State Medical Board Positions on Peptide Therapy

If you're a physician prescribing peptide therapy — or a patient receiving it — the FDA is only one of the regulators you need to worry about. State medical boards have their own authority over how providers practice medicine within their borders, and in 2025-2026, several boards have used that authority to discipline providers involved in peptide prescribing.

This guide covers how state medical boards view peptide therapy, which states have taken notable positions, how "standard of care" applies to unapproved peptides, and what providers and patients need to know about the liability risks.

Table of Contents

How State Medical Boards Regulate Peptide Therapy
The Standard of Care Problem with Unapproved Peptides
Off-Label vs. Unapproved: A Distinction That Matters
Notable State Positions and Enforcement Actions
Cross-State Coordination on Disciplinary Actions
Board of Pharmacy Enforcement
Provider Liability: Where the Legal Exposure Lies
How Providers Can Protect Themselves
What Patients Should Know
The Bigger Picture: Medical Freedom vs. Patient Safety
FAQ
The Bottom Line
References

How State Medical Boards Regulate Peptide Therapy

State medical boards exist to protect the public by licensing physicians, setting practice standards, and disciplining providers who fall below acceptable standards of care. Every state has one, and their authority is independent of federal agencies like the FDA or DEA.

When it comes to peptide therapy, medical boards evaluate prescribing practices through several lenses:

Standard of care compliance. Is the provider practicing within the bounds of what a reasonable, similarly qualified physician would do? Prescribing substances with no FDA approval and limited human data raises this question immediately.

Evidence-based practice. Most boards require that treatment decisions be supported by evidence. The weight of evidence required varies by state, but "I saw it on a biohacking podcast" does not qualify anywhere.

Proper patient evaluation. Boards expect a thorough medical evaluation before prescribing — including history, physical examination (or thorough telehealth evaluation), relevant lab work, and documented clinical reasoning.

Informed consent. Patients must be told that a treatment is not FDA-approved, what the known and unknown risks are, and what alternatives exist. Inadequate informed consent is a standalone violation in most states.

Sourcing and dispensing compliance. Where the peptides come from matters. Boards expect prescriptions to be filled through legitimate pharmacies. Using research-grade peptides obtained from online vendors is a red flag that can trigger investigation.

Medical boards do not need to wait for patient harm to act. Several states have disciplined providers based on the finding that prescribing practices deviated from accepted standards — even when no patient complaint was filed.

The Standard of Care Problem with Unapproved Peptides

Here's the core legal issue that most providers underestimate: prescribing an unapproved substance is not the same as prescribing an FDA-approved drug for an off-label use.

When a physician prescribes metformin (FDA-approved for diabetes) for weight management (an off-label use), they are prescribing a drug that has been through rigorous safety and efficacy testing, just for a different indication than the one on the label. This is accepted medical practice, and courts and medical boards generally support it.

But when a provider prescribes BPC-157 or CJC-1295, they're prescribing a substance that has no FDA approval for any indication. There is no "label" to prescribe off of. The substance has never been through the FDA's drug approval process.

This distinction matters because in a malpractice suit or board investigation, the provider isn't just defending a bad outcome — they're defending the decision to use a substance that the FDA does not recognize as a medicine. As healthcare attorney D.J. Holt has written, prescribing "Research Only" chemicals for human use is "by definition, considered a breach of the medical standard of care."

The practical consequences:

Malpractice insurance may not cover claims. Many malpractice policies exclude coverage for the administration of unapproved drugs. A provider who faces a lawsuit over peptide therapy may find themselves without insurance protection.
The burden of proof shifts. When a provider uses an FDA-approved drug and a bad outcome occurs, the patient must prove the provider was negligent. When the provider uses an unapproved substance, the provider may need to justify why they chose that approach at all.
Board investigations can be triggered by sourcing alone. The presence of research-labeled peptide vials in a clinic — even without a patient complaint — has been sufficient to trigger disciplinary proceedings in some states.

Off-Label vs. Unapproved: A Distinction That Matters

This confusion persists throughout the peptide therapy community, so it's worth being precise.

Term	Meaning	Legal Status
FDA-approved	Drug has completed the NDA process and is approved for a specific indication	Legal to prescribe for the approved indication
Off-label	FDA-approved drug prescribed for a condition other than its approved indication	Legal and widely accepted; supported by courts
Unapproved	Substance has never been approved by the FDA for any indication	Legally problematic; no federal approval exists

Examples of each:

FDA-approved: Semaglutide (Ozempic) for type 2 diabetes
Off-label: Semaglutide prescribed for weight loss before Wegovy received its separate approval
Unapproved: BPC-157 for any purpose — it has never been approved for anything

Many providers in the peptide therapy space describe their practice as "off-label prescribing." This is inaccurate for most wellness peptides. Off-label prescribing assumes the existence of a label — an FDA-approved drug with documented safety and efficacy for at least one indication. Peptides like BPC-157, Thymosin Alpha-1, and ipamorelin have no label. Calling their prescribing "off-label" misrepresents the legal and medical reality.

Some peptides do have legitimate off-label prescribing pathways. Sermorelin, which was previously FDA-approved as a diagnostic agent, is sometimes prescribed off-label for growth hormone-related conditions. Tesamorelin (Egrifta), approved for HIV-associated lipodystrophy, might be prescribed off-label for other conditions. These are genuine off-label uses because the drugs have FDA-approved labels.

Notable State Positions and Enforcement Actions

State medical boards do not publish formal "position papers" on peptide therapy the way medical societies might. Instead, their positions emerge through enforcement actions, board meeting minutes, and the standards they apply when investigating practitioners.

Ohio

The State Medical Board of Ohio has been among the most active in peptide-related enforcement. In 2024-2025, the board:

Took disciplinary actions against providers for prescribing without proper examination, diagnosis, or medical records — violations that frequently arise in peptide clinic settings
Coordinated with medical boards in Florida and Texas on cross-state disciplinary actions against providers with multi-state practices
Applied its "minimal standards of care" framework to cases involving prescribing of non-controlled medications without proper patient evaluation

Ohio's October 2025 Formal Action Report included cases where providers prescribed medications "without properly examining the patient, obtaining a diagnosis, or creating a medical record" — a pattern common in high-volume peptide clinics that prioritize throughput over proper evaluation.

Florida

Florida has one of the highest concentrations of peptide therapy clinics in the country, particularly in South Florida. The Florida Board of Medicine has:

Pursued enforcement against providers involved in grey-market peptide sourcing
Coordinated with the Ohio and Texas boards on multi-state disciplinary cases
Applied scrutiny to med spa operations that prescribe peptide therapies outside traditional medical settings

The Florida Department of Health has issued final orders against providers whose peptide prescribing practices were found to deviate from acceptable standards, with those orders then serving as the basis for disciplinary action in other states where the provider held licenses.

Texas

The Texas Medical Board (TMB) has been consistently active in disciplining providers across multiple categories relevant to peptide therapy:

At its August 2024 meeting, the TMB disciplined 22 physicians, including orders related to unprofessional conduct, quality of care violations, and nontherapeutic prescribing
At its October 2024 meeting, 18 physicians were disciplined, including actions for nontherapeutic prescribing and improper supervision or delegation
At its August 2025 meeting, 21 physicians were disciplined, with cases involving nontherapeutic prescribing and standard-of-care violations

Texas has also applied its "corporate practice of medicine" doctrine to med spa operations, disciplining providers who enter contractual relationships with non-medical corporations at multiple clinic locations — a common business model for peptide therapy chains.

California

California's Medical Board has taken action against providers involved in med spa practices that prescribe peptide therapies, with a focus on:

Corporate practice of medicine violations
Supervision requirements for nurse practitioners and physician assistants who prescribe
Advertising standards for medical practices offering peptide services

Other States

While Ohio, Florida, Texas, and California have been the most visibly active, other states are watching. State medical boards communicate through organizations like the Federation of State Medical Boards (FSMB), and enforcement trends tend to spread as boards learn from each other's cases.

Cross-State Coordination on Disciplinary Actions

One of the most significant developments in state-level peptide regulation is the increasing coordination between medical boards across state lines.

When a physician holds licenses in multiple states — common among telehealth providers — a disciplinary action in one state often triggers investigations in every other state where the provider is licensed. The Ohio Medical Board's formal action reports from 2024-2025 show this pattern clearly:

Florida-to-Ohio coordination: The Ohio Board took action against providers based on prior Florida Board of Medicine final orders
Texas-to-Ohio coordination: The Ohio Board referenced Texas Medical Board disciplinary actions as the basis for its own proceedings
Multi-state cascading: Providers disciplined in one state faced subsequent actions in two or three additional states

This creates a multiplier effect. A single adverse finding in one state can result in license suspensions or restrictions across every jurisdiction where a provider practices. For telehealth peptide providers who hold licenses in 10 or more states, the exposure is substantial.

The practical takeaway for providers: a risky prescribing decision in one state does not stay in one state. Board actions are reported to the National Practitioner Data Bank (NPDB) and are visible to every medical board in the country.

Board of Pharmacy Enforcement

Medical boards aren't the only state-level regulators involved. State boards of pharmacy govern compounding pharmacies and the dispensing of prescription medications, and they've become an independent enforcement vector in the peptide space.

Board of pharmacy actions relevant to peptide therapy include:

License investigations of compounding pharmacies that prepare peptide formulations using substances not authorized for compounding
Actions against pharmacies that fill prescriptions from telehealth providers without adequate verification of the provider-patient relationship
Enforcement related to USP 795/797 compliance — the sterility and compounding standards that pharmacies must follow

In some states, the board of pharmacy and the medical board coordinate their investigations. A pharmacy flagged for compounding a Category 2 peptide may lead to an investigation of the prescribing provider, and vice versa.

Provider Liability: Where the Legal Exposure Lies

Providers who prescribe peptide therapy face legal exposure from multiple directions simultaneously:

State medical board discipline. This can include license suspension, restriction, probation, reprimand, or revocation. Board discipline also triggers reporting to the NPDB, affecting the provider's ability to be credentialed at hospitals, participate in insurance networks, or obtain future licenses.

Civil malpractice liability. If a patient is harmed by a peptide treatment, the provider faces a malpractice lawsuit. The use of an unapproved substance weakens the provider's defense because the standard of care does not generally support administering products that the FDA has not evaluated for safety and efficacy.

FDA enforcement. The FDA can pursue enforcement against individual prescribers who distribute unapproved drugs, though this is less common than actions against companies. In egregious cases, criminal prosecution under the FD&C Act is possible.

State consumer protection actions. State attorneys general have begun using consumer protection statutes against medical practices that market peptide therapies with misleading claims.

A single adverse event — gastroparesis, vision changes, infection from a contaminated product — can trigger multiple simultaneous proceedings: a malpractice lawsuit, a board complaint, and potentially a state AG investigation. As one healthcare attorney noted, "One claim could bankrupt a small clinic."

How Providers Can Protect Themselves

For physicians who want to practice peptide therapy within the legal framework, the compliance requirements are clear, if demanding:

1. Prescribe only legally available peptides. This means FDA-approved peptides or those that can be legally compounded under Section 503A. Check the FDA's Category 1/Category 2 lists before prescribing any compounded peptide. For the latest status, see our BPC-157 legal status guide.

2. Document medical necessity thoroughly. For every peptide prescription, chart why other approved therapies were inadequate and why the peptide is believed to be the best option for this specific patient. "Patient requested it" is insufficient.

3. Obtain proper informed consent. Have patients sign a written informed consent that:

Acknowledges the peptide is not FDA-approved (if applicable)
Describes known and unknown risks
Lists alternative treatments that were considered
Explains the experimental nature of the treatment

4. Source exclusively from licensed pharmacies. Use 503A compounding pharmacies or 503B outsourcing facilities that are licensed in the relevant state and can provide certificates of analysis. Never use research-grade peptides from online vendors.

5. Conduct genuine medical evaluations. Complete intake forms, medical history, physical examination (in-person or thorough telehealth), relevant lab work, and documented clinical reasoning for each patient. High-volume, minimal-evaluation models invite scrutiny.

6. Maintain follow-up protocols. Schedule follow-up appointments, order appropriate monitoring labs, adjust dosages based on patient response, and document everything. Prescribe-and-forget models are indefensible.

7. Stay current on regulatory changes. The peptide regulatory environment is changing rapidly. Peptides that were legally compoundable six months ago may not be today. For ongoing updates, see our complete FDA regulation timeline.

8. Consult a healthcare regulatory attorney. Before establishing or expanding a peptide therapy practice, have an attorney review your business model, marketing materials, and prescribing protocols. This is an investment, not an expense.

For a broader guide on talking to your doctor about peptides from the patient perspective, see our how-to section.

What Patients Should Know

If you're a patient considering peptide therapy, state medical board positions should factor into your decision-making:

Verify your provider's license. Every state medical board maintains a public license lookup tool. Check that your provider's license is active and unrestricted. Look for any disciplinary history.

Ask about the legal status of the peptide. A provider who can explain whether the peptide they're prescribing is FDA-approved, compounded under 503A, or something else entirely is a provider who knows the regulatory terrain. One who dismisses the question is a warning sign.

Ask where the peptide comes from. "From our pharmacy partner" should be verifiable. Ask for the pharmacy name and license number. Cross-reference with your state's Board of Pharmacy.

Understand that "off-label" does not mean "unapproved." If a provider tells you a peptide like BPC-157 is being prescribed "off-label," ask which FDA-approved use it has. If they can't answer, the term is being used incorrectly.

Know that you have recourse. If you experience an adverse event or believe your provider was negligent, you can file a complaint with your state medical board. Complaints can be filed online in most states. The board will investigate independently — you do not need to hire an attorney to file a board complaint.

For help evaluating peptide therapy providers, see our guide on choosing a peptide therapy clinic.

The Bigger Picture: Medical Freedom vs. Patient Safety

The peptide therapy debate sits at the center of a broader tension in American medicine: medical freedom versus regulatory oversight.

On one side, proponents argue that physicians should have the authority to prescribe peptides with evidence of benefit (even if only from animal studies) when patients provide informed consent. They view the FDA's compounding restrictions as overreach that restricts access to potentially beneficial therapies and pushes patients toward riskier alternatives.

On the other side, regulators argue that allowing providers to prescribe unapproved substances with limited safety data exposes patients to unknown risks. The FDA's position is that the drug approval process exists to protect patients, and bypassing it — no matter how promising the preclinical data — puts people in danger.

Some physicians have navigated this tension by shifting to education-only models — discussing peptide mechanisms and research without directly prescribing. Others work exclusively with legally compoundable peptides, accepting the narrower range of options in exchange for regulatory compliance.

Where this tension resolves will depend largely on clinical data. If peptides like BPC-157 eventually generate human trial data sufficient for FDA approval or Category 1 reclassification, the regulatory barriers will diminish. Until then, providers who prescribe unapproved peptides do so in a legal environment where the risks are real and growing.

FAQ

Can a doctor lose their license for prescribing peptides?

Yes, depending on the circumstances. Prescribing unapproved peptides, using research-grade products, failing to document medical necessity, or prescribing without proper patient evaluation can all result in disciplinary action by a state medical board. The severity ranges from reprimand and probation to license suspension or revocation.

Do medical boards have specific rules about peptides?

Most medical boards do not have peptide-specific rules. Instead, they apply their existing standards for prescribing, standard of care, informed consent, and professional conduct. The practical effect is that peptide prescribing is evaluated under the same framework as any other treatment — which means using unapproved substances requires strong justification.

What happens if I file a complaint about a peptide provider?

Your state medical board will review the complaint and decide whether to investigate. Investigations may include reviewing medical records, interviewing the provider, and consulting expert witnesses. If the board finds a violation, it can impose discipline ranging from a letter of concern to license revocation. The process varies by state but typically takes several months to over a year.

Is it safer to get peptides from a provider in a state with less enforcement?

Receiving treatment from a provider in a less-active state does not protect you from harm. If something goes wrong medically, you're dealing with the consequences regardless of where the provider is licensed. And for telehealth, the provider must be licensed in the state where you're located — so your state's enforcement environment applies.

How can I check if my provider has been disciplined?

Use your state medical board's license verification tool (available on the board's website). You can also search the National Practitioner Data Bank at npdb.hrsa.gov, though direct consumer access is limited. DocInfo.org, maintained by the Federation of State Medical Boards, provides a free lookup tool with information from all 50 states.

Are nurse practitioners and physician assistants held to the same standards?

NPs and PAs are regulated by their respective licensing boards (which may be the same board of medicine or a separate board, depending on the state). The same principles apply: prescribing unapproved substances requires documentation of medical necessity, informed consent, and compliance with state-specific scope-of-practice rules. Supervision requirements vary by state.

The Bottom Line

State medical boards represent a layer of peptide regulation that operates independently of the FDA and, in some cases, moves faster. While the FDA focuses on drug approval and compounding rules at the federal level, medical boards regulate the individual providers who prescribe and administer peptide therapies.

The trend is clear: boards in states like Ohio, Florida, Texas, and California are coordinating enforcement and taking action against providers whose peptide prescribing falls outside accepted standards. The triggers include using research-grade products, prescribing without adequate evaluation, failing to document medical necessity, and making claims that unapproved peptides are "off-label" when they have no label at all.

For providers, the message is to operate transparently, document everything, source only from licensed pharmacies, and let evidence — not patient demand or marketing trends — drive prescribing decisions. For patients, the message is to verify your provider's credentials, ask questions about the legal status and sourcing of any peptide prescribed, and know that state medical boards exist to protect you if something goes wrong.

For the broader regulatory picture, see our FDA regulation timeline, our state-by-state legal guide, and our guide on how the FDA compounding crackdown affects consumers.

References

Holt Law. "The Unregulated World of Peptides: A Legal Minefield for Providers." https://djholtlaw.com/the-unregulated-world-of-peptides-a-legal-minefield-for-providers/
Holt Law. "Peptide Legal Frequently Asked Questions." https://djholtlaw.com/peptide-legal-frequently-asked-questions/
MedBio Institute. "Peptides in Limbo: The Legal and Ethical Crossroads of America's Booming Bioregulator Market." https://www.medbioinstitute.com/resources/topics/peptides-in-limbo-the-legal-and-ethical-crossroads-of-americas-booming-bioregulator-market
Texas Medical Board. "TMB Disciplines 22 Physicians at August Meeting." August 2024. https://www.tmb.state.tx.us/about-us/newsroom/tmb-disciplines-22-physicians-august-meeting
Texas Medical Board. "TMB Disciplines 18 Physicians at October Meeting." October 2024. https://www.tmb.state.tx.us/about-us/newsroom/tmb-disciplines-18-physicians-october-meeting
Texas Medical Board. "TMB Disciplines 21 Physicians at August Meeting." August 2025. https://www.tmb.state.tx.us/about-us/newsroom/tmb-disciplines-21-physicians-august-meeting
State Medical Board of Ohio. "Formal Action Report — October 2025." https://dam.assets.ohio.gov/image/upload/med.ohio.gov/laws-and-regulations/MFAL/2025/October_2025_MFAL.pdf
State Medical Board of Ohio. "Formal Action Report — January 2025." https://dam.assets.ohio.gov/image/upload/med.ohio.gov/laws-and-regulations/MFAL/2025/January_2025_MFAL_FINAL.pdf
Frier Levitt. "Regulatory Status of Peptide Compounding in 2025." https://www.frierlevitt.com/articles/regulatory-status-of-peptide-compounding-in-2025/
OptiMantra. "Peptide Therapy Trends 2026: What Clinics Must Know." https://www.optimantra.com/blog/peptide-therapy-trends-to-watch-in-2025-what-clinics-need-to-know
Stevens & Lee. "GLP-1 Weight Loss Drug Enforcement in 2025: State Attorneys General Step into a Growing Regulatory Gap." https://www.stevenslee.com/health-law-observer-blog/glp-1-weight-loss-drug-enforcement-in-2025-state-attorneys-general-step-into-a-growing-regulatory-gap/
Florida Healthcare Law Firm. "Are Peptides Legal in the U.S.? Complete 2025 Legal Guide." https://floridahealthcarelawfirm.com/are-peptides-legal/
ShineRx. "How to Navigate Peptides as a Medical Director." https://shinerx.com/how-to-navigate-peptides-as-a-medical-director/
Safe HG. "FDA's Overreach on Compounded Peptides: Legal Battles and How Clinics Can Push Back." https://www.safehg.com/fdas-overreach-on-compounded-peptides-legal-battles-and-how-clinics-can-push-back/