Dr.ObesityLA said:

Resolution therefore closed the doors unevenly, and the asymmetry follows from the bulks lists.

This is where I part company with the consensus forming above. A research-chemical supplier selling lyophilised powder labelled research use only is not compounding and is not claiming to. It is a different legal universe with no pharmacy oversight, no patient relationship and no content guarantee, and conflating the two in these threads helps nobody.

Dr.AddMedPHL said:

My pharmacy stopped supplying with three weeks notice and a letter that explained nothing, so I went and read the statute.

I have been on both brand and compounded, and in the context of compounded supply, my experience has been equivalent with both. The key is finding a reliable 503B pharmacy with independent testing.

DataDave said:

A research-chemical supplier selling lyophilised powder labelled research use only is not compounding and is not claiming to.

Coming at DataDave’s question from a different direction. Denials are usually procedural rather than clinical, and the order that works reflects that. Get the denial reason in writing, because it names the criterion you failed. Then supply the documentation that criterion asks for — usually documented BMI with a comorbidity, or a failed prior therapy. Then appeal, and ask for a peer-to-peer review, because a prescriber talking to a reviewing clinician resolves a large fraction of denials that written appeals do not. Manufacturer copay assistance is separate and applies mainly to commercial insurance, and patient assistance programmes are means-tested rather than a discount.

One thing that is still open after Dr.MetabolicMD’s answer:

Why a shortage listing created a legal pathway at all, since a shortage is a supply fact rather than a permission?

Reporting back.

The bulks-list asymmetry was the piece I had missed entirely. It explains why one of my two pharmacies is still arguing it can supply and the other simply stopped.