How to Open a GLP-1 Weight Loss Clinic in Texas (2026)

By Tom Kashul, Founder, Moonshot EHR; clinic owner-operator

To open a GLP-1 weight loss clinic in Texas, form a physician-controlled entity such as a professional association or PLLC, because prescribing for weight management is practicing medicine and only a physician may organize a medical PLLC. NPs and PAs prescribe under a written prescriptive authority agreement, and one physician may delegate to no more than seven. Semaglutide and tirzepatide are not controlled substances, so a clinic that prescribes only GLP-1s needs no DEA registration; adding phentermine, a Schedule IV drug, changes that, and a delegated Schedule III to V prescription is limited to 90 days without a documented physician consultation. Build the program on FDA-approved products: FDA declared the tirzepatide and semaglutide shortages resolved in December 2024 and February 2025, a 503A pharmacy may not regularly compound essential copies of an approved drug, and FDA says it knows of no lawful basis for compounding with the semaglutide salt forms. Send labs to a reference lab, register your texting brand, expect processors to underwrite you closely, and run programs, prescribing, labs and texting in one system; Moonshot EHR is $1,000 per location per month with one prescriber.

What a GLP-1 weight loss clinic sells

The business is a medical program, not a product sale. What patients pay for:

• Visits: an initial medical evaluation, then follow-up visits in person or by video on the prescriber's schedule.
• Medication: an FDA-approved GLP-1 prescribed to a pharmacy, or a compounded preparation from a pharmacy when the prescriber documents a patient-specific reason.
• Labs and measurements at baseline and over time.
• Programs: monthly memberships or prepaid multi-month packages that bundle visits, check-ins and messaging, with medication included or billed separately.
• Add-ons some clinics offer, such as nutrition coaching, body composition scans or other prescriptions.

1. Entity and ownership in Texas

Prescribing a GLP-1 for weight management is practicing medicine, whatever the storefront looks like. A med spa, gym or wellness brand that adds weight loss still needs the medical side owned and controlled by the licensee, with the business side contracting around it.

These statutes are why most Texas cash-pay clinics are owned by a physician, not by the partner who funded them.

Only a person licensed in Texas may practice medicine in Texas. (Occ. Code 155.001)

A physician can be disciplined for aiding the practice of medicine by an unlicensed person or entity. (Occ. Code 164.052(a)(17))

An unlicensed person or entity that indicates it is entitled to practice medicine commits an offense. Read this provision before a company owned by non-physicians puts "medical" or "clinic" in its name or advertising. (Occ. Code 165.156)

Physicians may form a professional association or a professional limited liability company (PLLC). Physicians and physician assistants may form one together, but only a physician may organize it and physicians must control it. (Bus. Orgs. Code 301.012(a), (a-1), (a-4))

A physician assistant in a jointly owned entity may not serve as an officer, may hold only a minority stake that is never equal to or larger than any physician owner's, and may not employ the supervising physician. (Bus. Orgs. Code 301.012(a-2), (a-3), (a-6))

A nonprofit health organization certified by the Texas Medical Board, organized solely by licensees and with licensed, active directors, may employ physicians. (Occ. Code 162.001)

Open questions on this topic: see things to confirm.

Background: the MSO and corporate practice guide.

2. Prescribers: physician, NP and PA rules

After the first visit, most GLP-1 visits are dose and side-effect check-ins, which NPs and PAs handle under the physician's agreement. The agreement, not the drug, decides how many clinicians you can staff.

The delegation rules decide how many NPs and PAs you can staff, what the paperwork says and how often the physician is involved.

22 TAC Chapter 193, the old standing delegation order chapter, was repealed effective January 9, 2025, so templates that cite it are out of date. Delegation now lives in 22 TAC Chapter 169, physician assistant rules in Chapter 183, advertising in Chapter 164, business organizations in Chapter 174 and telemedicine in Chapter 175. (22 TAC Chapter 169)

An NP or PA may prescribe under delegation only through a written prescriptive authority agreement with adequate supervision. (Occ. Code 157.0512(a))

According to the Texas Medical Board, adequate supervision does not require the physician's constant physical presence. (TMB FAQ on delegation)

A physician may delegate to no more than seven APRNs and PAs, or seven full-time equivalents, with exceptions for medically underserved populations and facility-based hospital practice. (Occ. Code 157.0512(c), (d))

The agreement must at minimum be signed and dated and list license numbers, practice settings, delegated drug categories, a consultation and referral plan, an emergency plan, a communication process, alternate physicians and a quality assurance plan. (Occ. Code 157.0512(e))

The agreement sets how many charts the physician reviews, and the two must hold a documented meeting at least monthly. The circulating figure of a 10 percent chart review and an on-site visit every 10 business days comes from a 2007 bill draft, not current law. (Occ. Code 157.0512(e)(9), (f); 22 TAC 222.5(c)(9), (d))

The agreement is reviewed, dated and signed every year, kept for two years after it ends, and produced to the board by the third business day after a request. (22 TAC 222.5(h), (k))

The physician registers each delegation with the Texas Medical Board within 30 days (name, license, start date and locations) and reports a termination within 30 days. (22 TAC 169.5)

An APRN also needs prescriptive authority approval and an authorization number from the Texas Board of Nursing. (22 TAC Chapter 222)

Since September 1, 2025, agreements for elective IV therapy count toward the seven-person cap, and the underserved exception does not apply to them. (HB 3749; Occ. Code 172.051(d))

Open questions on this topic: see things to confirm.

3. Controlled substances: when a weight loss clinic needs DEA

Semaglutide and tirzepatide are not controlled substances, so a clinic that prescribes only GLP-1s needs no DEA registration for them. Many weight loss clinics also prescribe phentermine or another scheduled appetite suppressant, and the day one is added, every rule in this section applies.

Semaglutide and tirzepatide are not listed in the federal controlled substance schedules, so prescribing them alone needs no DEA registration. (21 CFR 1308.11 to 1308.15)

Phentermine and diethylpropion are Schedule IV controlled substances. (21 CFR 1308.14(f))

Phendimetrazine and benzphetamine are Schedule III controlled substances. (21 CFR 1308.13(b))

DEA requires a separate registration for each principal place of business where controlled substances are dispensed. (21 CFR 1301.12)

Each prescriber registers with DEA individually. (21 CFR 1301.11(a))

A Schedule III or IV prescription may not be refilled more than six months after it was written or more than five times without a new prescription. (21 CFR 1306.22(a))

Texas adds its own rules on top of the federal ones:

A federal DEA registration is required to prescribe, possess or dispense controlled substances in Texas. The separate Texas DPS controlled substance registration was repealed effective September 1, 2016. (HSC 481.061)

Texas law carries the same Schedule III and IV refill limit as federal law. (HSC 481.074(g))

When an NP or PA prescribes a Schedule III, IV or V drug under delegation, the prescription including refills may not cover more than 90 days; going past that requires a documented consultation with the delegating physician. Schedule II delegation is limited to hospital and hospice settings. This is the rule that shapes an NP-staffed clinic's refill calendar. (Occ. Code 157.0511(b); 22 TAC 222.8(b), (c))

Checking the Texas Prescription Monitoring Program is mandatory only before prescribing opioids, benzodiazepines, barbiturates or carisoprodol, so before phentermine it is permitted, not required. Many clinics check anyway as a written policy. (HSC 481.0764(a), (b), (d))

The Texas Medical Board says controlled substance prescriptions must be sent electronically, with limited exceptions, and that NPs and PAs consult the delegating physician for controlled substance refills after the first 90-day supply. (TMB, prescribing and supervision)

Telemedicine

GLP-1 follow-ups move well to video. The DEA telemedicine rules matter only for the controlled substances on your menu; the Texas relationship rules apply to every prescription.

A valid telemedicine prescription requires an established practitioner and patient relationship and compliance with the Medical Practice Act and Health and Safety Code Chapters 481 and 483. Only chronic pain carries an extra telemedicine-specific condition. (22 TAC 175.3(a))

The relationship can come from a preexisting relationship, call coverage, or a synchronous audio and video visit (or qualifying store-and-forward). The practitioner gives follow-up guidance and, with consent, sends records to the patient's primary care physician within 72 hours. (Occ. Code 111.005)

Telemedicine must follow Chapter 111 and the Medical Practice Act, including the delegation rules and the complaint-notice posting requirement. (22 TAC 175.2)

DEA's Fourth Temporary Extension, published December 31, 2025, lets an audio and video telemedicine visit start a Schedule II through V prescription without a prior in-person visit through December 31, 2026, unless extended or replaced. Re-check before you rely on it. (90 FR 61301)

Open questions on this topic: see things to confirm.

4. Sourcing GLP-1s: FDA-approved, compounded, 503A and 503B

This is the part of a weight loss clinic that changed most since 2024. With the shortages over, the federal room for compounded semaglutide and tirzepatide is narrow, and pharmacies, processors and regulators all ask what you prescribe and why. Plan the business around FDA-approved products, and treat any compounded prescription as a patient-specific clinical decision the prescriber documents. Nobody, including us, can promise supply of any product.

A 503A compounding pharmacy is exempt from the new-drug rules only when it compounds for an identified patient on a valid prescription. (21 U.S.C. 353a(a))

Under the statute, a 503A compounder may not regularly or in inordinate amounts compound drugs that are essentially copies of a commercially available drug. A change for an identified patient that the prescriber determines makes a significant difference is not a copy. (21 U.S.C. 353a(b)(1)(D), (b)(2))

Under FDA's guidance, a 503A pharmacy may not ship office stock without patient-specific prescriptions; a 503B outsourcing facility may. (FDA, Prescription Requirement Under Section 503A)

A 503B outsourcing facility's drug may not be essentially a copy of an approved drug unless a change produces a clinical difference for an individual patient, as the prescriber determines. (21 U.S.C. 353b(a)(5), (d)(2))

FDA has declared the GLP-1 shortages resolved: tirzepatide on December 19, 2024 (enforcement discretion ended February 18, 2025 for 503A and March 19, 2025 for 503B) and semaglutide on February 21, 2025 (April 22, 2025 for 503A and May 22, 2025 for 503B). Neither is on the 503B bulks list. (FDA GLP-1 compounding policy page)

On April 1, 2026, FDA said "essentially a copy" compounding is not covered without a documented significant difference for an identified patient, citing semaglutide plus B12, and that it does not intend to act at four or fewer such prescriptions a month. (FDA GLP-1 compounding policy page)

FDA says compounded drugs are not FDA-approved, that semaglutide sodium and semaglutide acetate are different active ingredients from those in the approved drugs, and that it is not aware of any lawful basis for compounding with them. (FDA, concerns with unapproved GLP-1 drugs)

FDA approved Zepbound (tirzepatide) on November 8, 2023 for chronic weight management in adults with obesity, or with overweight and a weight-related condition, alongside diet and exercise. (FDA press release, November 8, 2023)

Indications on the Wegovy (semaglutide) label include reducing excess body weight and keeping it off long term in adults and patients 12 and older with obesity, and reducing major cardiovascular events in adults with established cardiovascular disease and obesity or overweight. Read the current label for the full list. (Wegovy prescribing information, 2026)

FDA says a prescriber generally may prescribe an approved drug for an unapproved use when it is medically appropriate for the patient, and that FDA has not found the drug safe and effective for that use. (FDA, unapproved use of approved drugs)

In Texas, office stock and take-home dispensing are where state and federal rules diverge.

The State Board of Pharmacy says Texas law allows office-use distribution of compounded preparations, but "such action may not be allowed by federal law", and non-compounded drugs cannot be dispensed for office use. (TSBP Rules FAQ, February 2025)

A Class A, C or E pharmacy may supply a reasonable quantity of non-sterile compounded preparations for office use under a written agreement, for administration in the clinic only, never for dispensing or resale. (22 TAC 291.131)

A physician may supply any drug, remedy or clinical supply necessary for a patient's immediate needs. That permission is not a license to run a pharmacy. (Occ. Code 158.001)

Open questions on this topic: see things to confirm.

5. Labs and blood draws

Weight loss clinics usually run a baseline panel before the first prescription and monitoring labs on the prescriber's schedule. Most draw in the clinic or route patients to a patient service center and send every test to a reference lab.

Collecting and preparing specimens, with all testing sent to an outside lab, does not make a clinic a laboratory under CLIA. (42 CFR 493.2)

Any test performed on site, including a waived test, requires a CLIA certificate. (42 CFR 493.3(a))

A lab that runs only waived tests files a certificate of waiver for each location. (42 CFR 493.35(a))

This research found no Texas license an office lab must hold beyond CLIA; that absence is on the confirm list.

Open questions on this topic: see things to confirm.

6. Patient texting and reminders

Text is how a GLP-1 clinic talks to patients: visit reminders, lab-draw reminders, refill and renewal nudges. Clinic texting rules are federal, and the business number must be registered before carriers will deliver at volume.

Marketing texts need prior express written consent, health care messages from HIPAA covered entities have their own carve-out, and a reply of "stop", "quit", "end", "revoke", "opt out", "cancel" or "unsubscribe" revokes consent by itself. (47 CFR 64.1200)

The Campaign Registry charges $4.50 per brand ($4.00 for a sole proprietor), $41.50 for a standard vet and $101.50 for an enhanced vet, and $10 a month per Marketing, Mixed, Customer Care or Account campaign ($1.50 Low Volume Mixed, $2.00 Sole Proprietor). Vendors add their own fees. (TCR fees and pricing, August 13, 2026)

HIPAA's minimum necessary standard applies to what you put in a message. (45 CFR 164.502(b))

A practical rule, not a quoted regulation: keep diagnoses and drug names out of reminders.

Open questions on this topic: see things to confirm.

7. Getting paid: processors, underwriting, memberships

Processors commonly treat medical weight loss as higher risk, and compounded GLP-1s more so. The reasons operators hear most:

• Recurring card-not-present charges for programs, which processors associate with disputes when a patient stops early.
• Compounded products in the mix, which some processors will not underwrite.
• A controlled substance in the mix, if you prescribe phentermine or a similar drug.

Processors commonly ask for licenses, any DEA registrations, the pharmacy partner and its 503A or 503B status, the FDA approval status of each product you sell, any LegitScript certification, supervision agreements, a written refund policy and prior processing history. Reserves on new accounts are common. Have the package ready before you apply.

Programs turn one-off visits into a predictable business. Common structures:

• Monthly program: visits, check-ins and messaging, with medication billed separately.
• All-in monthly, medication included: simpler for the patient, but your margin moves with drug cost and dose.
• Prepaid multi-month program, paid up front or in installments, with written terms for stopping early.
• A la carte visits and labs, often the on-ramp to a program.

Put cancellation, refund and dose-change terms in a signed agreement at enrollment; it is what a processor reads when a patient disputes a charge.

Physicians and practitioners, including nurse practitioners and physician assistants, may opt out of Medicare and treat Medicare patients under private contracts. An opt-out or contract that does not meet the rules is void. (42 CFR 405.400, 405.405)

The first two-year opt-out period starts on the date the affidavit is signed if it is filed within 10 days after the first private contract. It renews by default; cancelling takes written notice to each Medicare contractor at least 30 days before the period ends. (42 CFR 405.410(c), 405.445(a))

The private contract is signed by both parties before services, not during urgent or emergency care, and says the patient pays in full, Medicare limits do not apply, no claim will be filed, Medicare and Medigap will not pay, and the dates of the opt-out period. A new contract is signed for each two-year period. (42 CFR 405.415)

For months after December 31, 2025, a direct primary care arrangement does not stop HSA contributions if it covers only primary care for a fixed fee of no more than $150 a month ($300 for more than one person). Prescription drugs other than vaccines are excluded, and an arrangement that includes other services does not qualify, whatever the member uses. (IRS Notice 2026-5)

Open questions on this topic: see things to confirm.

8. Texas filings, taxes and fees

What a new Texas clinic files and pays in its first year.

Open questions on this topic: see things to confirm.

9. Advertising rules

Weight loss marketing runs on before-and-after photos, drug names and results claims, which is exactly what the state and FTC rules watch. Never present a compounded preparation as if it were an FDA-approved brand.

Texas holds the physician responsible for what the clinic's marketing says.

Ads may not be false, deceptive or misleading. Testimonials need a credentials disclaimer and a compensation disclosure, models must be identified, and medical directorship or supervision must be disclosed at non-primary locations run under protocols. (22 TAC 164.3)

The physician is responsible for all of the practice's advertising, must have a patient's consent before the patient's photos appear in an ad, and must keep copies of ads for two years. (22 TAC 164.2)

The FTC's Consumer Reviews and Testimonials Rule, effective October 21, 2024, bans fake reviews and undisclosed insider reviews. (16 CFR Part 465)

Under the FTC Endorsement Guides, claims in an endorsement need substantiation, and when the endorser's result is not typical you disclose the results people can generally expect. (16 CFR 255.2)

FTC health products guidance requires competent and reliable scientific evidence for health benefit claims, and for most such claims that generally means randomized, controlled human clinical testing. (FTC Health Products Compliance Guidance)

In December 2025 the FTC approved a final order against telehealth provider NextMed over GLP-1 weight loss program claims, undisclosed costs, fake testimonials and charges without consent; it requires reliable evidence before claiming typical results. (FTC, NextMed final order)

10. The software stack and what it costs

You need these pieces whichever vendor you choose. The right column is what Moonshot EHR includes and charges.

At list price that is 1 prescriber: $1,000; 2 prescribers: $1,200; 3 prescribers: $1,400 per location per month, before the optional packages and your processor's fees.

11. A 30-item opening checklist

1. Decide who owns the practice; if a non-physician is investing, take the structure to health care counsel first.
2. Form the practice entity with the Secretary of State.
3. File an assumed name if you market under a different brand.
4. Get an EIN, a business bank account and bookkeeping before the first charge.
5. Register for state business taxes, including a sales tax permit if you sell taxable products, and calendar the annual filings.
6. Sign a supervising physician agreement with a physician who will do the work.
7. Sign a written prescriptive authority agreement for each NP and PA.
8. Register each delegation with the medical board.In Texas, register each delegation with the Medical Board within 30 days.
9. Confirm each APRN's prescriptive authority.Texas APRNs need Board of Nursing prescriptive authority approval and an authorization number.
10. Calendar the required supervision meetings and chart reviews and keep minutes.
11. Carry malpractice coverage for every prescriber.
12. Decide in writing whether the clinic will prescribe phentermine or any other controlled substance.In Texas and federally, semaglutide and tirzepatide are not scheduled; phentermine is Schedule IV.
13. If it will, register each prescriber and each dispensing location with DEA.
14. If it will, complete EPCS identity proofing for every prescriber and write a refill policy within the federal and state limits.Texas limits a delegated Schedule III to V prescription, refills included, to 90 days without documented physician consultation.
15. Base the program on FDA-approved products, and decide who may prescribe a compounded preparation and how the patient-specific reason is documented.
16. Choose pharmacies, and confirm each one's state license and 503A or 503B status in writing.A pharmacy that ships to Texas patients needs a Texas license, usually Class E if it is out of state, or an exemption.
17. If you administer in the clinic, settle office-use sourcing in writing and confirm it with the pharmacy board.
18. Write a plain patient explanation of which products are FDA-approved and which are compounded.
19. Open a reference lab account and set up draws or patient service center routing.
20. Get a CLIA certificate before running any test on site.
21. Build baseline and monitoring panels so ordering is one click.
22. Register the texting brand and campaign for your clinic number.
23. Add texting consent to intake, with marketing consent as a separate choice.
24. Write reminder templates with no diagnosis or drug name.
25. Apply for a merchant account with the underwriting package ready, listing every product and its approval status.
26. Publish program plans with signed cancellation, refund and dose-change terms.
27. Configure appointment types, intake, consents, programs, e-prescribing and lab ordering.
28. Have the physician review every ad, substantiate every results claim, never present a compounded product as an FDA-approved brand, and keep copies.
29. Work the confirm list below with the boards and counsel.
30. Run a test patient from booking to first follow-up before the first real one.

12. Things to confirm before you open

Questions this guide could not settle from a primary source, each with who can answer it. Ask in writing and keep the answers.

• Confirm with Texas health care counsel whether a management services organization (MSO) fits your plan, where a non-physician company provides non-clinical services to the physician-owned practice for a fair-market-value fee. No Texas statute, Medical Board rule or Medical Board FAQ found for this guide expressly approves it, and the status of 2023 HB 2982 is unconfirmed.
• Confirm with the Board of Nursing and your counsel whether a nurse practitioner may own a Texas practice entity; the statute is silent.
• Confirm with the Texas Medical Board that Occ. Code 157.0511 and 157.0512, HSC 481.074 and 481.0764, and 22 TAC Chapters 169 and 183 read as cited here after the 2025 session; this guide used statute and rule mirrors, not the official sites.
• Confirm with the Texas Medical Board how large an immediate-needs supply may be under Occ. Code 158.001; no primary source found for this guide gives a number.
• Confirm with the State Board of Pharmacy the current text of 22 TAC 291.133, the sterile office-use rule, reportedly amended in February 2026.
• Confirm with the Texas Medical Board whether in-office IV drips at your clinic fall under Occ. Code Chapter 172, which turns on whether the clinic counts as a physician's office.
• Confirm with the Texas Health and Human Services Commission, which handles CLIA applications for CMS in Texas, the current form and whether any state license applies to an office lab; none was found.
• Confirm with the Texas Comptroller how sales tax applies to prescription drugs the clinic dispenses and to the services and memberships it sells.
• Confirm the Form 206 (PLLC) filing fee with the Secretary of State.
• Confirm with the Texas Medical Board whether any current rule or board position sets exam, documentation or follow-up requirements for prescribing weight loss drugs, including phentermine; no obesity-specific rule was found after the 2025 reorganization.
• Confirm with the State Board of Pharmacy whether it has issued any statement or enforcement position on compounded semaglutide or tirzepatide, including salt forms.
• Confirm with the State Board of Pharmacy the exemptions in Occ. Code 560.004 before you use an out-of-state pharmacy that ships to Texas patients without a Class E license.
• Confirm with the Texas Comptroller how a meal replacement or protein shake sold by the clinic is taxed when it carries a Supplement Facts panel but is marketed as a meal.
• Confirm with the Texas Medical Board whether any current rule or board position sets exam, documentation or follow-up requirements for prescribing weight loss drugs, including phentermine; no obesity-specific rule was found after the 2025 reorganization.
• Confirm with the State Board of Pharmacy whether it has issued any statement or enforcement position on compounded semaglutide or tirzepatide, including salt forms.
• Confirm with the State Board of Pharmacy the exemptions in Occ. Code 560.004 before you use an out-of-state pharmacy that ships to Texas patients without a Class E license.
• Confirm with the Texas Comptroller how a meal replacement or protein shake sold by the clinic is taxed when it carries a Supplement Facts panel but is marketed as a meal.
• Confirm with DEA whether the telemedicine flexibilities were extended past December 31, 2026 or replaced by a special registration rule before you build a remote-start model.
• Confirm with your counsel how the FCC treats appointment-reminder texts from a covered entity to wireless numbers.
• Confirm with your texting vendor how long brand and campaign review take and what each submission needs, such as privacy policy and terms URLs.
• Confirm with your processor, in writing, which of your products and services they accept, including any controlled substances and compounded preparations, and what reserve they hold and for how long. No card-brand rule found for these guides names a clinic type.
• Confirm with your Medicare Administrative Contractor the current opt-out affidavit form and filing address before you see a Medicare patient under a private contract.

Related

• All Texas opening guides
• How to Open a Functional Medicine Clinic in Texas (2026)
• How to Open a Hormone and Menopause Clinic in Texas (2026)
• How to Open a Longevity Clinic in Texas (2026)
• How to Open a TRT Clinic in Texas (2026)
• How to start a GLP-1 weight loss clinic
• 503A vs 503B compounding
• Does Moonshot EHR do membership billing?
• Does Moonshot EHR offer installment payment plans?
• Does Moonshot EHR generate and e-sign program agreements?
• Does Moonshot EHR do e-prescribing and EPCS?
• Moonshot EHR pricing

This guide is operating information, not legal advice. Confirm the current rules with the Texas Medical Board, the Board of Nursing, the State Board of Pharmacy and your counsel before you open. Each statement above is tied to the source beside it as read on the date shown; statutes and rules change, and some sources are statute mirrors, not the official text. Moonshot prices are current as of October 19, 2026.