Business doesn't stop. We're still marketing, we're still promoting weight loss because there's a huge demand for it. The more muscle you have, the longer you're going to live. You know, so that's where the hormones and the increased testosterone, which obviously is good for your heart, your muscle is a heart, that there's that's where the longevity play comes into. 

Welcome to the Wellness Practice Playbook podcast, where we offer tactical insights on attracting high-quality patients, optimizing your operations, and building a cash pay practice that runs like a business. 

Today's guest is David Cadell from EC3 Health that offers compounding pharmacy services nationwide. I'm super excited about this podcast because there are so many questions about GLP-1's regulations, how to navigate these great areas. 

And that's why I invited David to this episode. Welcome, David. Thank you. I met David at A4M conference. Every time we go there, he's representing pharmacy. So he's an expert in this field. And that's, I think, will be an amazing episode. 

David, why don't you start with who you are? Excellent. No problem, Alex. So, hello, everybody. My name is David Cadell. I'm the president of EC3 Health. I've been involved in the compound pharmacy space for over about 20 years now. 

And I've been attending the A4M and meeting practitioners like yourselves that are interested in transitioning from conventional medicine into more of an integrative and functional medicine. Obviously, utilizing hormone optimization programs, medical weight loss, IV nutrition, and regenerative medicine, and of course, longevity. 

I'm happy to be on the show with Alex to kind of share some insight on the compound pharmacy space as a whole, and particularly diving into information about the GLP1s, the regulatory issues going on with sterile injectables right now for 503A compound pharmacies, and also kind of explaining the difference between a 503A compound pharmacy and a 503B compound pharmacy. 

So I'm going to jump right into it and start to talk about what everybody really wants to know about coming into the new year and with all the new year's weight loss resolutions and the utilization of GLP-1s. 

You know, there's been so many questions that have been asked about, oh, is it legal for a compound pharmacy to do this? Or from a practice standpoint, am I going to get in trouble if we're going to offer these GLP ones? 

And, you know, I'm not a lawyer. I'm not here to give you legal advice, but I will tell you from the compound pharmacy standpoint where we feel that there's a bit of a comfort level to be able to continue to meet the demand from your patients on these GLP-1s. 

And as you can know right now, as you know right now, I should say, the GLP-1s are not on the FDA shortage list. So those that are making these GLP-1s feel that there's a little bit of a sweet spot there to be able to add some B6 or some B12 to the existing formulation and then thus making a non-essential copy. 

You know, there's just a lot going on right now in this space, Alex, and especially with the demand being so high and the issues in the supply chain and the patients' demand is so great. So, you know, there's compound pharmacies that have spent hundreds of thousands of dollars looking at this and deciding that, you know, they feel a little bit comfortable in making, like, for instance, Terzipatide with B6 and making a non-essential copy. 

So, I mean, you know, it's going to vary from state to state, but we are seeing so many different compound pharmacies offering these GLP ones. Some feel that the patent is being challenged with terzipatide, and that gives them a little bit of an ability to kind of go down that path. 

But, you know, so you'll find a lot of compound pharmacies right now that are actually offering both samaglotide and terzipotide with either putting some B6 or B12 in it. And, you know, as long as you're using a pharmacy that has a very good quality control and is testing these injectables from a sterility, endotoxin, and potency standpoint, you know, you just want to make sure that you're doing the right things and you're involved with the right compound pharmacy that's looked at it backwards and forwards and is offering a quality compound and medication. 

But again, the whole purpose of getting a patient started on a GLP-1 is not maybe for the long term, but being able to transition that patient after 90 days into an ongoing hormone optimization program. 

That's really the main vein or vertical of any concierge or self-paid practice. You want to be able to kind of, after that patient loses a significant amount of weight, is being able to transition them into hormones where you're doing practicing full medicine or good medicine by looking at the underlying issues that may prohibit that patient from keeping that weight off. 

And that's when a qualified hormone replacement therapy specialist will start to do some blood works and look at your thyroid levels, your cortisol levels, your testosterone levels, estradi levels, and things like that so that they can guide that patient into an ongoing hormone optimization program where they can continue to retain the muscle. 

And that's what we're seeing out there is that these long-term GLP-1 programs, you know, with every four pounds of muscle or four pounds of weight that you lose, one pound is going to be muscle. And at the end of the day, we want to retain that muscle. 

So using GLP-1s in a short period of time to lose some weight is a good thing. And also it can be cardioprotective and neuroprotective like the dual agonist terzipatide is with less side effects and somagatide. 

But at the end of the day, trying to transition that patient into a different lifestyle of where they're able to be on hormones and really balance that patient out and will definitely improve their quality of life. 

And then that's where it gets fun. You know, that's where you start to really partner with these clinicians that are into integrative and functional medicine or preventative care and see how you can help them. 

And that's what EC3 Health does is how we can help you develop your menu of treatment programs that you can offer at your own practice. You know, I think about these programs as a fine dining menu. You know, when I walk in, I want to see all your medical weight loss options on the left column. 

I want to see all of your hormone optimization programs in the middle. And then your peptides and a little a la carte section here with your vitamin D and your IV nutrition and maybe even some regenerative medicine programs as well. 

But developing this venue is what EC3 Health has helped thousands of practitioners do in transitioning from a conventional medicine model into an integrated functional medicine model. And it gets really fun. 

You know, you don't want to, it's great that we have the GLP ones out there. It really is. But to really offer and expand your menu of treatment options to your practices, to your patients, excuse me, that's where you can really start to develop different programs that are going to improve your patients' quality of life and then obviously add and increase the practice revenues as well. 

That's exactly what we're telling them too. Yeah, you take them for the weight loss. I mean, we're thinking as a business owner. They come for the weight loss. They lost weight. You did the blood work on the initial consultation. 

You discovered that they have hormone imbalance. Maybe they didn't want to purchase hormone therapy right at the start. But once they lost weight and they feel amazing, as long as you bring them back every month to show them the progress of the weight they're losing, pointing that, hey, maybe you're losing some muscle mass here too. 

And then at the end, you're like, hey, remember, we looked at this and you say, no, I have no energy. Remember, we looked at your blood work and your testosterone is all the way at the floor. You don't have any? 

Well, that's time to transition to hormonotherapy. And now it becomes a patient, lifelong patient who's on hormone therapy and hopefully start buying additional services that the clinic is offering. That's exactly the model that EC3 Health and yourself has been developing for what, now, 14, 15 years, where, yeah, I mean, you know that after 90 days of a medical weight loss program, that's the perfect opportunity to talk to Mrs. 

Jones and say, Mrs. Jones, you know, 80% of patients put the weight back on. Let's do that additional testing and look at your hormones and let's optimize them. Because at the end of the day, I speak to so many clinicians and they're changing their minds as far as, oh, well, first it was nutrition was the top thing to keep you, you know, keep the longevity in your life for the long run. 

But now it's really down to working out and building muscle. The more muscle you have, the longer you're going to live. So that's where the hormones and the increased testosterone, which obviously is good for your heart, your muscle is a heart, that's where the longevity play comes into. 

And then down the road, after the hormones, right, we balanced all the hormones, then there's another way to increase that patient's monthly annuity to the practice. And that's by adding some of these unique peptides to their program. 

Where you're using BPC-157 for tendon and ligament repair, or you're utilizing IGF-1LR3 for muscle building, testamorellin. There's so many amazing peptides that we're starting to also some of the regulations are starting to loosen up on where you're seeing more and more compound pharmacies start to dabble in producing these peptides and compounding these peptides again and then regulating it. 

And that's where it needs to go. And I think the legislation is loosening up here. And I do think that you'll see more and more qualified compounding pharmacies in 2026 start to roll out more of these peptides as well. 

So one of the questions, David, I get from practices we're talking to during our discovery calls, they scared. Like we want to advertise weight loss, semi-gluta, but we're scared. We're seeing examples of the clinics across the road got shut down for one reason or another. 

Can you clear up why is this and what to do? Yeah, I mean, it goes back to how I, you know, what some of the compound pharmacies have done some legal investigations on and feeling a little bit more confident and making a non-essential copy where you're not, you know, where you're adding that B6 or B12 to your GLP1s, which then kind of puts you in a little bit of a different ballgame as far as not making exactly what the big pharma companies are making with regards to getting in trouble with for patent infringement and things like that. 

So that's really what it boils down to is they're just kind of resting on that non-essential copy that they're making to adjust the different titrations of the strengths and concentrations or maybe even change the route of delivery and offer more of a liposomal sublingual route of delivery as well. 

So you're seeing very unique different concentrations of these GLP1s, the changes of the route of delivery of the medication as well. And that's where you're kind of erring on the side of caution when writing these GLP1s that can help your patients lose that weight. 

So technically, what I'm seeing, and correct me if I'm wrong, but business doesn't stop. We're still marketing, we're still promoting weight loss because there's a huge demand for it. Yes, yes. You just have to be careful as far as what, you know, what you're saying and, you know, not using trade names and working within the kind lines of not making any false claims. 

These are, again, these are compounded medications. These are not regulated by the FDA. So there's things that you have to be careful with in your marketing and what you're saying. And those two things are the biggest things as well to make sure that you're not using trade names and you're not making any false claims. 

There's one of the things I've heard is a clinic pre-purchased lots of semaglutide, sitting on it, it's in the office, and they're selling them from the practice. I think that's one of those not-to-do things. 

Am I right? Not really. I mean, if you're buying from a 503B compound pharmacy, which is a 503b outsourcing facility is what it's called, and you have a dispensing license. It's perfectly legitimate as far as how you're selling and dispensing. 

You're covered as far as what you're doing from a legal standpoint. The pharmacies, the 503B outsourcing facilities are, you're able to purchase non-controlled substances, even controlled substances for office use and in bulk. 

So you are allowed to do that, but you definitely have to check with your state regulations and make sure you have a dispensing license to do it the right way. You mentioned the 503B. What are those things? 

Yeah, so the difference between the two pharmacies, a 503A compound pharmacy, and we have both in our network under the EC3 Health umbrella. A 503A compound pharmacy means every prescription that an ARNP, a PA, an MD, or a DO writes has to be patient-specific. 

Has to have your full name, date of birth, address. You know, every prescription is written with specific directions. That's a 503A compound pharmacy. A 503B outsourcing facility is when the doctor can write for office use and you can sell, they can purchase in bulk medication, compounded medications, in bulk without having a patient's name attached to it. 

This is very popular in the IV nutrition space where experience practices, med spas are mixing different types of amino acids, high dose ascorbic acid, NAD, magnesium chloride, gluconate, all of these things to make Myers cocktails and administer them for intravenous use. 

These would mostly be purchased from a 503B compound pharmacy or outsourcing facility. Did you mention there was 503C? No, not that 503A and 503B only. Yeah. David, what do you see happening moving into 2026? 

Well, what's exciting in 2026 is we're seeing some of the regulations on peptides loosen up some. I mean, right now there's so many amazing peptides, which are sequences of branch-chain amino acids held together by a peptide bond, that are on the bulk category two do not compound list. 

And as that's being said, I mean, as that is by, you know, the governing bodies, you're not supposed to be compounding, but only a handful of these. So we're seeing at the legislation level that some we're hoping and hoping that these regulations loosen up a little bit more so that we can regulate this under the compound pharmacy as well, where it requires a prescription and all the testing from sterility, 

endotoxy, and potency. Not that the other companies aren't doing that, some are, some aren't, but it needs to be more regulated and brought back into the under the compound pharmacy so the liability comes off of the prescribers and practitioners. 

Where right now, if you're ordering research use only medications or peptides, the liability is heavy on the practitioner side. Whereas if it's brought under the compound pharmacy, the liability is more heavily on the pharmacy side. 

So loosening those regulations. Yeah, loosening those regulations is really going to be exciting 2026. And obviously being able to see more of the GOP1s, some of the newer GOP1s that are essentially peptides, like retatrutide and cagnimoglide, get those out there as well, you know, where you have a triple agonist and can continue to preserve some of the muscle while you continue to lose the weight. 

Yeah, we see on the marketing side a huge growth in demand for peptides. Yeah, which is amazing because while peptides were around for a very long time, this is kind of we've seen first time in a long time increase in demand from a consumer in amount of searches. 

Our clients also reporting that they're selling more and more of those and they love it. Right, right. Like I said, it's a slippery slope right now because again, it's been about almost, well, I guess it's going on almost two and a half, three years now that the FDA did place a lot of these peptides on the bulk category do not compound list, which took them out of, took them out from under the compound pharmacy production. 

But now it's starting to loosen up and you start to see more compound pharmacies diving back into it again and the patients be able to get them from a compound pharmacy. Yeah. What else can you share with listeners in terms of working with compounding pharmacies, the legal side of it? 

So I think we covered the legal side of it pretty well, but I would say that if anybody's looking to continue to transition from a conventional medicine model into a self-pay model, integrated functional medicine, anti-aging model, then we do have the ability and the knowledge to have a little practice assessment. 

You can go to ec3health.com where we have a practice assessment. It'll take you about five minutes to fill this out. And then we can schedule a call and see if it's a good fit for you to transition into a self-pay model. 

We look at your patient population, what type of patients you currently have, what your personal interests are. We go into the A4M in Las Vegas again here December 11th through the 14th, the Longevity Fest in Las Vegas. 

And that's where all of our practitioners are. And we know why they're there. They're tired of the insurance model being controlled by insurance on how to practice medicine. Their own quality of life is kind of in limbo. 

And they want to do more with their degree. And they want to transition into a self-pay model. And we'd love to have these conversations with you out there. We have a booth at 12105. You can stop by and talk to us and see if it's a good fit for you to transition into this model. 

Whether you're going full force into it or maybe you want to do a little hybrid model where you have a little side concierge medicine business, we can definitely help you and grow with you and help you understand the market a little bit better. 

Thank you. So the best way to get in touch with you is by going to the website and ec3health.com or you can email us at info at ec3health.com and we'd be happy to talk to you a little bit more. We don't really do the marketing for the practice. 

That's what Alex is here for. But from the compound pharmacy side of it, the regenerative medicine, IV nutrition, medical weight loss and hormones, we ship to all 50 states and would love to evaluate and see if we have a good partnership for a collaboration. 

Very good. Well, David, thank you for joining our podcast and sharing all the information. I'm sure it's going to be valuable. And for anyone who needs additional help, reach out to David. He is a crazy amount of knowledge. 

I've known him for years going through A4M. Definitely the right person to reach out. Thank you, Alex. I appreciate your time. And thanks, everybody, for your time as well.