What SAHPRA actually did, and didn't do
SAHPRA's December 2023 position statement is the live framework: semaglutide can be compounded only when it is the form contained in a SAHPRA-registered product (Ozempic, semaglutide 1.34 mg/ml). Compounding using semaglutide sodium, semaglutide acetate or other salt forms is illegal under the Medicines and Related Substances Act 101 of 1965. On 5 March 2025 SAHPRA published a "Communication to Stakeholders" stating intent to declare compounded GLP-1/GLP-1-GIP agonists undesirable under section 23. That declaration has not been finalised. As of early 2026, compounding pharmacies continue to operate, and CEO Boitumelo Semete-Makokotlela has said publicly that the authority has 12 inspectors trying to police the trade.
The practical posture from operator partners in Johannesburg and Cape Town is unchanged: compounded semaglutide products are sold through telehealth services and weight-loss practices. Novo Nordisk's interdict against compounding pharmacy Idexis Pharmaceuticals remains unresolved in court. Eli Lilly's distribution agreement with Aspen Pharmacare for Mounjaro in South Africa is in review for chronic weight management — until that registration completes, tirzepatide is not registered at all in SA, and any compounded tirzepatide is per se illegal.
MCAZ and the Botswana/Namibia silence
MCAZ Zimbabwe issued a 6 June 2025 joint statement with the Health Professions Authority Zimbabwe warning against the "skinny jab" trade. The legal hooks: sales by unlicensed persons under SI 150 of 1991 sections 50, 52 and 106; unregistered medicines under MASCA section 29(1)(a); unqualified practice under Health Professions Act section 126. MCAZ Director-General Richard Rukwata stated directly: "Ozempic is a prescription-only medicine and should only be dispensed upon presentation of a valid prescription. Its unsupervised use, particularly for weight loss, can result in harmful side effects and long-term complications." MCAZ has issued no public guidance specifically on tirzepatide or on compounding rules.
BoMRA Botswana and NMRC Namibia have not issued public GLP-1-specific statements as of May 2026. Both jurisdictions regulate via standard medicines registration regimes — Botswana under the Medicines and Related Substances Act 2013, Namibia under the Medicines and Related Substances Control Act 13 of 2003. The absence of public statements should not be read as permissiveness; both authorities can act under their general unregistered-medicines provisions.
Pharmacy-of-record and the distribution implication
The operative concept across all four jurisdictions is "pharmacy of record." A compounded medicine is legally protected only when (a) prepared for a specific patient on a valid prescription, (b) by a licensed pharmacist in a licensed compounding facility, (c) using a registered API in the dosage form contained in a registered product. Most of the volume currently moving through SA telehealth fails one or more of these tests.
For brand operators evaluating distribution of weight-management adjuncts (GLP-1 support supplements, B12+amino-acid stacks, ketogenic protocols), the implication is direct: distributing alongside a compounded GLP-1 telehealth flow creates downstream liability if SAHPRA finalises the section 23 declaration. The cleaner posture is to distribute only with practitioners using SAHPRA-registered Ozempic and the forthcoming registered Mounjaro.