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Knockoff weight-loss drugs have become a huge cottage industry — and in the case of one online pharmacy, it may have been deadly.

In a deep-dive investigation, the Washington Post has revealed the complex inner workings of the now-shuttered ACA Pharmacy, a drug compounding firm that sold its drugs out of a facility in Nashville.

According to people who worked there, the pharmacy that made generic versions of name-brand drugs was said to be filling up to 1,000 prescriptions a day, mostly for knockoff versions of the diabetes injectables Ozempic and Mounjaro, and bringing in millions of dollars before shuttering last fall.

As WaPo reports, the messy situation inside ACA and its parent company, Rx Partners, led to a dramatic string of events last summer that included the exit of a facility director one month, a government inspection the next, and then, just a few days after that, the chief operating officer's suicide.

As drugs like Ozempic have caught a wave of viral attention, there's been a disturbing rise in black market sites selling compounded semaglutide — the active ingredient in Ozempic and Wegovy, its weight-loss sister drug — without prescriptions.

ACA Pharmacy appears to have been one step above those sorts of sites on the legitimacy ladder by requiring prescriptions, but the nature of them gave some employees pause. In particular, some workers were concerned that physicians were prescribing dosages way too high or filling too many prescriptions to be legit — but as former ACA pharmacist Miranda Lane told WaPo, discussing those issues was taboo in the company's culture.

"If you questioned the clinical appropriateness of anything, you were told, 'Don’t worry about it,'" Lane said.

What's worse, according to former employees who spoke to the Post but asked to keep their names private, staffers at ACA would openly use the company's custom-made weight-loss drugs on themselves, and at least two people who did so didn't have prescriptions for it.

Those were far from the last of ACA's problems, either. Its national accreditation was said to have lapsed just a few weeks after it was issued last year, customers were complaining about their drugs being sent to the wrong addresses, and after that seemingly fateful inspection, Tennessee health officials issued a disciplinary action that required the retraining of employees — some of whom, per the Post's interviews, had little to no experience in pharmacies before being working at the compounding facility.

It was against that backdrop that Rx Partners' COO, Brantley Wescott, died by suicide in the summer of 2023. According to Ned Ashley, the parent company's CEO, the executive had suffered from anxiety before, and police reports reviewed by WaPo indicated that the state's audit "was stressing [him] out."

Very soon after the COO's death, state officials met to discuss suspending ACA's operations. The pharmacy did them one better, and voluntarily surrendered its sterile compounding registration, records indicated.

Still, employees expected the company to resume business at some point in the near future — and were shocked, as they told the newspaper in interviews, when they learned in October that they were being laid off and that ACA was closing for good.

The tale of ACA Pharmacy could be viewed many ways, but given the gravity of Wescott's death, it seems, perhaps, that it's best left as cautionary — or perhaps as a parable of the highs and lows of the grey market surrounding the pharmaceutical industry.

More on the weight loss industrial complex: Semaglutide Patients Regained More Weight Than They'd Lost After Stopping Their Injections

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