GLP-1 medications — semaglutide, tirzepatide, and their compounded analogs — have created one of the fastest-growing segments in digital health. Telehealth platforms offering weight management programs built around GLP-1 prescriptions have attracted hundreds of millions of dollars in venture capital, and the consumer demand is extraordinary.
But that growth has attracted something else: regulators. In 2025, the FDA issued warning letters to 30 telehealth companies for misleading marketing of compounded GLP-1 products. Pharmaceutical companies have filed lawsuits alleging that MSO-driven telehealth platforms exert undue influence over clinical prescribing. And state medical boards are asking a question that strikes at the heart of how these companies are built: who is actually making the medical decisions here — the physician, or the platform?
For GLP-1 telehealth founders, that question has a direct answer in CPOM law. And if your answer is not unambiguously "the physician," your company has a problem.
Why GLP-1 Platforms Face Unique CPOM Pressure
The standard CPOM analysis asks whether a non-physician entity owns or controls a medical practice. The standard MSO-PC solution separates ownership (physician owns the PC) from administration (MSO handles everything else). For most healthcare startups, that structural separation — if properly documented — satisfies regulators.
GLP-1 telehealth platforms strain that model in ways that other digital health businesses do not, for several reasons:
The Protocol Problem
Most GLP-1 platforms operate at scale by standardizing the clinical experience: a specific intake questionnaire, a defined titration schedule, a set of dosing protocols. These standardized protocols are often drafted by product managers or medical directors employed by the MSO, then handed to the physician PC to administer. When the MSO controls the protocol — including which patients get GLP-1 prescriptions, at what doses, on what schedule — it is effectively directing clinical care. That is CPOM territory, regardless of who signs the prescription.
The Fee-Splitting Trap
Many GLP-1 platforms structure their management fees as a percentage of the PC's revenue. When the PC's revenue is driven entirely by prescription volume, a revenue-linked management fee creates a direct financial incentive for the MSO to push for more prescriptions. Regulators treat this as fee-splitting — and in some states, as an illegal CPOM violation — because the MSO's compensation is tied to clinical output rather than administrative services.
The threshold that has emerged in enforcement analysis is meaningful: management fees consistently exceeding 15-20% of the PC's revenue, especially when tied to prescription or visit volume, are a significant red flag in regulatory and litigation contexts.
The Compounding Angle
The FDA's 2025 warning letters focused on marketing claims about compounded GLP-1 products — but the enforcement interest in the compounding space signals broader scrutiny. When a telehealth platform directs patients toward a specific compounding pharmacy, negotiates on formulary, or sets compounding specifications, it may be influencing clinical decisions about what drug the patient receives and from whom. That is a clinical function. If the MSO is making those choices rather than the physician PC, CPOM exposure follows.
The Enforcement Shift: From Ownership to Control
For the first two decades of digital health, CPOM enforcement focused primarily on ownership: does a non-physician own this medical practice? Today, regulators are asking a more sophisticated question: who functionally controls clinical decision-making, regardless of what the ownership documents say?
Regulators increasingly assess functional control to determine who truly directs patient care. When MSOs control protocols, visit frequency, and prescription criteria, the physician's nominal ownership of the PC provides little legal protection.
For GLP-1 platforms, this shift is particularly consequential. The physician may genuinely own the PC on paper. But if the platform's algorithm determines which patients are eligible for GLP-1 therapy, the MSO's clinical team wrote the dosing protocols, and the management fee increases when prescription volume goes up — the physician is functioning more as a prescribing agent for the platform than as an independent clinical decision-maker.
Pharmaceutical Company Litigation: A New Risk Vector
Beyond regulatory enforcement, GLP-1 telehealth platforms now face litigation risk from pharmaceutical manufacturers. Pharmaceutical companies have filed lawsuits against MSO-driven telehealth platforms alleging that those companies exert undue influence over prescribing decisions — specifically, influencing physicians to prescribe compounded alternatives over branded medications. The litigation theories include CPOM violations, fee-splitting, and tortious interference.
This is a new risk vector that did not exist when most CPOM analysis was written. It means that non-compliant GLP-1 platform structures face not just regulatory action from state medical boards, but civil litigation from well-resourced pharmaceutical companies with strong incentives to challenge competitors.
What a CPOM-Compliant GLP-1 Platform Looks Like
A compliant structure does not mean you cannot build a scalable, efficient GLP-1 telehealth platform. It means the operational decisions that constitute clinical care must be genuinely made by the physician PC — not directed by the MSO and rubber-stamped by a physician employee of the platform.
Clinical Protocol Governance
GLP-1 prescribing protocols should be developed and approved by the physician PC's clinical leadership, not by the MSO's product or medical affairs team. The MSO can provide infrastructure (intake forms, scheduling, telehealth software) but the clinical criteria for prescribing — eligibility thresholds, dosing schedules, titration decisions — must originate with and be controlled by the PC's physicians. Document this clearly. The governance process matters as much as the output.
Fee Structure Redesign
Move toward flat-fee or time-and-services-based management fees rather than percentage-of-revenue structures. If you must use a revenue-linked fee, ensure it covers genuine administrative services and remains well below the 15-20% threshold that draws scrutiny. Under no circumstances should management fee amounts correlate directly with prescription volume or patient count growth.
Physician Clinical Independence
Each prescribing physician should have the documented authority and practical ability to deviate from platform protocols based on individual patient circumstances. A platform that makes deviation practically impossible — through software design, performance metrics, or peer pressure — is one where the MSO is effectively directing clinical care. Give physicians the tools and the authority to exercise independent judgment, and document that they actually use it.
Compounding Pharmacy Relationships
If your platform works with compounding pharmacies, ensure that pharmacy selection and formulary decisions are made by the PC's clinical team, not by the MSO's business development or supply chain teams. Negotiate compounding agreements through the PC, not the MSO, and ensure the PC's physicians can prescribe from any qualified pharmacy based on clinical judgment.
A 10-Point GLP-1 Compliance Checklist
- All prescribing protocols are approved by the PC's physician leadership, not MSO product teams
- Management fees are fixed or services-based, not volume-linked
- Management fees do not exceed 15-20% of PC revenue
- Each prescribing physician has documented authority to deviate from platform protocols
- Compounding pharmacy selection is made by the PC, not the MSO
- FDA compounding product marketing is reviewed by legal and does not imply equivalence with branded drugs
- Physician productivity metrics are tracked for quality purposes only, not used to pressure prescribing volume
- Patient intake criteria are set and periodically reviewed by the physician PC, not the MSO
- The MSA explicitly limits the MSO to non-clinical administrative services
- State-by-state CPOM analysis has been conducted for every state where prescriptions are issued
GLP-1 telehealth is one of the most exciting segments in digital health. The regulatory environment around it is also one of the most active. Getting your CPOM structure right now — before an enforcement action or a litigation filing — is significantly less costly than trying to fix it under pressure.