why all of this is under pressure right now. Why does it feel like it’s being taken away?

You can feel it.

The more people start finding out about compounded GLP-1s, the more pushback there is.

Pharmaceutical companies don’t like when people go outside the system and spend their money somewhere else. And regulators? They step in when something grows this fast, asking questions about safety, sourcing, and whether the rules are being followed.

And here’s the part that matters to me:

They aren’t getting $1,700 from me.
They aren’t getting $300.
They aren’t even getting $200.

I can’t afford that. Most people can’t.

If compounding pharmacies didn’t exist—if they didn’t make these medications available—then I wouldn’t be taking them at all.

Not unless prices came back down to reality.

And here’s the part that really gets me—they want to take this option away and push everyone back through the same system. You have to schedule a doctor’s visit—there’s time and money. Then wait for approval. Then deal with insurance. Then go to the pharmacy. Pay again. Drive there. Wait in line. All of it adds up—time, stress, gas, money. And after all that? You still have to take their dose, their schedule, their one-size-fits-all approach. You have no control. Compare that to having something show up at your door, being able to manage your own dosing, and actually making it work for your life. That difference matters.

And honestly, it doesn’t take a genius to see why this is happening.

On one side, you’ve got companies like Eli Lilly and Company. They built these drugs. They spent years and billions getting them approved by the U.S. Food and Drug Administration.

But here’s the reality for people like me:

You’re told, “This medication could help you.”
And then right after that—“You can’t have it.”

Insurance denies it.
The price is $1,500… $1,700 a month.

So what are we supposed to do?

Just sit there and stay unhealthy?

No.

We find another way.

And when we do—when we finally find something that works and we can actually afford—it changes everything.

And that’s when the pressure starts.

Because now it’s not just about the medication anymore.

It starts to feel like control.

Like they don’t want us to have control over what we put in our bodies.
Like they don’t want us to be able to afford it unless we go through their system, on their terms, at their price.

And yeah—maybe that’s not how they’d say it.

But that’s how it feels on this side of it.

So now you’ve got the U.S. Food and Drug Administration stepping in more.
You’ve got pharmaceutical companies protecting their patents and their market.

Pressure from both sides.

And right in the middle?

Us.

People who are just trying to get healthier without going broke doing it.

And this is the part that frustrates me the most:

The system works great… if you can afford it.

If you can’t?

You’re out.

So when something like compounding gives people a way in—a way to actually take the medication, to control dosing, to make it work financially—you’re going to see people take it.

Of course they are.

This isn’t about trying to game anything.

It’s about not being locked out.

Is compounding perfect? No.

There are trade-offs. People need to understand that.

But the bigger issue is this:

People are being priced out of something that could help them.

And until that changes, this isn’t going away.

Because this isn’t just about a drug.

It’s about whether regular people actually get a say in their own health.

Let Me Get the Medicine I Already Know I Need

I like doctors. I like pharmacists. I like insurance companies. I like the U.S. Food and Drug Administration. They all serve a purpose.

But there are certain medicines that shouldn’t require going through all of them every single time.

And I’m not talking about new diagnoses or complicated cases. I’m talking about people with established conditions who already know what works for them. I still see my doctor twice a year. I’m not trying to avoid care—I just don’t need to keep jumping through the same hoops over and over.

For instance, I need Trelegy Ellipta. One puff a day. I’ll likely need it for the rest of my life unless something better comes along. It’s already been determined that I need it to breathe. So why do I have to keep going through a doctor, a pharmacy, and an insurance company just to get it? It should just be automatically available to me.

Same with my blood pressure medication, like lisinopril. Doctors are helpful in figuring out what I need. But once that’s established, why do I have to keep jumping through hoops? I’m not saying it should be free—but it should be accessible and reasonably priced.

There’s a difference between maintenance meds, rescue meds, and acute treatments—and right now, the system treats them all the same.

Maintenance meds should be automatic once they’re established.

Rescue meds—like Albuterol—should be easy to access. It’s proven to be safe for shortness of breath. Why do I need a prescription for that? It should be on the shelf—over the counter—like Tylenol or Ibuprofen.

And yes, people worry about overuse. But the real issue isn’t the albuterol—it’s the uncontrolled asthma behind it. That’s where doctors come in. It’s called education and follow-up, not restriction.

Hell, epinephrine inhalers are generally considered more risky than albuterol, and they’re already available over the counter. If the goal is safety, then give people better options, not fewer. I’d bet the use of epinephrine inhalers would drop off pretty fast if albuterol were just as easy to get.

Then there are acute treatments like corticosteroids, such as prednisone. I understand these need more oversight. But if I’m having an asthma flare and I’ve been down that road before, there should be a faster, easier way to access them than paying $40 just to be told what I already know I need.

Right now, they tell me I need a refill. My doctor has me come into the office twice a year. I pay $40 for that visit. Then I pay whatever price the pharmaceutical company and insurance decide. And after insurance, I’m sure the system is making a lot more than that $40.

So let me just get the medicine I need.

Of course, I’m not saying you shouldn’t see your doctor regularly. They’re needed to monitor your health and adjust medications when necessary. But once it’s established that I benefit from a certain dose, why do I have to call for a refill every six months? Why not just auto-renew it unless something changes?

It would save patients a lot of stress—and a lot of money.

And honestly, it would make the system work the way it was supposed to in the first place.

Compounding Pharmacies — What They Are and Why GLP-1s Cost Less

In my last post, I shared how I got started with a GLP-1. My doctor wanted me on Wegovy for prediabetes and weight loss, insurance denied it, and I wasn’t about to pay $1,700 a month out of pocket. That led me down the road of finding alternatives, which is how I ended up using a compounded version of tirzepatide.

Since then, I’ve had a lot of people ask the same question: what exactly is a compounding pharmacy, and how are they able to sell this stuff so much cheaper?

A compounding pharmacy is a licensed pharmacy that custom-makes medications for individual patients. Instead of a one-size-fits-all pen, they can adjust the dose, formulation, or delivery based on what a provider prescribes. This isn’t new—it’s actually how medicine used to be practiced before mass-produced drugs became the norm.

Back in the 1800s, you’d go to a doctor with a symptom, get a prescription, and then the pharmacist—sometimes the same person—would mix the medication right there. There was no one-size-fits-all dose. The dose was tailored to you.

In the case of GLP-1s like tirzepatide, that often means getting a vial instead of a preloaded pen, and drawing up your own dose with an insulin syringe.

That’s where the cost difference comes in. The brand-name versions—like Zepbound or Mounjaro made by Eli Lilly and Company—are patented, heavily marketed, and come with all the research, development, and delivery systems built in. You’re paying for all of that. Compounded versions don’t carry those same costs, so they’re often a fraction of the price.

In my case, I’m paying about $300 for a 50 mg vial. It comes with bacteriostatic water, syringes, and instructions. At lower doses, that can last more than a month. And instead of being locked into a preset weekly pen, I can adjust my dosing. If I’m doing well on a lower dose, I stay there. If I need to move up, I can. That flexibility has been one of the biggest benefits.

That flexibility also helps with side effects. If higher doses are causing symptoms like nausea, one option is to split the weekly dose—taking half at the beginning of the week and the other half a few days later. This avoids a large single dose, which can make it easier on your system. It also keeps the medication more steady in your body, so you don’t feel it wearing off toward the end of the week.

Another thing worth understanding is what this medication actually is. Tirzepatide is a peptide—a short chain of amino acids. The easiest way to think of peptides is like keys fitting into locks. Your body has receptors, and when the right peptide binds to the right receptor, it triggers a specific effect. In this case, tirzepatide targets GLP-1 and GIP receptors, helping regulate blood sugar, slow digestion, and reduce appetite. That’s why people lose weight on it, and often with relatively targeted effects.

Now, here’s where things get a little gray, and it’s important to be honest about it.

Some of these online sources don’t operate exactly like a traditional pharmacy. You’ll sometimes see language like “for research use only.” That’s there for legal and regulatory reasons. At the same time, it’s not hard to see why people are going this route. When something costs $1,700 through the traditional system and a few hundred dollars through an alternative channel, people are going to look for options.

But that also means there are trade-offs.

These products are not the same as FDA-approved, brand-name medications. They don’t go through the same level of oversight, and quality can vary depending on where you get them. You’re also taking on more responsibility—mixing the medication, measuring doses, and giving the injection correctly. That’s not nothing.

For some people, that level of involvement works. For others, it’s not a good fit.

I also had a friend who had been taking this for years before I ever started. That made it easier for me to consider. When she first told me about it, my thinking was pretty simple: You’ve been on it for years and you’re still here—it must be safe. It worked for you, so maybe it could work for me too.What I will say is this: people aren’t doing this because they want to play pharmacist. They’re doing it because they’re priced out of the system.

If insurance covered these medications, or if pricing made sense, most people would go through their doctor, pick it up at the pharmacy, and never think twice about it. Instead, people are left figuring it out on their own.

For me, and for a few friends, it’s worked. One of them is down 50 pounds and feels great. I’m losing weight, my appetite is under control, and I feel like I finally found something that works.

That’s why I wrote this follow-up—to explain what’s actually going on behind the scenes, what a compounding pharmacy is, and why more and more people are going this route.

It’s not perfect. But for a lot of people right now, it’s the only realistic option.

When Insurance Said No, I Found Another Way: How I Now Afford the Weight Loss Drug of My Choice

My doctor wanted me on a GLP-1—both to get my blood sugar down (I was prediabetic) and to help me lose weight. He prescribed Wegovy. My insurance denied it.

So I couldn’t get it. And paying out of pocket would have been around $1,700 a month.

A few months later, I learned about Trump Rx. I told my doctor I could get it for about $200 a month, and that got me started. But then during that first month I realized the catch—after a couple months, the price jumps to around $450. GoodRx and the deals on the pharma sites all work the same way.

That’s what got me looking for alternatives.

What I found is there are online options offering compounded versions of these medications. Instead of the expensive auto-injector pens, you get a vial, mix it with bacteriostatic water, and use a simple insulin syringe. Much cheaper.

A friend introduced me to the company and their website. I won’t share the name here, but if you want more information, you can email me using the link to the right.

Because I’m the one paying for it—and making the decision—I skipped Wegovy and went straight to tirzepatide—the medication behind Zepbound—for a fraction of the cost (not the brand name). I chose it because it targets two pathways—GLP-1 and GIP—and has been shown to help people lose more weight than semaglutide.

The cost is about $300 for a 50 mg vial. It comes with bacteriostatic solution, mixing syringes, and insulin syringes, along with instructions so you can prepare and use it properly.One vial can last more than a month, especially at lower doses, and you can control your dosing instead of being locked into a preset pen.

It’s nice. No doctor. No insurance. Simple. Easy. Inexpensive.

A couple things to be clear about:

• This is compounded, not brand-name
• It’s not exactly the same as what you get from the pharmacy
• You’re trading cost for convenience and tighter controls
• You need to know how to mix the medication, measure the dose, and give the injection properly
• You also need to understand dosing—what to take and when (or if) to increase

But because you’re essentially your own caregiver, you have some flexibility. For example, if the plan says to move up to a higher dose but I’m still losing weight on the current dose, I just stay where I am.

That’s the freedom of it.

But here’s the bigger issue:

People aren’t going this route because they want to. They’re doing it because they’re getting priced out.

If insurance covered these medications—or if pricing made sense—most people would just go through their doctor and pharmacy and be done with it.

Instead, people are left figuring it out on their own.

For my friends, this has worked great. One of them has lost 50 pounds and said, “I love this.” That’s how I was introduced to it—and so far, I’m losing and loving it too.

When BiPAP Works… and the Blood Gas Looks “Worse”

Here’s a scenario many respiratory therapists and clinicians have seen.

A chronic CO₂ retainer wears their BiPAP all night.
Morning labs come back.

And suddenly…

The pH is alkalemic.
The bicarbonate is higher.
The base excess is elevated.

At first glance, it looks confusing.
Shouldn’t the gas look better?

Actually — this is often a sign that BiPAP worked.

---

The Setup: Chronic CO₂ Retention

Many patients with:

• COPD
• Obesity hypoventilation syndrome
• Chronic respiratory failure

Live with chronically elevated CO₂.

For example:

• CO₂ in the 60–70 range
• pH near normal
• Elevated bicarbonate

How does the body tolerate this?

The kidneys compensate.

They retain bicarbonate to buffer the respiratory acidosis.
This is slow compensation — it takes days.

So over time, these patients develop:

• High CO₂
• High bicarbonate
• Near-normal pH

This becomes their baseline.

---

Then Comes a Good Night on BiPAP

The patient wears BiPAP consistently overnight.

Ventilation improves.
CO₂ is blown off more effectively.
Gas exchange improves.

But here’s the key:

The kidneys cannot adjust quickly.

Respiratory changes happen in minutes to hours.
Renal compensation takes 24–72 hours.

So what happens?

• CO₂ improves overnight
• Bicarbonate remains elevated
• pH rises

Result:

Metabolic alkalosis with alkalemic pH

---

It Looks Like This

Chronic respiratory acidosis (CO₂ ~63–65)
Renal compensation (chronically elevated bicarbonate)
Improved ventilation overnight with BiPAP
Kidneys can’t adjust quickly → bicarbonate stays high
Result → metabolic alkalosis / alkalemic pH

---

Why This Is Actually a Good Sign

When you see this pattern, it often means:

• The patient wore their BiPAP
• Ventilation improved
• The body is adjusting

In other words:

The therapy worked.

It may look worse on paper — but clinically, it's often reassuring.

---

A Common Clinical Pearl

Chronic CO₂ retainers often develop post-hypercapnic metabolic alkalosis when ventilation improves.

This happens:

• After BiPAP
• After intubation
• After improved ventilation
• After resolving respiratory failure

It’s not unusual.
And usually, it resolves gradually.

---

Why It Still Matters

Significant metabolic alkalosis can:

• Reduce respiratory drive
• Promote CO₂ retention later
• Make weaning more difficult

So it's worth:

• Monitoring
• Checking electrolytes
• Watching trends

But in most cases, it’s expected physiology — not a problem.

---

The Bottom Line

Sometimes when BiPAP works…
the blood gas looks “worse.”

But when you understand the physiology, it makes perfect sense.

And often, it’s actually a quiet sign of improvement.

The Stages of Respiratory Therapy Apathy

Stage 1: Innocence

You don’t know any better, so everything feels important.
A call comes from the ER and you drop whatever you’re doing — including your food — and rush down. STAT means stat. You walk fast. Sometimes you run. You feel needed.

---

Stage 2: Questioning

You start to notice things.
Why was this called stat? The patient looks fine. Why am I giving a breathing treatment to someone with a head cold? Is this pneumonia, or is she just wet?

You still do the work, but the questions start piling up.

---

Stage 3: Total Realization

At some point it hits you: a lot of what we do doesn’t change outcomes. Sometimes it just fills time. Sometimes it delays something else.

This lady doesn’t need it.

You do the treatment anyway — frustrated. An annoying patient really annoys you now. What burns you out isn’t just the work, it’s doing work that isn’t needed, over and over, until it piles up.

This is the stage where you try to educate. You explain to nurses. You explain to doctors. You go out of your way to say why it isn’t necessary.

And in the end, you do it anyway.

You realize you just wasted valuable time and training. You’ve been busy all day, finally sit down, and another treatment pops up. You feel it physically. Acceptance doesn’t arrive calmly — it arrives irritated.

---

Stage 4: Acceptance

You stop fighting reality. You understand the job for what it is. You may look at other careers. You may even daydream about leaving.

Then you realize leaving would mean more school, less money, or starting over.

So you stay.

You do what you’re told. You get it done. The anger fades, but it doesn’t completely disappear.

---

Stage 5: Selective Engagement

At this stage, you simply go into action.

You don’t blow up. You don’t complain — at least not much. You don’t argue anymore. You don’t try to change the course of treatment. You just do it, get it done, and go back to the RT cave.

You chill.

This is where experience finally turns into control. You don’t rush for everything anymore — you triage with your brain. You know when something actually matters and when it doesn’t. You still show up when it counts. You still advocate when it matters.

But you stop letting every unnecessary call hijack your nervous system.

You don’t care less.
You care more precisely.

And maybe that’s the part no one tells you:
apathy isn’t the end stage.

Clarity is.

Do Mucus-Clearing Treatments Really Work? A Look at the Evidence (and the Myths)

I’ve been a respiratory therapist for 28 years and 4 days. Hard to believe it’s been that long. I remember learning about hypertonic saline in RT school back in ’96. By the time I hit the floors in ’97, it was already out of style — “proven useless.”

Now?

It’s back with a vengeance. I see it ordered almost every day for… whatever disease of the week.

Same with CPT.

We used to pound on the chests of every post-op patient as if soreness alone was a mucus diagnosis. Eventually studies caught up and said, “yeah… this doesn’t actually do anything.” Plus, hitting fragile 85-year-old ribs? Maybe not our best era.

Mucomyst has always been the strange child. Ordered for people who “can’t bring up secretions,” or because a doctor thinks “it’ll help.” And of course the whole room ends up smelling like rotten eggs. The only people who don’t mind are the ones so old they don’t care about anything anymore — including their own room smelling like poop, as their comode sits filled in the corner.

And after this many years in the job, you learn the difference between:

something that actually works
and
something that looks like work.

Hypertonic saline. Pulmozyme. Mucomyst. The Vest. Acapella. CPT.

We’ve all done them. We’ve all questioned them.

Some days you walk into a patient’s room and they have everything ordered. If I actually did all of it by the book, I’d be in the room for two straight hours. No thanks. Nobody’s got that kind of time.

And eventually the question creeps in:

Does any of this actually help the patient?

Or are we just doing it because we've always done it?

So I dug through the research — real numbers, solid studies, repeatable results. Because one study is not science, guys. Science is when multiple studies show the same thing again and again — and even then, people still argue about it. That’s real science. And honestly, the reason we debate it is because only God knows the full truth — we’re just here trying to figure out our tiny piece of it.

Here’s what actually holds up.

---

CYSTIC FIBROSIS

The only place where mucus therapy truly delivers — even if the gains are smaller than you think.

Hypertonic Saline (3–7%)

• FEV₁ improves ~3%

• Exacerbations drop ~50%

• Good, repeatable evidence

• Helps clear mucus and improves sleep

Pulmozyme (Dornase Alfa)

• FEV₁ improves 5–12%

• Fewer infections

• Slows long-term decline

The Vest

• Works about the same as solid manual CPT

• FEV₁ improves 1–3%

• Reliable long-term airway clearance

Now here’s the part no one says out loud:

"If Pulmozyme improves FEV₁ 5–12%, that means, in 88–95% of patients, of lung function does not change.

CF is the condition where these therapies shine — and even there, the gains are modest.

Still worth it. Still life-extending. Just not magic.

---

BRONCHIECTASIS (Non-CF)

Helpful, but not groundbreaking.

OPEP Devices (Acapella, Aerobika, PEP)

• Patients feel less congested

• Increased sputum production

• FEV₁ improves 1–3% (which also means it does absolutely nothing in the other 97–99% of cases).

• Some studies show 10–20% fewer exacerbations (So in 80-90% of cases it has no effect)

The Vest

• Helps move mucus

• Patients feel better

• Minimal FEV₁ impact

Bottom line:
Therapies help people feel better and cough more effectively —
but they barely move the pulmonary function numbers.

---

THE VEST (General Use)

It looks dramatic. It sounds dramatic.
It helps the right patients — but it’s ordered for the wrong ones just as often.

Good for:

• CF

• Bronchiectasis

• Chronic heavy secretions

Not good for:

• Most COPD patients

• Pneumonia

• Mild secretions

• People who just “have rhonchi”

The Vest does not:

• Improve oxygenation

• Shorten hospital stays

A lot of doctors order it because it feels like “doing something.”
The evidence does not back that up for most inpatients.

---

COPD

The land where tradition rules over data.

Most COPD orders look like this:

• Mucomyst

• Acapella

• Light CPT

• Maybe the Vest (usually pointless)

Mucomyst (NAC Neb)

We all know it thins mucus.
But when you actually look at outcomes?

• No meaningful FEV₁ change

• No better oxygenation

• No reduction in hospitalizations

• Bronchospasm 10–20%

• Studies are old and weak

Translation:
Mucomyst for COPD is 90% tradition, 10% actual effect.

And the smell?
Rotten eggs. Every time.

Acapella / Aerobika

This actually does something.

• Helps mobilize mucus

• Patients feel better after using it

• FEV₁ changes 0–2%

• Some studies: 10–30% fewer COPD readmissions

Not a miracle — but useful.

The Vest (in COPD)

The research says:

• Helps the small handful of COPD patients with lots of mucus

• Does little to nothing for the majority

• No significant FEV₁ improvement

• No consistent length-of-stay improvement

80–90% of COPD patients get almost no benefit.

Yet it still gets ordered on autopilot.

---

PNEUMONIA

If we’re doing airway clearance here, we’re doing it for comfort — not cure.

Research shows:

• Chest PT does not cure pneumonia faster

• Vest does not improve oxygenation

• OPEP does not reduce mortality

• ACT does not reduce complications

• Does not shorten length of stay

The only tiny benefit?
A couple small studies suggest fever may break 12 hours sooner.

That’s it.

---

NEUROMUSCULAR & SPINAL CORD INJURY

Finally — a therapy that actually does exactly what it should.

CoughAssist / MIE

• Increases cough flow 50–150%

• Prevents mucus plugging

• Cuts pneumonia risk

• Reduces intubations

• Reduces hospitalizations

These patients don’t have a mucus problem —
they have a weak cough problem.

This device is a game-changer.

---

THE BOTTOM LINE

After almost three decades doing this job, this is the simplest way I can put it:

Some therapies help a lot.
Some help a little.
Some don’t help much at all.

But tradition sticks around forever.

And some days, when you’re dragging a Vest into the room of a COPD patient who hasn’t coughed anything up since 2003, you can feel the gap between what we know and what we’re ordered to do.

Here’s the honest breakdown:

STRONG EVIDENCE

• Pulmozyme (CF)

• Hypertonic saline (CF)

• CoughAssist (NMD, spinal injury)

MODERATE EVIDENCE

• Acapella / Aerobika

• OPEP for bronchiectasis

• The Vest for CF & bronchiectasis

WEAK EVIDENCE

• Mucomyst for COPD

• The Vest for COPD

• Chest PT for pneumonia

• OPEP for pneumonia

ALMOST NO EVIDENCE

• “We have to order something.”

I’m not trying to stir drama. I love respiratory care.
But I also like knowing the difference between what works and what’s just habit.

And honestly?

If a therapy only helps 10% of patients,
that means 90% of the time we’re basically doing busywork.
That’s not bad RT care — it’s just the reality of old habits in medicine.

And that’s why asking questions matters.