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The peptide has been slowly degrading over its entire shelf life, even under perfect refrigeration

6 Since then, states have altered their positions on covering anti-obesity GLP-1 therapies: Four have withdrawn coverage entirely (California, New Hampshire, Pennsylvania, and South Carolina), three have added coverage (Missouri, Tennessee, and Utah), and at least two states (Michigan and Virginia) have enacted more narrow utilization criteria, limiting future use to those with morbid obesity

Its complicated this is an evolving area of the law

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So Akkermansia is best thought of as one part of a broader, gut-supportive approach to discuss with your clinician, not a proven remedy for GLP-1 side effects