GLP-1 Telehealth Prescribing Rules by State (2026)

Semaglutide, tirzepatide, and liraglutide are not controlled substances, so no federal rule requires an in-person visit before you prescribe them over telehealth. What governs instead is state law: each state’s telehealth standard of care, the license you need where the patient is sitting, and, for shipped product, the nonresident pharmacy registration of whoever dispenses it. Of the 14 states we verified against primary sources, 2 (Mississippi, New Jersey) require a real-time encounter for a non-controlled drug and a third (Georgia) requires a prior personal exam or an exam by technology equal or superior to one, 5 (Georgia, Idaho, Indiana, Mississippi, New Jersey) reject prescribing on a questionnaire or electronic consultation alone, and none requires an in-person exam up front for a non-controlled GLP-1.

The pages that rank for this question are mostly telehealth vendor blogs, and they conflict. One widely copied page claims California, Texas, and Florida each removed an in-person requirement in early 2026 and now mandate audio-video visits with 90-day follow-ups. We could not confirm any of it from a statute, board rule, or bill record, and the Texas bill number it cites is a truancy bill (details in the “Not verified” section below). This guide works only from primary sources, state by state, with the exact citation next to each claim.

Current as of October 2026.

Can you prescribe a GLP-1 over telehealth without an in-person visit?

In most of the states we checked, yes, provided the evaluation you do remotely meets the same standard of care as an in-person one. The federal baseline explains why: semaglutide, tirzepatide, and liraglutide do not appear on DEA’s alphabetical list of controlled substances (checked October 22, 2026), while phentermine does (Schedule IV). The DEA telemedicine flexibilities and the Ryan Haight in-person rule therefore govern phentermine, not GLP-1s. If you also prescribe phentermine, read our DEA telemedicine rule guide.

That leaves four layers: the state telehealth statute or board rule, the license required where the patient is located, nonresident pharmacy registration for shipped product, and, in one state we found (Florida), a weight-loss-specific rule. The table below sets out the first two layers for each verified state, with controlled-substance triggers noted where they differ.

The sections below give the language behind the entries that need the most explanation.

Which states require a live video visit before prescribing?

Two states in our set require a real-time encounter outright for a non-controlled drug, and a third comes close. Mississippi’s board rules (as last amended February 2026) say store-and-forward technology may be used “to enhance, but never replace, real-time provider-patient interaction,” which may be audio-visual or audio-only where medically appropriate. New Jersey requires “interactive, real-time, two-way communication technologies” that generally include a video component (6B.5(c)); without video, real-time audio plus store-and-forward is allowed only if, after reviewing records, the licensee determines the standard of care can be met as if the service were provided in person.

Georgia does not name a modality: Rule 360-3-.07 (effective September 28, 2020) is satisfied by a prior personal exam by a Georgia-licensed provider or by an exam using technology and peripherals equal or superior to a personal one, so what matters is that the provider has personally examined the patient or can examine by equal-or-superior technology, not which modality carries the visit.

Elsewhere the rule is modality-neutral. Texas lists synchronous audiovisual interaction, asynchronous store-and-forward, or another audiovisual technology that lets the practitioner meet the standard of care, and Ohio allows synchronous or asynchronous technology during an initial visit (ORC 4743.09, effective April 9, 2025) if the in-person standard is met.

Which states ban questionnaire-only prescribing?

Five states in our set address the questionnaire, or the electronic-only consultation, directly, and they do not agree.

• New Jersey is the bluntest: a licensee “shall not issue a prescription based solely on responses provided in an online questionnaire” unless a proper licensee-patient relationship under 6B.4 has been established.
• Idaho says that treatment based solely on a static online questionnaire does not constitute an acceptable standard of care (Idaho Code 54-5706, as amended 2023).
• Mississippi says a simple questionnaire without an appropriate exam violates the policy and may subject the physician to board discipline.
• Indiana excludes an “Internet questionnaire” from the definition of telehealth unless the practitioner has an established relationship with the patient (IC 25-1-9.5-6, per the Professional Licensing Agency).
• Georgia makes it unprofessional conduct to prescribe controlled substances or dangerous drugs “for a patient based solely on a consultation via electronic means” (Rule 360-3-.02(5), amended effective August 27, 2024), except within a valid physician-patient relationship under O.C.G.A. 33-24-56.4, on-call coverage up to a 30-day supply, or a documented emergency. The rule is not questionnaire-specific; it reaches any electronic-only consultation outside a valid relationship.

California goes the other way. Bus. & Prof. Code 2242(a) says an appropriate prior examination “does not require a synchronous interaction” and can be achieved through telehealth “including, but not limited to, a self-screening tool or a questionnaire,” as long as the licensee complies with the standard of care. The exposure is on the other side of the line: Bus. & Prof. Code 2242.1 bars prescribing dangerous drugs on the Internet for delivery in California without an appropriate prior examination and medical indication, with a fine or civil penalty of up to $25,000 per occurrence.

Florida needs its own paragraph. Fla. Stat. 456.47 counts synchronous or asynchronous telecommunications as telehealth and says a provider whose evaluation is sufficient to diagnose and treat is not required to conduct a physical examination first. But the weight-loss rule, Rule 64B8-9.012 (last amended August 8, 2022), requires an initial evaluation that includes a “physical and complete history,” tests related to medical treatment for weight loss, referrals “as indicated by the physical examination, history, and testing,” written informed consent, and re-evaluation at least once every 3 months. A questionnaire alone will not satisfy those elements. The Board’s 2022 rulemaking notice described the amendment as one that “allows for the use of telemedicine for such prescribing,” but the adopted text still refers to a physical examination, so document what examination the technology actually delivered.

Which states ever require an in-person exam?

For a non-controlled GLP-1, none of the 14 requires one before the first prescription. Several have triggers later or in narrower circumstances:

• Alabama: if a physician or practice group provides telehealth more than four times in 12 months to the same patient for the same condition without resolution, the physician must see the patient in person within a reasonable time not exceeding 12 months, or refer, per the Alabama Board of Medical Examiners (Ala. Code 34-24-700 to 707, enacted by Act 2022-302). For weight management, where one condition is treated across many visits, flag it.
• Georgia: providers must make diligent efforts to have the patient seen and examined in person at least annually by a Georgia-licensed physician, PA, or NP.
• Ohio: if the standard of care cannot be met by telehealth, the provider shall see the patient in a reasonable timeframe or refer (OAC 4731-37-01, effective February 28, 2023). Under ORC 4743.09, a professional may also choose to require an in-person visit.
• Louisiana, New Jersey, New York: in-person triggers apply to controlled substances or Schedule II only. Louisiana also says a provider need not conduct an in-person history or physical first (effective January 1, 2024).

Do you need a license in the patient’s state?

Yes, in every state in the table, and the location that counts is the patient’s. Georgia requires that all treatment and consultations be done by Georgia-licensed practitioners; Ohio’s rule requires the provider to verify the patient’s physical location in Ohio; South Carolina requires a South Carolina license with narrow exceptions; Louisiana requires licensing or registration of out-of-state providers; Indiana deems a practitioner located elsewhere to be providing health care services in Indiana once a relationship is formed with an Indiana patient; and California makes practicing without a valid certificate a public offense (Bus. & Prof. Code 2052). Mississippi’s rule is explicit: the practice of medicine is deemed to occur in the location of the patient, so only Mississippi-licensed providers may practice telemedicine. Idaho says virtual care is considered rendered at the physical location of the patient, and it reaches providers located outside Idaho.

Texas requires a full license under 22 TAC 175.1 (effective January 9, 2025), and Occ. Code 151.056(a) treats an out-of-state person acting on a Texas patient care service as practicing there.

Exceptions are narrow. Alabama exempts only irregular or infrequent services (fewer than ten days or ten patients in a calendar year), Idaho’s 54-5713 lists limited situations, and Florida offers registration under Fla. Stat. 456.47(4) with an active unencumbered license, no discipline in five years, an in-state agent, and insurance. If you also own the practice through a professional entity, see NP weight loss clinic ownership by state.

Which states regulate out-of-state pharmacies shipping GLP-1s to their residents?

The obligation belongs to the pharmacy, but you choose the pharmacy. Four states in our research have rules worth reading before you pick one: two state a registration mandate (Florida and Montana), one creates a nonresident license class (Texas), and one restricts shipments of compounded product (Colorado).

Ask the compounder or the brand dispensing pharmacy for its registration number in each state you ship to, and keep it in the vendor file. The exposure when product comes from an unlicensed source is real: the Ohio Board of Pharmacy’s settlement agreement in Ree’s Bar of Beauty (Case A-2025-0299, summary suspension September 30, 2025, settled with a $25,000 penalty) involved compounded semaglutide and tirzepatide bought from an unlicensed distributor. Whether compounded product is permissible at all is a separate question, covered in our guide to compounded GLP-1 prescribing rules.

What does the first telehealth visit have to include?

The state rules differ on modality but converge on the elements. Each element below is tied to a rule cited above:

• Identity and location verified and documented. Required by Ohio (identity and physical location) and New Jersey (identity under 6B.4; originating site under 6B.5(b)), among others.
• Consent to telehealth documented. California’s Bus. & Prof. Code 2290.5(b) requires documented verbal or written consent before telehealth is delivered, and Ohio’s rule requires documented consent. Florida adds written informed consent for weight-loss prescribing under Rule 64B8-9.012(5).
• History and records reviewed before the encounter. New Jersey requires that medical history and records be reviewed before an initial encounter, and Texas’s store-and-forward path depends on relevant clinical records or images.
• An evaluation that meets the in-person standard, by whatever modality can deliver it, as Mississippi, Virginia, and Florida (a “physical and complete history” plus tests) each require.
• Diagnosis and treatment plan, including contraindications. Ohio’s rule requires it, and Idaho requires history and symptoms sufficient to diagnose and identify contraindications.
• Follow-up arranged. Texas requires follow-up guidance and, if the patient has a primary care physician and consents, a report to that physician within 72 hours; Florida requires re-evaluation at least every 3 months.
• A record of all of the above, required in Louisiana (40:1223.4(B)(8)) among others. Our EHR requirements for weight loss clinics guide covers what a system needs to support this.

What have boards actually disciplined?

The published board order that fits this fact pattern most exactly comes from Mississippi. In the Corrected Determination and Order in the matter of Laura Purdy, M.D. (May 18, 2023), the Mississippi State Board of Medical Licensure found that the licensee conducted all patient encounters by instant message through a phone application and website and only reviewed questionnaires completed at registration; the complaint that opened the case alleged she had prescribed medications such as Ozempic via telehealth with no audio or video contact. The Board found she failed to establish a valid physician-patient relationship and used a questionnaire in lieu of a physical examination. The three-month suspension was immediately stayed, she completed a CPEP PROBE course, and she was barred from telehealth practice in Mississippi until June 17, 2023.

We searched the Texas Medical Board newsroom and Florida Department of Health sources and found no published order specific to GLP-1 questionnaire prescribing, so we do not claim one exists. Separately, the FDA sent warning letters to 30 telehealth companies on March 3, 2026 over compounded GLP-1 marketing.

Where does the DEA rule still apply?

Only to phentermine. The flexibility under 21 CFR 1307.41 is scheduled to expire at the end of December 31, 2026, and the details are in the DEA guide. State controlled-substance triggers in the table (Alabama, Louisiana, New Jersey, New York, Indiana) sit on top of that federal rule, not in place of it.

Not verified

We could not verify Michigan (MCL 333.16285, where the legislature’s site returned server errors on every attempt), Oklahoma (59 O.S. 478.1, where only bill drafts were retrievable), or Arkansas (17-80-117, where no primary source for the current text was available), so they are left out of the table. Montana appears only in the pharmacy table: MCA 37-3-342 was repealed in 2015, and we did not locate a current medical board standard. We also could not confirm vendor claims of early-2026 changes in California, Texas, and Florida. The Texas bill number those pages cite, HB 2847 in the 89th Regular Session (2025), is captioned “Relating to truancy and parental contribution to nonattendance of school; increasing a criminal penalty” and last moved on March 19, 2025 (fetched October 22, 2026). Florida’s Rule 64B8-9.0141 on telemedicine standards was repealed effective October 14, 2019.

This is a compliance guide, not legal advice. State laws and board rules change, and your counsel and the relevant state boards govern what applies to your practice.

Whether a state wants a video visit, a documented history, or a three-month re-evaluation, the work lands in the chart. PrismEHR gives wellness practices video telehealth, eRx with EPCS, a patient portal, intake forms from the form builder, built-in messaging, and GLP-1 management and progress-visit documentation templates, so the elements above can be captured at each visit. For the compounding side of the same decision, see our guide to compounded GLP-1 prescribing rules.