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Standard escalation protocol The most widely used escalation schedule for compounded tirzepatide B12 formulations follows this structure

While many different physicians can prescribe GLP-1s, TMH houses the only surgical center in the region that has earned accreditation through the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), a joint quality program of the American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS)

The problem comes when compounding is exploited as a loophole

Prescribing Information: Glucophage (metformin hydrochloride) tablets