Ask An Attorney: Guidelines for Prescribing Medication for Weight Loss

Q: What are some of the state and federal laws that govern prescribing medication for weight loss?

A: Under New York State law, specific restrictions apply to the prescribing of controlled substances for the treatment of obesity. The Public Health Law, for example, prohibits physicians from prescribing amphetamines or sympathomimetic amine drugs, which are Schedule II controlled substances, exclusively for the treatment of obesity, weight control, or weight loss. Prescriptions for controlled substances must be issued in good faith, for legitimate medical purposes, by a licensed professional, and in electronic form (unless an exception applies such as temporary technological failure or impracticality).

While GLP-1 medications such as semaglutide and liraglutide are not Schedule II controlled substances, physicians must still adhere to general prescribing requirements under New York law. The prescribing of typical weight loss medications, including those for obesity such as GLP-1 receptor agonists (e.g., semaglutide or liraglutide), is governed by a combination of state and federal laws and regulations. 

At the federal level, the Food, Drug, and Cosmetic Act (FDCA) governs the approval, labeling, and marketing of drugs, including GLP-1 medications. The FDA is vested with the authority to approve the drug’s label, which includes indications, contraindications, warnings, and dosage instructions. However, as the FDA does not regulate the practice of medicine, physicians may prescribe FDA-approved drugs for both on-label and off-label uses.

Physicians prescribing GLP-1 medications for obesity should ensure the following:

1. That the prescription is issued in good faith for legitimate medical purposes. Physicians should document the medical necessity of the prescription, including the patient’s diagnosis and treatment plan.

2. That the prescription is issued electronically unless an exception applies, and that the electronic prescribing system meets both federal and state requirements.

3. Adherence to FDA-approved labeling for GLP-1 medications and consider any new safety information or warnings issued by the FDA.

4. If prescribing GLP-1 medications off-label for weight loss, that the use is supported by sound medical judgment and evidence, and they should advise patients of the off-label nature of the prescription.

Q: What are best practices for prescribing weight loss medications in New York?

A: Prescribers should document consent and keep detailed records of the patient’s medical history, diagnosis, and treatment plan, and the prescriber’s rationale for prescribing weight loss medication, including any off-label use. Further, prescribers should inform and counsel patients on the benefits, risks, and potential side effects of weight loss medications, and regularly monitor the patient’s progress, including weight loss, side effects, and overall health, and adjust the treatment plan as necessary. If prescribing off-label, physicians should also explain the off-label use and obtain informed consent from the patient. Prescribers should also adhere to clinical guidelines for the treatment of obesity to ensure evidence-based prescribing and treatment. Physicians must ensure compliance with prescription requirements, and prescriptions should include the patient’s name, address, and dosage instructions. Finally, prescribers should stay current with ever-evolving policy and standard of care. By adhering to these legal and regulatory requirements and best practices, physicians can ensure the safe and effective use of weight loss medications while minimizing legal risks.

Q: Are there specific rules that apply to weight-loss clinics?  Do these rules apply to ordinary physicians who might prescribe weight loss medications?

A: Yes and no. Physicians in New York may prescribe certain weight loss medications within the scope of their professional practice. Weight-loss clinics are subject to additional consumer protection laws requiring transparency and prohibiting deceptive practices. Under the New York General Business Law, weight-loss clinics offering services or products to the public must provide specific disclosures, including warnings about the health risks of rapid weight loss, the importance of consulting a physician before starting a weight-loss program, and information about the qualifications of personnel providing weight-loss advice. The requirements for weight-loss clinics do not apply to businesses that provide weight-loss services incidental to their primary professional services and do not sell weight-loss services or products to the public.

Q: What insurance coverage and medical necessity issues should providers be aware of? What are best practices for physicians in this instance?

A: Physicians may be caught in disputes over whether obesity treatment and weight loss medication is medically necessary, and the patient may face denial of insurance coverage. Under federal law, Medicaid may exclude or restrict coverage of certain drugs, including those used for weight loss, unless the prescribed use is for a medically accepted indication. Providers should be aware that these issues may present and they should consider the legal risks regarding improper or incorrect coding and billing. Providers may also face patient complaints involving standard of care.  Physicians must ultimately balance patient advocacy with compliance requirements. 

Providers should evaluate whether weight loss medications are covered under the patient’s insurance plan, whether they meet the criteria for medical necessity, and comply with any applicable utilization management requirements. Providers should also stay informed about formulary changes and ensure that prescribed medications align with both federal and New York State regulations to facilitate coverage and minimize patient out-of-pocket costs.

Reprinted with permission from the February/March 2026 issue of The Bulletin from the Monroe County Medical Society and available as a PDF file here.

Ericka B. Elliott is a Partner in Underberg & Kessler LLP’s Health Care and Litigation Practice Groups. She helps health care providers navigate the ever-changing world of health care compliance and can be reached at eelliott@underbergkessler.com or 585.258.2830.