Every cash GLP-1 service publishes a list of states it serves, usually in small type near the checkout. That list is often read as a business decision about market size. It is closer to a compliance disclosure: a statement about which state legislatures and boards the company believes it has satisfied. The rules behind it are published, they are not uniform, and on at least one central question two states say the opposite thing in their own statutes.
What follows describes what specific published rules say. It is not legal advice, it does not describe any particular seller’s compliance, and it covers only the four jurisdictions whose primary texts are quoted here. A missing state list is one of the tells listed in the red-flag article; this page is about what the list is made of.
The law that applies is the law where the patient is sitting
Telehealth does not move a patient to the clinician. It moves the clinician into the patient’s state, and that state’s professional statutes attach. Florida states the consequence directly: a health care professional not licensed in Florida may provide services to a patient located in Florida using telehealth only if that professional registers with the applicable board, and must then practice consistently with the prevailing professional standard of practice for someone providing the same care in person.[7]
That requirement is not a formality that everyone quietly ignores. When states temporarily waived in-state licensure during the public health emergency, an analysis of commercial claims from 2,037,977 people in three metropolitan areas straddling Midwestern state borders found out-of-state telehealth rose as a share of out-of-state mental health care by 1,679.76% after licensure waivers and 467.48% after waivers of the pre-existing relationship requirement.[1] Those are large multiples of a small base, and the direction is the point: remove the rule and behavior changes immediately, which is what a binding constraint looks like.
The waivers were temporary. What replaced them is a patchwork of expedited licenses, licensure compacts and credentialing platforms whose coverage differs by state and by profession, and whose relative usefulness the Federation of State Medical Boards itself has described as an open question.[2] A company that wants to serve all fifty states has to solve that patchwork fifty times.
Two states, one question, opposite answers
The question that decides whether an asynchronous intake form can carry a first prescription is whether it counts as a proper examination. California answers it permissively, in statute. Business and Professions Code section 2242 makes prescribing without “an appropriate prior examination and a medical indication” unprofessional conduct, and then defines the term: an appropriate prior examination does not require a synchronous interaction between the patient and the licensee and can be achieved through the use of telehealth, including, but not limited to, a self-screening tool or a questionnaire.[4]
Idaho answers it restrictively, also in statute. Idaho Code section 54-1733 requires a prescriber-patient relationship that includes a documented patient evaluation adequate to establish diagnoses, if applicable, and identify underlying conditions and/or contraindications to the treatment, and states that treatment, including issuing a prescription drug order, based solely on a static online questionnaire does not constitute a legitimate medical purpose.[5] The same section allows a valid relationship to be established through virtual care technologies provided the applicable Idaho community standard of care is satisfied, and the Idaho Virtual Care Access Act repeats that formulation at section 54-5705.[6]
Read those two side by side. A form-only intake is expressly contemplated by one statute and expressly excluded by the other, and neither is an outlier position. So the widely repeated claim that a questionnaire is never a real medical evaluation is not a general fact about American medicine; it is a true statement about some states and a false one about others. That is precisely why a seller ships to some states and not others, and why the composition of an intake changes what the list can contain.
One word in the Idaho text is doing work: static. A fixed set of questions that everyone answers is a static questionnaire. An intake that branches on the answers, escalates to a live clinician when a flag trips, or requires a recorded conversation before release is something else, and Idaho’s own text routes that question to the community standard of care rather than to a modality rule. Whether a given intake clears that line is a judgment for the board, not for a buyer or a review site.
The pharmacy is licensed separately, and also by your state
Prescribing is only the first half. The package has to be dispensed by a pharmacy that is permitted to send it where you live. Florida again states the rule plainly: any pharmacy located outside the state that ships, mails or delivers a dispensed medicinal drug into Florida is a nonresident pharmacy and must be registered with the board. Registration carries conditions — a current valid license in its home state, disclosure of the pharmacist managing prescriptions for Florida residents, records held separately and retrievably, compliance with lawful requests from regulators, and a toll-free line staffed for at least 40 hours a week across six or more days so a patient in Florida can reach a pharmacist. Florida also prohibits an unregistered nonresident pharmacy from advertising its services in the state.[8]
That is one state’s version of a requirement most states impose in some form, and it is why the identity of the dispensing pharmacy matters as much as the identity of the telehealth brand. Which pharmacy actually fills the order, and what can be checked about it, is the subject of the pharmacy vetting article.
Federal law does not fill the gap. It points back at state law
The federal exemption that makes a compounded GLP-1 possible is section 503A of the Federal Food, Drug, and Cosmetic Act, codified at 21 U.S.C. § 353a. It switches off three requirements — new drug approval, adequate directions for use, and current good manufacturing practice — but only for a product compounded for an identified individual patient based on the receipt of a valid prescription order, and only where the compounding is done by a licensed pharmacist in a State licensed pharmacy or by a licensed physician, on the order of a practitioner authorized by State law to prescribe drugs.[9]
Read that clause as a buyer rather than a lawyer. The federal exemption does not define a valid prescription, does not say what examination precedes one, and does not license the pharmacy. It borrows all three answers from state law. If the prescription is not valid where the patient is, the federal condition is not met either, and the whole structure rests on the state rules described above. The three sections switched off are the subject of the approval-status article.
The FDA describes the same division of labor from its side. Its compounding questions and answers state that compounded drugs are not FDA-approved, that the agency does not verify their safety, effectiveness or quality before they are marketed, and that state boards of pharmacy have primary responsibility for the day-to-day oversight of state-licensed pharmacies that are not registered as outsourcing facilities. The same page notes that consumers buying compounded drugs through online pharmacies and telehealth platforms may not know the identity of the compounder or whether it is appropriately licensed and regulated.[10] The difference between the two compounder categories is set out in the 503A and 503B article.
The federal telemedicine rule people cite does not apply here
Discussion of telehealth prescribing usually arrives carrying the controlled-substance rules: the in-person examination requirement that was suspended during the pandemic, and the enforcement history around telemedicine-only platforms prescribing stimulants.[3] Those rules govern scheduled drugs. Semaglutide and tirzepatide are not controlled substances, so that federal layer is simply absent, and its absence removes the one nationally uniform constraint from the picture. What is left is state law, which is the layer that varies.
What an intake form can and cannot substitute for
An intake can collect a history, a medication list, a weight, an allergy list and a set of contraindication screens, and in a state that accepts an asynchronous evaluation it can be the legal basis for a first prescription. What it cannot do is produce anything it does not ask for. A form that never asks about a personal or family history of medullary thyroid carcinoma has not screened for it; one that never asks about pregnancy or contraception has not screened for that either. Those are not legal questions, they are questions about what is on the form, and they are checkable by filling one out.
Nor does a form create follow-up. Every dose escalation, every adverse event, every decision to pause is a clinical event, and the route back to a clinician is a property of the service rather than of the intake. What each seller’s process actually includes is what the seller write-ups record, on the criteria described in the methodology.
How to read a state list
Treat it as an assertion with a date on it. A list that grows is a company clearing gates; a list that shrinks usually means a rule changed or a registration lapsed, and a state that disappears between two visits is worth asking about. Treat a service that will not say which states it covers, or which pharmacy dispenses, as having declined to answer a question that has a published answer.
And treat the whole structure as conditional. Compounded drugs are not FDA-approved and are not reviewed by the FDA for safety, efficacy or quality before they are dispensed; what makes a particular vial lawful is a chain of state-level conditions that a buyer cannot inspect directly and a seller can only assert. The difference between that chain and an approved product’s is the subject of the compounded versus brand article. Questions about what any of this means for a specific situation belong with a licensed professional in the relevant state.