Disclaimer: This material is provided for educational and informational purposes only. It does not constitute legal or medical advice or regulatory guidance. Requirements and interpretations may vary and change over time. Always verify current rules directly with the Texas Medical Board and the Texas State Board of Pharmacy and seek advice from qualified legal counsel before making decisions or taking action.
Executive Summary
- Medical directors must be Texas-licensed MDs/DOs. NPs and PAs require delegation agreements to prescribe.
- Prescriptive Authority Agreements (PAAs) are required for APRNs/PAs prescribing weight loss medications. They must include communication protocols, consultation/referral procedures, and QA plans with chart review, plus meetings.
- Telehealth rules (Tex. Occ. Code §111.005; TMB Chapter 174) require a valid practitioner–patient relationship, adequate records, and a standard of care equivalent to in-person.
- Controlled substances (phentermine, Schedule IV) require DEA registration, Prescription Monitoring Program (PMP) checks, and heightened QA.
- GLP-1 drugs (semaglutide, tirzepatide) are not controlled substances but are under heavy scrutiny — watch for FDA, pharmacy, and board alerts.
- Only physicians can own/control the medical side; lay entities may run MSOs (business operations) but not direct clinical decisions.
Texas has one of the strictest regulatory environments for outpatient care. Weight loss clinics, obesity management programs, and telehealth providers face overlapping rules from:
- Texas Medical Board (TMB): Governs delegation, prescriptive authority, and supervision.
- Texas Occupations Code (Chapters 157 & 111): Sets the framework for delegation and telemedicine.
- Texas State Board of Pharmacy: Regulates dispensing, compounding, and advertising of medications like phentermine or GLP-1s (semaglutide, tirzepatide).
- Corporate Practice of Medicine (CPOM) Doctrine: Bars nonphysicians from controlling medical judgment.
Combine this with the national boom in GLP-1 medications and the expansion of telemedicine, and Texas clinics must tread carefully. A compliant structure isn’t just a formality — it protects licenses, shields physicians and NPs from liability, and builds patient trust.
Quick Compliance Checklist
Physician-owned professional entity (for clinical services) paired with MSO (for business operations).
Medical director = Texas-licensed MD/DO.
Prescriptive Authority Agreement for every NP/PA prescribing weight-loss drugs.
Chart reviews + monthly QA meetings documented.
Telehealth workflows (video visits, e-prescribing, recordkeeping) align with Chapter 174.
DEA + PMP compliance for controlled substances (e.g., phentermine).
Pharmacy compliance for GLP-1 sourcing, compounding, and advertising.
Advertising avoids claims of “miracle cures” or unlicensed providers offering medical care.
The Legal Frame: CPOM and Who Can Be a Medical Director
- A physician-owned professional entity (PC or PLLC) must employ or contract the clinicians.
- A management services organization (MSO) may handle staffing, rent, marketing, or billing, but cannot direct diagnoses, treatments, or prescribing decisions.
- Violating CPOM can trigger fines, board discipline, or even injunctions.
Who Can Be a Medical Director?
Delegation & Prescriptive Authority: The Documents That Matter
Delegation of Medical Acts (Procedures, Labs, IV Therapy
- Covered under TMB rules (22 TAC, Chapter 193).
- Must define scope, training, and supervision.
Prescriptive Authority Agreements
- Required for APRNs/PAs prescribing in Texas (Tex. Occ. Code §157.0512).
- Must be in writing, signed, and include:
- Categories of drugs/devices authorized (e.g., GLP-1s, phentermine).
- Consultation/referral requirements.
- Communication channels (phone/video availability).
- Emergency procedures.
- Quality assurance (chart reviews + periodic meetings).
- Categories of drugs/devices authorized (e.g., GLP-1s, phentermine).
- PAAs must be reviewed at least annually and produced to regulators within three (3) business days if requested.
Delegation Limits
- General cap = 7 APRNs/PAs with delegated prescriptive authority per physician, unless exceptions apply (e.g., facility-based).
Weight Loss Clinics — What Texas Requires
Who Can Prescribe Weight Loss Medications?
- MD/DO: Unrestricted (if licensed).
- NP/PA: Only with written PAA from the supervising physician.
- RNs, estheticians, nutritionists: Cannot prescribe.
Phentermine (Controlled, Schedule IV)
- Requires DEA registration.
- PMP query required before prescribing.
- Document rationale and follow-up visits.
- Avoid “cookie-cutter” scripts; show individualized care.
GLP-1 Medications (Semaglutide, Tirzepatide, etc.)
- Not federally controlled, but Texas pharmacies scrutinize sourcing.
- Compounding: Must comply with FDA/USP standards, and only if shortages justify.
- Delegation: APRNs/PAs may prescribe under PAA if specifically authorized.
IV Therapy, Supplements, Adjuncts
- Each infusion/adjunct protocol should be approved and signed by the physician.
- Staff must have competency checklists + adverse event protocols (e.g., anaphylaxis).
Advertising Rules
- Cannot market nonphysicians as “doctors.”
- Avoid unsubstantiated claims (“lose 30 lbs in 30 days”).
- The Texas AG and TMB have cited clinics for deceptive weight loss advertising.
Telehealth in Texas — Compliance Rules
Practitioner–Patient Relationship (Tex. Occ. Code §111.005)
- Must be established via synchronous video or in-person exam.
- Questionnaires only ≠ valid relationship.
- The standard of care must match in-person.
TMB Chapter 174 Rules
- Document patient identity, consent, diagnosis, and treatment.
- E-prescribing is allowed but must follow the same protocols as in-person.
- Secure records must be accessible for chart review.
Delegation in Telehealth
- PAAs must explicitly cover telemedicine prescribing.
- Define escalation for red-flag cases (psychiatric crises, medication complications).
- Ensure the supervising physician has remote record access for QA.
Telehealth Weight Loss Prescribing
- GLP-1: Permitted via telehealth if practitioner–patient relationship is valid.
- Phentermine: Possible, but riskier due to controlled status; must document PMP checks and careful follow-up.
- Best practice: Require at least one in-person or live video exam before prescribing controlled meds.
Psychiatry & Mental Health Clinics
- PAAs with explicit drug class permissions.
- Stronger QA for controlled meds.
- Emergency escalation protocols documented.
Psychiatry & Mental Health Clinics
- TMB Enforcement: Failure to maintain PAAs, inadequate chart review, or unlicensed delegation.
- Pharmacy Board: Advertising violations, improper compounding of GLP-1s.
- DEA: Improper prescribing of phentermine or stimulant misuse.
- CPOM Violations: MSO overreach into clinical decisions.
- Civil Lawsuits: Malpractice or deceptive trade practice claims from patients.
FAQs
Can a nurse practitioner run a weight loss clinic in Texas?
An NP may own the business entity (as MSO) but cannot independently practice medicine. A physician-owned entity must control the medical side, and prescribing requires a PAA.
Can GLP-1 medications be prescribed via telehealth?
Yes, if a valid practitioner–patient relationship exists, documented via video/in-person, and delegation rules are followed.
Is phentermine prescribing allowed via telemedicine?
Technically yes, but only with careful compliance: PMP query, charted rationale, follow-up visits, and full documentation.
Do PAAs need to list specific drugs?
Best practice = yes. At a minimum, they must define categories of drugs/devices authorized or excluded.
Psychiatry & Mental Health Clinics
- Licensed Texas Physicians: Matched to your clinic’s needs (med spa, weight loss, telehealth, psychiatry, general practice).
- Turnkey PAAs: Pre-built templates with communication, QA, and escalation language required by law.
- Quality Assurance Systems: Chart review schedules, meeting templates, and documentation trackers.
- Telehealth Support: Guidance on Chapter 174 workflows, e-prescribing protocols, and HIPAA compliance.
- Drug-Specific Guidance: Phentermine (controlled) vs. GLP-1 (non-controlled), compounding, and advertising rules.
- MSO Alignment: We review agreements to ensure CPOM compliance.
- Licensed Texas Physicians: Matched to your clinic’s needs (med spa, weight loss, telehealth, psychiatry, general practice).
Areas We Serve
Who We Serve
- Nurse Practitioners (NPs) – Including collaborative agreements, prescriptive authority, and regulatory oversight. Our services simplify the process of connecting NPs with medical directors in Texas.
- Registered Nurses (RNs) – Providing oversight for starting medspas, weight loss clinics, and wellness centers. We make it easy to match RNs with collaborating physicians in the metropolitan area.
- Physician Assistants (PAs) – Delivering supervision, protocol evaluation, and compliance support in line with Texas regulations.
- Estheticians in Medical Spas – Enabling safe and compliant advanced aesthetic treatments through physician-approved protocols.
Texas Resources & References
- Texas Medical Board — Board Rules
- Texas Occupations Code Chapter 157 — Delegation & PAAs
- Texas Occupations Code Chapter 111 — Telemedicine
- TMB Rule 174 — Telemedicine practice standards
- Texas State Board of Pharmacy — Compounding & advertising
- Texas Prescription Monitoring Program — Controlled substances checks
Blaz Korosec is the CEO and co-founder of Medical Director Co., a nationwide platform that connects aesthetic and wellness professionals with licensed physicians for medical oversight, supervision, and compliance support. With a background that bridges healthcare operations, regulatory compliance, and entrepreneurial growth, Blaz has worked closely with hundreds of nurses, physician assistants, and clinic owners to help them legally launch and scale medical spas, telehealth weight loss clinics, IV hydration businesses, and aesthetic practices.
Blaz holds a degree in finance from Southern Methodist University (SMU) and has built a diverse portfolio of businesses ranging from healthcare to hospitality, including a national network of RV parks and medical clinics. Through MedicalDirector.CO, he’s developed a deep understanding of the state-by-state rules that govern collaborative agreements, PC/MSO structures, telemedicine protocols, and injectable treatments—translating complex legal frameworks into easy-to-implement solutions for clinicians and business owners.
Blaz is particularly passionate about helping nurses and mid-level providers unlock business ownership opportunities, and he’s known for designing systems that streamline operations, boost revenue, and ensure long-term legal protection. His team includes former prosecutors, senior RNs, and physicians who together support a growing number of clinics across all 50 states.
When he’s not working, Blaz enjoys mountain biking, restoring properties, and exploring the outdoors with his wife. He’s based in Texas but works with clients nationwide.
