State by state.

Indiana's distinctive signal is fresh, peptide-relevant legislation. Senate Bill 282, signed by the Governor on March 5, 2026 as Public Law 136 (2026), sets drug-compounding requirements and — beginning January 1, 2027 — requires med spas to register with the Medical Licensing Board of Indiana, designate a responsible practitioner, report serious adverse events, and submit to board investigation. Telehealth practice runs under IC 25-1-9.5, which holds telehealth to the in-person standard of care and lets a prescriber issue a prescription without a prior in-person exam if that standard is met. Compounding otherwise tracks the baseline USP framework under 856 IAC (the Board's interim rule to adopt updated USP chapters was postponed, not tightened).

Alabama's Telehealth Medical Services Act (Ala. Code § 34-24-701 et seq., 2022) permits forming a physician-patient relationship and prescribing legend drugs entirely via telehealth, but the state is aggressive on compounded GLP-1s. The Board of Pharmacy and Board of Medical Examiners prohibit compounding with semaglutide salt forms, research-grade, or any non-pharmaceutical-grade/non-FDA-registered API. This is backed by real enforcement: on November 10, 2025, Attorney General Steve Marshall sued a Cullman clinic (Aurora IV and Wellness) for injecting patients with research-grade tirzepatide and semaglutide marketed as 'pharmaceutical-grade,' obtaining a temporary restraining order and asset freeze.

Aggressive enforcement against unlicensed peptide prescribing. The Medical Board of California has issued multiple cease-and-desist letters since 2023 to wellness clinics dispensing peptides without a documented in-person evaluation. AB-2098 (effective 2023) tightened the telehealth standard-of-care framework that governs initial encounters.

Connecticut is restrictive on the enforcement axis: in 2025 Attorney General William Tong opened a documented crackdown on bootleg GLP-1s — a CUTPA lawsuit against distributor Triggered Brand (May 2025) over 'research grade' semaglutide/tirzepatide, followed by cease-and-desist letters to med spas and a settlement (December 2025). Telehealth practice under Conn. Gen. Stat. § 19a-906 permits establishing care and prescribing non-controlled drugs (including GLP-1s) via telehealth without a prior in-person visit, and compounding follows USP <795>/<797> under the Commission of Pharmacy with no CT-specific GLP-1 rule beyond federal 503A. The enforcement targets illegal research-grade product, not compliant physician-supervised therapy.

Louisiana pairs a permissive telemedicine baseline (La. R.S. 37:1271 and the Telehealth Access Act, R.S. 40:1223.1 et seq., allow audio-video initial visits and prescribing) with a distinctive, in-force restriction directly relevant to peptides: the Board of Medical Examiners' rule LAC 46:XLV.7513 prohibits using telemedicine 'for the treatment of obesity' and bars telemedicine controlled-substance prescribing without an in-person visit in the prior year. The Board of Pharmacy has also disciplined GLP-1 compounding — 2023 consent orders against pharmacies using unapproved semaglutide-sodium salt forms (Cases 23-0086/23-0087) — though those two flagship orders were rescinded in May 2024 after corrected certificates of analysis. Compounding otherwise follows USP <795>/<797>/<800> and FDCA 503A under LAC 46:LIII Ch. 25.

Restrictive. Following the 2012 NECC meningitis outbreak — which originated at a Massachusetts compounding pharmacy — the state imposed the strictest 503A oversight regime in the country. Inspection frequency, complaint review, and disciplinary action rates exceed national averages.

Mississippi has a documented, dual-board restriction on compounded GLP-1s backed by primary sources. The State Board of Medical Licensure's Rule 1.5(F) prohibits off-label use of a non-FDA-approved legend drug solely for weight loss; in its Guidance Regarding Semaglutide-Based Medications (August 2023), the Board rescinded its prior off-label waiver and rejected a waiver for compounded semaglutide. A July 2024 Board Order (Supplemental Guidance on GLP-1 and GIP Medications) then created a narrow exemption allowing compounded GLP-1/GIP only for a documented specific clinical need or FDA shortage plus verified API sourcing. The Board of Pharmacy separately warns that compounding semaglutide salt forms fails FDA bulk-substance requirements and 'may result in enforcement action.'

Restrictive. The New York State Office of the Professions oversees professional discipline through the State Education Department — an unusual structure that has historically meant slower but stricter enforcement. New York's Section 6530 (definitions of professional misconduct) is broad and has been applied to peptide prescribing cases.

Ohio's distinctive signal is aggressive Board of Pharmacy enforcement on peptide and GLP-1 compounding at prescriber clinics and med spas — not telehealth. In its own guidance, the Board states that since the beginning of 2025 it has summarily suspended more than 30 clinics and med spas after finding clear and convincing evidence of danger of immediate harm, and its July 2025 GLP-1 guidance holds that research-only peptides such as retatrutide and cagrilintide cannot be compounded under state or federal law. Individual board orders name retatrutide directly (e.g. the Slimbolic and Ageless Medica summary suspensions). Telehealth itself is comparatively open under ORC 4743.09.

Wyoming permits telemedicine, but its Board of Pharmacy has a significant, documented enforcement record against unauthorized GLP-1 compounding. In 2024 the Board ordered City Drug of Cheyenne to cease all compounding after finding it was compounding semaglutide without proper sterile-compounding capability (March), then summarily suspended the pharmacy's license (September) over a compounded semaglutide product dispensed with a false label; the October 2024 settlement imposed a three-year stayed suspension, a multi-year compounding ban, fines plus disgorgement of the pharmacy's semaglutide profits, and a required sale of the business. Telehealth practice runs under the Medical Practice Act (Wyo. Stat. §§ 33-26-101 et seq.), and compounding under Board of Pharmacy Rules Chapter 22 adopts the USP chapters (795/797/800/825) by reference.

Alaska tracks federal defaults with no distinctive peptide/GLP-1 rule and no documented state enforcement. AS 08.64.364 (prescription of drugs without physical examination) permits physicians and PAs to prescribe non-controlled drugs without an in-person exam if a provider in the practice is available for follow-up and records are offered to the patient's primary care provider; it bars prescribing solely via internet questionnaire or email to a patient with no existing relationship. 12 AAC 40.943 adopts AMA and FSMB model telemedicine standards by reference. For compounding, 12 AAC 52.440 points to the Board's own 'Compounding Practices' pamphlet rather than incorporating current USP <795>/<797>, and no state-specific GLP-1/semaglutide restriction was found.

Arkansas requires a professional relationship before telemedicine treatment under the Telemedicine Act (Ark. Code § 17-80-401 et seq.) and Arkansas State Medical Board Rule 2.8: a new patient relationship may be formed via real-time audio-and-visual technology (an online questionnaire, audio-only, email, text, or fax alone are insufficient), after which prescribing of non-controlled drugs is permitted. This audio-plus-visual requirement is a standard-of-care provision similar to other states rather than a peptide-specific restriction. Compounding follows USP <795>/<797> with no distinctive state GLP-1 rule, and no Arkansas-specific peptide/GLP-1 enforcement was found.

Moderate. The Colorado Medical Board and Pharmacy Board have not visibly targeted peptide compounding, but Colorado generally follows USP guidance closely and out-of-state mail-order compounding is monitored.

Delaware's telehealth practice-of-medicine and prescribing rules are codified in Title 24, Chapter 60 (24 Del. C. §§ 6001–6005; the former § 1769D was repealed and recodified into Chapter 60 in 2021). Section 6003 requires a provider-patient relationship and bars prescribing solely from an internet questionnaire, internet consult, or telephone consult; § 6004 allows that relationship to be established via synchronous audio-video. Compounding under the Board of Pharmacy's 24 DE Admin. Code 2500 requires FDCA 503A, FDA compounding, and USP <795>/<797> compliance, with no Delaware-specific GLP-1/semaglutide restriction. No documented Delaware board enforcement against peptide/GLP-1 compounding was located.

The District of Columbia follows a mainstream posture with no peptide/GLP-1-specific restrictions identified. Under DC Official Code § 3-1201.05 (Telehealth, added by D.C. Law 25-191, effective July 2024), a practitioner-patient relationship may be established through telehealth consistent with the standard of care, and Board of Medicine rules at 17 DCMR § 4618 permit real-time telemedicine to establish the relationship and evaluate the patient. Pharmacy compounding under 22-B DCMR and 17 DCMR Ch. 65 tracks federal 503A norms with no state-specific GLP-1/semaglutide rule found. No documented DC board enforcement against peptide/GLP-1 compounding or telehealth prescribing was located.

Telemedicine runs under Ga. Comp. R. & Regs. 360-3-.07, which lets a physician-patient relationship form remotely when the provider uses technology 'equal or superior' to an in-person exam and holds telemedicine to the same standard of care. Compounding under Chapter 480-11 expressly adopts USP <795> and <797> plus state facility, quality-assurance, and recordkeeping rules. No Georgia-board enforcement specific to peptides or GLP-1 compounding was found; the Board's December 2023 rollback of COVID-era controlled-substance tele-prescribing flexibility is now complete and applies mainly to controlled substances.

Hawaii's telehealth practice-of-medicine statute (HRS § 453-1.3) permits establishing a physician-patient relationship and prescribing via telehealth, but its definition of 'telehealth' is distinctive: standard telephone contacts, fax, and email — alone or combined — do not constitute telehealth unless delivered through an interactive real-time audio-video system, so audio-only prescribing generally does not qualify. Prescribing based solely on an online questionnaire is declared not to meet the standard of care, and opioids require a prior in-person consultation. Compounding under HRS ch. 461 and HAR Title 16 Ch. 95 follows the federal 503A framework with no Hawaii-specific GLP-1/semaglutide restriction. No documented Hawaii board enforcement was found.

Telehealth runs under the Telehealth Act (225 ILCS 150), which holds telehealth to the in-person standard of care but imposes no statutory in-person-exam prerequisite, so a relationship for non-controlled prescribing can be established by real-time audio-video. Compounding under the Pharmacy Practice Act (225 ILCS 85) and 68 Ill. Adm. Code 1330.640 adopts USP-NF standards and limits sterile 'office-use' compounding to registered 503B outsourcing facilities. No IDFPR enforcement action specific to peptides or compounded GLP-1s was found; activity in this space has been federal.

Iowa applies standard telemedicine and compounding frameworks with no peptide/GLP-1-specific rule and no documented board enforcement located. Telemedicine practice is governed by IAC 481-655.9 (recodified from 653-13.11, effective May 2025): a valid physician-patient relationship may be established through a synchronous telemedicine encounter, and a static internet questionnaire is expressly not an acceptable exam. Compounding under IAC 657 ch. 20 adopts USP <795> (nonsterile, 657-20.3) and USP <797> (sterile, 657-20.4); the 'essentially a copy of an approved drug' limit (657-20.12) tracks federal 503A.

Kansas takes a conventional, federally-aligned posture. The Kansas Telemedicine Act (K.S.A. 40-2,212, effective 2019) provides that telemedicine may establish a valid provider-patient relationship and applies the same standards as in-person care; prescribing via telemedicine is governed by the same laws as in-person, and K.S.A. 65-28,135 requires an appropriate assessment and documented medical indication. Compounding follows K.A.R. Article 68-13; HB 2068 (2025, signed) adopts USP <795>/<797>/<825>, with no Kansas-specific GLP-1 ban beyond federal 503A. No documented Kansas board enforcement was found.

Kentucky's Board of Pharmacy treats compounded semaglutide and tirzepatide (now off the FDA shortage list) as generally impermissible 'essentially copies' except in narrow patient-specific circumstances, per its 2025 GLP-1 guidance and a November 14, 2025 compliance alert, enforceable under 201 KAR 2:076 (which adopted the 2022 USP 795/797/800 revisions, full enforcement from January 1, 2026). As with New Jersey and Oregon, this guidance restates federal 503A rather than a distinctive state rule, and no documented board enforcement order against a specific peptide/GLP-1 compounder was found. Telehealth is permitted with informed consent under KRS 311.5975 and 900 KAR 12:005. (A broader pharmacy-safety bill, HB 729, stalled in committee in the 2026 session.)

Maine follows a fairly standard framework with no distinctive state peptide/GLP-1 rule and no documented board enforcement located. Telehealth practice of medicine is governed by the Board of Licensure in Medicine's 'Telemedicine Standards of Practice' rule (02-373 C.M.R. ch. 6); a valid physician-patient relationship may be established via telemedicine 'if the standard of care does not require an in-person encounter,' and prescribing may occur in that encounter. Sterile compounding pharmacies are licensed under the Board of Pharmacy's 02-392 C.M.R. ch. 37, consistent with USP compounding standards; Maine has adopted no semaglutide/GLP-1-specific compounding restriction beyond federal 503A.

Maryland regulates telehealth practice of medicine through the Board of Physicians under COMAR 10.32.05, which requires a patient evaluation adequate to establish diagnoses before prescribing and prohibits prescribing based solely on an online questionnaire; a synchronous audio-video initial visit is a permitted evaluation method. Sterile compounding under the Board of Pharmacy's COMAR 10.34.19 expressly adopts USP <795> (non-sterile) and <797> (sterile). No distinctive restrictive or permissive signal specific to peptides or GLP-1 telehealth was found.

Michigan's telehealth provisions in the Public Health Code (MCL 333.16283, 333.16285) let a prescriber acting within scope prescribe via telehealth without a mandatory prior in-person exam, so a treatment relationship can form by synchronous telehealth; controlled substances must additionally satisfy the Code's bona-fide-relationship requirements. Compounding under Mich. Admin. Code R. 338.533 adopts USP 795 and 797 (2023 revisions) by reference. No Michigan-board enforcement specific to peptides or compounded GLP-1s was found.

Minnesota permits telehealth practice of medicine under Minn. Stat. § 147.033, which expressly allows a physician-patient relationship to be established via telehealth and holds it to the in-person standard of care, with 'telehealth' defined in Minn. Stat. § 62A.673 as real-time two-way interactive audio-and-visual communication (audio-only permitted for limited scheduled/crisis services through July 1, 2027). Compounding under Minn. Rule 6800.3300 mandates USP <795> (non-sterile) and <797> (sterile), placing sterile injectables such as compounded GLP-1s under standard board oversight. No documented Minnesota board enforcement targeting peptides or GLP-1 compounding was found.

Missouri regulates telemedicine prescribing under RSMo § 191.1145 (telehealth definitions), § 191.1146 (physician-patient relationship), and § 334.108 (telemedicine/internet prescriptions), which permit establishing a physician-patient relationship via a telemedicine encounter where the standard of care does not require an in-person visit but bar prescribing based solely on an internet questionnaire. The Board of Pharmacy adopts USP Chapter 797 by reference for sterile compounding under 20 CSR 2220-2.200, standard 503A oversight without unusual state-specific peptide restrictions. No documented Missouri-specific board enforcement targeting peptides or compounded GLP-1s was found.

Montana tracks the federal 503A/USP framework without a distinctive restrictive rule and has no located state-board enforcement targeting peptide or GLP-1 compounding. Telemedicine is governed by MCA Title 37, ch. 3 (definitions at 37-3-102) and Mont. Admin. R. 24.156.813, which permit establishing a provider-patient relationship and prescribing entirely via telemedicine when the standard of care does not require an in-person encounter. The Board of Pharmacy expects compounders to follow USP <795> (nonsterile) and <797> (sterile), with sterile-compounding standards at ARM 24.174.841; no Montana-specific GLP-1/semaglutide restriction was found.

Nebraska is relatively permissive on telehealth and follows standard federal 503A compounding, with no distinctive state restriction or documented peptide/GLP-1 enforcement. Under Neb. Rev. Stat. § 38-1,143 (2019, amended 2021), a credential holder may establish a provider-patient relationship through telehealth and prescribe if otherwise authorized, and § 71-8506 provides that in-person contact is not required. Compounding under § 38-2867.01 requires USP <795>/<797> (as of Jan. 1, 2023) and bars compounding essentially copies of FDA-approved products — a restatement of federal 503A.

New Hampshire's telemedicine practice of medicine is governed by RSA 329:1-d (amended 2025), which permits diagnosis, consultation, and treatment via synchronous or asynchronous electronic media once a physician-patient relationship is established, under the same standard of care as in-person. Compounding under Board of Pharmacy rule Ph 404 requires compliance with current USP including <795> and <797> — a standard 503A framework with no distinctive GLP-1/semaglutide restriction. No NH-specific board enforcement was found in primary sources.

Telemedicine practice runs under the Telemedicine and Telehealth Act (N.J.S.A. 45:1-61 et seq.); N.J.S.A. 45:1-62 requires a proper provider-patient relationship, bars prescribing 'based solely on the responses provided in an online static questionnaire,' and holds telemedicine to the in-person standard of care. Compounding under N.J.A.C. 13:39 incorporates USP <795>/<797>/<800> by reference, with a Prohibited Compounding rule at 13:39-11.25. The State Board of Pharmacy's Statement Concerning Semaglutide Compounding (2023) restricts GLP-1 compounding to narrow 503A circumstances, but that restates federal law as guidance rather than a distinctive state rule, and no documented enforcement pattern against peptide/GLP-1 or telehealth-wellness prescribers was found.

New Mexico permits telehealth with the physician-patient relationship established electronically: the Medical Board's Medical Ethics rule (16.10.8.8 NMAC) allows treatment during a synchronous audio-video telehealth encounter where a history and informed consent are obtained, and permits waiving the physical exam where one would not normally be part of the in-person encounter. Compounding under 16.19.30 NMAC (USP <795>, non-sterile) and 16.19.36 NMAC (USP <797>, sterile) mirrors federal standards with no NM-specific GLP-1 restriction. No documented NM board enforcement against peptide/GLP-1 compounding was found (only a Department of Justice consumer advisory).

Telemedicine prescribing is governed by NC Medical Board Position Statement 5.1.4 (adopted 2010, amended March 2024), which applies an ordinary standard-of-care framework rather than distinctive restrictions and allows a new relationship to form by synchronous or asynchronous telemedicine with no required prior in-person visit. Compounding under 21 NCAC 46 .1810 and the Board of Pharmacy incorporates USP <795>/<797>. No North Carolina-specific enforcement targeting peptides or compounded GLP-1s was found.

North Dakota takes a conventional, USP-aligned posture with no peptide/GLP-1-specific rule and no documented board enforcement. Telemedicine practice of medicine and prescribing are governed by N.D. Cent. Code § 43-17-44, which requires a licensee to establish a bona fide relationship with the patient before diagnosis or treatment, held to the same standard of care as in-person. Compounding under NDAC 61-02-01-03 (Board of Pharmacy) adopts USP <795> (nonsterile) and <797> (sterile), plus <800> for hazardous drugs, with no state-specific additions or GLP-1/semaglutide restriction beyond federal 503A.

Oklahoma permits telemedicine to establish a physician-patient relationship and initiate treatment without a prior in-person exam, under Board of Medical Licensure rules OAC 435:10-7-12/13 and 59 O.S. § 478.1. Compounding under Board of Pharmacy Title 535 (OAC 535:15-10-53 non-sterile, 535:15-10-55 sterile) follows USP-consistent facility standards and generally prohibits compounding a commercially available drug product absent a documented patient-specific need. No documented Oklahoma board or Attorney General enforcement specific to peptides or GLP-1 compounding was found.

Oregon telemedicine practice is governed by ORS 677.135–677.141 and OAR chapter 847 division 025; the Oregon Medical Board does not require an in-person visit to establish the provider-patient relationship, applying the same standard of care regardless of modality. Compounding under OAR chapter 855 division 045 adopts the current USP <795>/<797>/<800> chapters. The Board of Pharmacy's Semaglutide/GLP-1 Position Statement (adopted Feb. 6, 2025) limits GLP-1 compounding to the federal 503A(b)(2) exceptions and warns of enforcement — but, like New Jersey's, it restates federal 503A rather than adding a distinctive state rule, and no documented board enforcement order was found.

No dedicated telemedicine practice statute — the State Board of Medicine applies the general 'acceptable and prevailing standard of care,' and for non-controlled drugs there is no explicit in-person-exam requirement. Compounding runs under 49 Pa. Code §§ 27.601-27.606 (effective 2019), which incorporates FDCA § 503A and the current USP chapters by reference. The distinctive signal is one flagship enforcement action: in October 2025 the State Board of Pharmacy imposed a $1 million penalty on Boothwyn Pharmacy for compounding roughly 30,000 doses of GLP-1 weight-loss drugs in unlicensed, uninspected facilities — an egregious-actor case, not evidence of broad strictness.

Rhode Island permits telemedicine practice and prescribing under the Telemedicine Coverage Act (R.I. Gen. Laws § 27-81) and Board of Medical Licensure and Discipline rules at 216-RICR-40-05-1, which hold online prescribing to the same standard as in-person care and bar prescriptions issued solely on an online questionnaire. Pharmacy compounding rules (216-RICR-40-15-1) adopt USP <795>, <797>, and <800> by reference and bar compounding that is 'essentially a copy of a commercially available product,' mirroring federal 503A rather than adding a distinctive state restriction. No RI-specific board enforcement against peptide or GLP-1 compounding was located.

South Carolina permits telemedicine under the Telemedicine Act, S.C. Code § 40-47-37, which lets a licensee establish a physician-patient relationship and prescribe without a prior in-person visit if the standard of care can be met remotely, subject to a medical-history interview and a bar on prescribing where an in-person exam is necessary. Compounding under S.C. Code Title 40 Ch. 43 and Regulations Ch. 99 (Board of Pharmacy/LLR) imposes no state-specific GLP-1 rule and tracks FDA policy; per the Board's May 2025 newsletter, FDA enforcement discretion for 503A compounding of semaglutide and tirzepatide has ended. No documented SC board enforcement targeting peptides or GLP-1 compounding was found.

South Dakota's telehealth framework (SDCL ch. 34-52, Telehealth Utilization by Health Care Professionals) lets a licensed provider establish a proper provider-patient relationship and prescribe via telehealth, including through a real-time audio-video initial visit, subject to the same standard of care as in-person practice. Pharmacy compounding is overseen by the South Dakota Board of Pharmacy under ARSD article 20:51, which references USP <795>/<797> compounding standards. No distinctive statewide GLP-1/semaglutide compounding ban or documented board enforcement was located — only a Board newsletter advisory about counterfeit/adverse-event GLP-1 supply risks.

Tennessee Practice of Medicine Act, Tenn. Code Ann. § 63-6-204, prohibits diagnosis or treatment without a valid provider-patient relationship — the statute The Peptide Column's own legal disclaimers reference. Telehealth permitted under Tenn. Code Ann. § 63-1-155 but requires an established relationship for prescribing controlled substances.

Utah's Telehealth Act (Utah Code § 26B-4-704, amended 2023; rule R156-1-602) is relatively permissive — it defines synchronous audio-video interaction and lets a provider establish the provider-patient relationship during the encounter, so an initial visit plus prescribing can occur via telehealth. Compounding follows federal 503A with USP <795>/<797>/<800> adopted. The Board of Pharmacy has reported (May 2024 Board newsletter) that DOPL issued citations around compounded semaglutide — targeting unlicensed med spas dispensing it in syringes, out-of-scope dispensing, salt forms, and 503A office-use — but these enforce federal and scope-of-practice baselines rather than a distinctive Utah rule, and the Board's 2025 posture was to monitor FDA. No primary-sourced named enforcement order was found.

Vermont permits establishing a provider-patient relationship and prescribing via telemedicine: under 18 V.S.A. § 9361(b) a Vermont-licensed provider may prescribe after 'an appropriate examination of the patient in person, through telemedicine, or by the use of instrumentation,' held to the in-person standard of care with no mandatory prior in-person visit. Compounding under the Board of Pharmacy's Rule 10-4 (effective Feb. 1, 2026) adopts USP <795>/<797>/<800> and 21 U.S.C. § 353a (503A) with no GLP-1/semaglutide-specific rule. The distinctive friction is licensing, not prescribing: Vermont's telehealth-license regime (26 V.S.A. § 3054) caps an out-of-state provider without a full Vermont license to 20 unique Vermont patients over a two-year term. No Vermont board enforcement specific to peptide/GLP-1 compounding was found.

Virginia permits establishing a bona fide practitioner-patient relationship via telemedicine under Code of Virginia § 54.1-3303, which allows examination through 'face-to-face interactive, two-way, real-time communications' where the standard of care does not require an in-person exam. Compounding under § 54.1-3410.2 requires compliance with USP-NF standards for both sterile and non-sterile compounding and bars regularly compounding 'essentially copies of commercially available' products, reinforced by Board of Pharmacy guidance document 110-36 (effective 2024). No distinctive statewide restriction or documented peptide/GLP-1 enforcement pattern was found.

Moderate. Washington State Medical Commission has not pursued visible peptide-targeted enforcement. The state Pharmacy Quality Assurance Commission follows USP guidance with state additions.

West Virginia telemedicine practice is comparatively permissive: W. Va. Code § 30-3-13a lets a prescriber establish the physician-patient relationship and e-prescribe via synchronous telemedicine (real-time audio-video, with audio-only permitted), though prescribing based solely on an online questionnaire is not an acceptable standard of care. On compounding, the Board of Pharmacy's Statement Concerning Semaglutide Compounding (2023) holds that pharmacies generally may not compound semaglutide as a copy of a commercial product and prohibits salt forms and 'research use only' API, warning of possible FDA and Board enforcement. As with New Jersey, that statement restates federal 503A policy as guidance rather than a distinctive state rule, and no documented enforcement pattern was found.

Wisconsin's telemedicine standards are in Wis. Admin. Code ch. Med 24 (2017), with informed consent under Wis. Stat. § 448.30; a physician-patient relationship may be established via telemedicine (Med 24.03) under the same standard of care as in person (Med 24.05), though prescribing based only on a static electronic questionnaire is expressly deficient (Med 24.07). Compounding under Wis. Admin. Code ch. Phar 15 incorporates USP 795/797/800/825 by reference (2022 revisions, updated by CR 24-092 effective Oct. 1, 2025), aligning with federal 503A. No distinctive state-specific restriction and no documented Wisconsin board enforcement targeting peptides or GLP-1 compounding was found.

Permissive jurisdiction with established compounding infrastructure. Arizona Medical Board has issued occasional disciplinary actions but no broad pattern of peptide-targeted enforcement. Strong 503A presence.

Permissive. Large concentration of anti-aging and wellness clinics offering peptide therapies. The Florida Board of Medicine has not pursued the visible enforcement pattern seen in California or New York. Telehealth was expanded under HB 23 (2019).

Idaho is one of the least-regulated states for both telehealth and compounding, on a cited statutory basis. The Idaho Virtual Care Access Act (Idaho Code §§ 54-5701–54-5714) and prescribing statute § 54-1733 let a prescriber establish a patient relationship and prescribe through virtual care with no prior in-person visit, subject only to the Idaho community standard of care and a bar on prescribing 'based solely on a static online questionnaire.' The Board of Pharmacy's compounding rule (IDAPA 24.36.01.700) adopts USP 795/797 with no GLP-1-specific overlay. The only Idaho-specific GLP-1 items are consumer counterfeit/fraud advisories, not restrictions on legitimate 503A compounding.

Permissive. Wellness and anti-aging clinic concentration in Las Vegas. Nevada State Board of Pharmacy has not surfaced active peptide-targeted enforcement.

Among the more permissive jurisdictions for peptide therapy. Multiple 503A compounding pharmacies operate openly. Texas Medical Board has not pursued the visible enforcement pattern that California has. Texas was an early adopter of broad telehealth authorization (SB 670, 2019).