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For a more detailed discussion of our CY 2026 payment policy for skin substitutes, please see section V

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Product Specifications Each vial in the Semaglutide Weight Loss Program with B-12 & Glycine is compounded for provider-prescribed use and includes the following formulation details: Per Vial Composition: Semaglutide + B-12 + Glycine Strength: 5 mg / 5 mg / 1 mg per mL Total Vial Size: 2 mL Form: Sterile injectable solution Total Active Content Per Vial: Semaglutide: 10 mg total per vial B-12: 10 mg total per vial Glycine: 2 mg total per vial Ordering Information: Maximum: Up to 3 vials per order Prescription required before fulfillment Compounded by a licensed pharmacy following provider approval All Wellness Medicines and Compounded Pharmacy Products require a Quick & Easy Medical Evaluation to Ensure the Medication is Appropriate for you

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