October 6, 2026

Via Comment Portal

Erin Barrett

Director of Legislative and Regulatory Affairs

Perimeter Center

9960 Mayland Drive, Suite 300

Henrico, VA 23233

erin.barrett@dhp.virginia.gov

Re:      Regulatory Considerations for IV Hydration Clinics and Med Spas in Virginia

Dear Director Barrett:

I write on behalf of Eli Lilly and Company (“Lilly”) to comment on the Virginia Board of Pharmacy (“VA BOP”), Virginia Board of Medicine (“VA BOM”), and Virginia Board of Nursing (“VA BON”) (collectively, the “Boards”) Joint Guidance Document titled “Regulatory Considerations for IV Hydration Clinics and Med Spas in Virginia” (“Guidance”).  Lilly appreciates the opportunity to provide input on this important regulatory initiative.

As a medicine company founded and headquartered in Indiana, Lilly has been at the forefront of drug innovation and drug quality for more than 150 years.  At Lilly, patient safety is at the heart of everything we do.  We believe our commitment to patient safety aligns with the Boards’ longstanding dedication to public health and the effective regulation of the practice of pharmacy, medicine, and nursing in Virginia.

Lilly commends the Boards for issuing the Guidance, which sets forth how existing Virginia law applies to IV hydration clinics and med spas.  As the Guidance rightly acknowledges, “IV hydration clinics and med spas offering … weight loss drugs such [as] GLP-1, GIP, or other peptides … are expanding across Virginia.”[1]  Specifically, the Guidance explains that: (1) practitioners at med spas are regulated by the VA BOM and/or the VA BON; (2) certain activities, such as prescribing medications, evaluating patients, and administering medications without a license, constitute the unlawful practice of medicine or nursing; (3) compounding activities must comply with United States Pharmacopeia (“USP”) chapters on compounding; (4) dispensing of prescription drugs, in any setting, is regulated by the VA BOP; and (5) a licensed prescriber must evaluate each patient and issue patient-specific orders rather than relying on protocols or standing orders.

Lilly supports the Guidance’s clear articulation of compounding requirements in the section titled “Compounding, Mixing, Diluting, and Reconstituting.”  The Guidance correctly states that “[a]ll IV fluids, including plain IV saline, are prescription drugs” and that “[d]rugs may only be mixed or compounded pursuant to a valid patient-specific prescription or order.”[2]  Further, the Guidance appropriately warns that “compounded drugs are not FDA-approved, and improper sterile technique can pose significant risks, including infection, contamination, and dosing errors.”[3]  This warning is well-founded.  As referenced in the Guidance, the United States Food and Drug Administration (“FDA”) has warned that compounded drugs “can be risky for patients” because they are not evaluated for safety, efficacy, or quality.  The risk is not hypothetical: a study from researchers at Binghamton University found that patients who took compounded GLP-1/GIP drugs reported adverse events that required hospitalization at a 2.5 times higher rate and were over 8.5 times more likely to have an adverse event that involved product quality issues as compared to those taking FDA-approved medicines.[4]

Lilly also supports the Guidance’s recognition that when a drug is mixed with additives, such as vitamins or minerals, the result is a compounded drug subject to regulation by the VA BOP.  Critically, the Guidance makes clear that compounding is the practice of pharmacy under Virginia Code § 54.1-3401, and that pursuant to Virginia Code § 54.1-3410.2, all non-sterile and sterile compounding must be performed in compliance with USP compounding standards.  Lilly welcomes the Guidance’s recognition that under Virginia law “a pharmacist may not perform regular compounding of inordinate amounts of drugs that are essentially copies of manufactured drugs.”[5]  This provision serves as an important safeguard against unlawful mass compounding that circumvents the FDA approval process.[6]  Further, the Guidance appropriately notes that when mixing, diluting, or reconstituting of drugs is delegated, individuals must be “trained to follow aseptic techniques and supervised in their work.”[7]  These provisions serve to protect Virginia patients from the serious risks posed by improper compounding practices.

In addition, Lilly commends the Boards for reiterating the prohibition on medications labeled “for research purposes only” (“RUO”) or similar designations.  The Guidance states that any such medication “is unlawful to possess by IV hydration clinics and med spas and is both a violation of state and federal law regardless of patient ‘consent.’”[8]  This is a critical patient safety provision, as RUO products cannot legally be administered or compounded for human use, have not been evaluated for safety or efficacy, and pose serious risks when administered to patients.  Lilly shares the Boards’ concerns regarding the prescribing, administering, and dispensing of RUO products and investigational drugs by med spas, as well as the purchase and use of these products by consumers.

To this point, Lilly wishes to reiterate that the RUO designation is widely used as a pretext to evade restrictions on importing and selling unapproved drug products.  RUO products are not human drug quality substances and, notwithstanding the product label, these products are routinely marketed, packaged, and sold explicitly for human use.  Entities that sell “research use only” weight loss products, peptides, SARMs, and other drugs to American consumers are engaged in dangerous and illegal conduct.  Indeed, prosecutors have taken enforcement action in multiple states against sellers that market purported RUO products for human consumption.[9]

Virginia is not alone in wanting to address these concerns.  Several other State Boards of Pharmacy are actively taking enforcement action against facilities compounding and dispensing RUO and investigational products.[10]  FDA has also issued numerous warning letters to telehealth companies, distributors, compounding pharmacies, and outsourcing facilities for marketing and selling investigational drugs.[11]  Lilly strongly encourages the Boards to prioritize enforcement against any entity compounding and/or selling these products in Virginia.

The threat to Virginia patients from RUO products and investigational drugs is real.  The United States poison control network reported a 265% increase in calls related to the use of retatrutide during just the first few months of 2026.[12]  According to reports from Australian authorities, at least seven individuals were hospitalized after taking black-market retatrutide.[13]  FDA has already stated that retatrutide “cannot be used in compounding under federal law” and has pursued enforcement against compounders that have done so.[14]

While the Guidance is a positive step, Lilly encourages the Boards to support future legislative changes that would enable more comprehensive regulation of IV hydration clinics and med spas in Virginia, including changes to the VA BOP’s ability to regulate these entities at the facility level.  The NABP Model Act, for example, would require standalone med spa facility licensure, formal “Responsible Person” Board registration, mandatory inspection schedules, facility-level enforcement sanctions, and adverse event reporting.[15]  The current Guidance, by contrast, relies on individual practitioner licensing and traditional pharmacy dispensing permits where applicable, lacks fixed inspection cadences, contains no facility-level sanctions framework, and does not require mandatory adverse event reporting to state licensing boards.  Closing these gaps through legislative action would significantly enhance the Boards’ ability to protect Virginians and advance public health.

Lilly appreciates the Boards’ commitment to patient safety and the opportunity to comment on these important matters.  If you have any questions or would like to discuss any of the above further, we would be happy to provide additional information.

Sincerely,

Brad Jordan, PhD

Associate Vice President

Regulatory Policy & Strategy

Eli Lilly and Company

October 7, 2026

Via Comment Portal

Erin Barrett

Director of Legislative and Regulatory Affairs

Perimeter Center

9960 Mayland Drive, Suite 300

Henrico, VA 23233

erin.barrett@dhp.virginia.gov

Re:        Regulatory Considerations for IV Hydration Clinics and Med Spas in Virginia

Dear Director Barrett:

The Collaborative for Evidence-Based Medicines (“CEBM”) is a national provider-led organization advancing evidence-backed medicines, safe compounding, and stronger oversight and accountability to protect patients.  CEBM brings together providers, patient advocates, academics, consumer groups, manufacturers, and other stakeholders to advance our patient safety mission.  The signatories to this letter are pharmacists, physicians, and regulatory professionals who sit on the CEBM Board. 

CEBM writes in strong support of the draft guidance document, Regulatory Considerations for IV Hydration Clinics and Med Spas in Virginia (the “Guidance”).  As the Virginia Boards of Medicine, Nursing, and Pharmacy (hereafter referred to as the “Boards”) acknowledge, IV hydration clinics and med spas offering IV fluids, vitamin and amino acid infusions, GLP-1 and other peptide products, and compounded drugs are expanding rapidly across the Commonwealth, often in consumer-focused settings where patients select treatments from a menu, complete a brief questionnaire, and receive therapy without ever meaningfully interacting with a prescriber (if at all).[1]  These practice models present real and avoidable risks of infection, contamination, and dosing errors.  The Guidance appropriately reminds these businesses that selecting, preparing, compounding, and administering prescription drugs is the practice of medicine, nursing, or pharmacy, and is subject to the same standards that apply in any other clinical setting.

The Guidance comes at a critical time.  We urge the Boards to consider the growing body of evidence documenting patient harm from compounded drugs[2] which motivates CEBM’s comments.  For example, a recent study from researchers at Binghamton University found that patients who took compounded GLP-1/GIP drugs reported adverse events that required hospitalization at a 2.5 times higher rate and were over 8.5 times more likely to have an adverse event that involved product quality issues as compared to those taking FDA-approved medicines.[3]  From our perspective as providers and patient advocates, these numbers represent real patients who sought treatment and instead received products that put their health at risk.

CEBM particularly supports the Guidance’s clarification of the following points:

• Patient-specific care.  Each patient must be evaluated by a licensed prescriber who issues a patient-specific order within a bona fide practitioner-patient relationship, and drugs may not be administered under protocols or standing orders.[4]

• Compounding standards.  Adding medications, vitamins, or minerals to IV fluids, or preparing customized formulations such as peptides, is compounding and constitutes the practice of pharmacy, and all such compounding must comply with USP standards as required by Virginia Code § 54.1-3410.2.  The Guidance’s reminder that compounded drugs are not FDA-approved, and that improper sterile technique can cause serious patient harm, is especially important.[5]

• Drug sourcing.  Drugs should be purchased only from licensed wholesale distributors, pharmacies, or outsourcing facilities, and products labeled “for research purposes only” may not be possessed by these businesses regardless of patient consent.  This is a critical safeguard against the unapproved and illegitimate products, including purported GLP-1 drugs, that have proliferated in this market.[6]

Further, we appreciate that the Guidance notes, “Any medication indicating ‘for research purposes only’ or other similar statement is unlawful to possess by IV hydration clinics and med spas and is both a violation of state and federal law regardless of patient ‘consent’”.[7]  The compounding of the investigational drug retatrutide has expanded dramatically over the past months, a trend that will likely repeat for future drugs after positive clinical data are announced.  The widespread compounding of unapproved drugs while they are still under clinical investigation puts patients at risk and threatens the foundation of drug development that depends on the creation of rigorous evidence to assess safety and effectiveness before new drugs reach patients.  Patients deserve treatments supported by rigorous evidence, not unauthorized products marketed before the development process is complete.

Beyond the guidance itself, we urge the Board to scrutinize potentially false or misleading marketing of compounded drugs by med spas, hydration clinics, and similar facilities. This can include the marketing of compounded drugs in ways that fail to disclose any meaningful risk information to prospective patients, and creates the impression that certain entities are licensed pharmacies when they are not. The mass marketing of compounded drugs induces demand for these products beyond the limited, gap-filling role compounding is intended to play in our health care system.

CEBM commends the Board for its leadership in protecting Virginia patients and urges the Boards to finalize the Guidance.  In addition, CEBM encourages the Boards to support legislation that would enhance the ability of the Boards to oversee med spas and IV hydration clinics. One example of such legislation is the National Association of Boards of Pharmacy (NABP) “Model Medical Spa Oversight Act,” which would require site licensure, specific inspection schedules, and adverse event reporting, all of which will enhance patient safety.[8] Additional legislation would further strengthen the Boards’ ability to take effective action to protect Virginians and ensure that patients receive high-quality care and medication regardless of the setting.

Thank you for your consideration.

Sincerely,

John Hertig, PharmD, MS, CPPS, FASHP, FFIP (Chair of CEBM)  Michael Stepanovic, PharmD, MS

Dr. Adonis Saremi, MD, MS, DABOM                Donney John, PharmD

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

October 7, 2026

Via Comment Portal

Erin Barrett

Director of Legislative and Regulatory Affairs

Perimeter Center

9960 Mayland Drive, Suite 300

Henrico, VA 23233

erin.barrett@dhp.virginia.gov

Re:        Regulatory Considerations for IV Hydration Clinics and Med Spas in Virginia

Dear Director Barrett:

The Collaborative for Evidence-Based Medicines (“CEBM”) is a national provider-led organization advancing evidence-backed medicines, safe compounding, and stronger oversight and accountability to protect patients.  CEBM brings together providers, patient advocates, academics, consumer groups, manufacturers, and other stakeholders to advance our patient safety mission.  The signatories to this letter are pharmacists, physicians, and regulatory professionals who sit on the CEBM Board. 

CEBM writes in strong support of the draft guidance document, Regulatory Considerations for IV Hydration Clinics and Med Spas in Virginia (the “Guidance”).  As the Virginia Boards of Medicine, Nursing, and Pharmacy (hereafter referred to as the “Boards”) acknowledge, IV hydration clinics and med spas offering IV fluids, vitamin and amino acid infusions, GLP-1 and other peptide products, and compounded drugs are expanding rapidly across the Commonwealth, often in consumer-focused settings where patients select treatments from a menu, complete a brief questionnaire, and receive therapy without ever meaningfully interacting with a prescriber (if at all).[1]  These practice models present real and avoidable risks of infection, contamination, and dosing errors.  The Guidance appropriately reminds these businesses that selecting, preparing, compounding, and administering prescription drugs is the practice of medicine, nursing, or pharmacy, and is subject to the same standards that apply in any other clinical setting.

The Guidance comes at a critical time.  We urge the Boards to consider the growing body of evidence documenting patient harm from compounded drugs[2] which motivates CEBM’s comments.  For example, a recent study from researchers at Binghamton University found that patients who took compounded GLP-1/GIP drugs reported adverse events that required hospitalization at a 2.5 times higher rate and were over 8.5 times more likely to have an adverse event that involved product quality issues as compared to those taking FDA-approved medicines.[3]  From our perspective as providers and patient advocates, these numbers represent real patients who sought treatment and instead received products that put their health at risk.

CEBM particularly supports the Guidance’s clarification of the following points:

• Patient-specific care.  Each patient must be evaluated by a licensed prescriber who issues a patient-specific order within a bona fide practitioner-patient relationship, and drugs may not be administered under protocols or standing orders.[4]

• Compounding standards.  Adding medications, vitamins, or minerals to IV fluids, or preparing customized formulations such as peptides, is compounding and constitutes the practice of pharmacy, and all such compounding must comply with USP standards as required by Virginia Code § 54.1-3410.2.  The Guidance’s reminder that compounded drugs are not FDA-approved, and that improper sterile technique can cause serious patient harm, is especially important.[5]

• Drug sourcing.  Drugs should be purchased only from licensed wholesale distributors, pharmacies, or outsourcing facilities, and products labeled “for research purposes only” may not be possessed by these businesses regardless of patient consent.  This is a critical safeguard against the unapproved and illegitimate products, including purported GLP-1 drugs, that have proliferated in this market.[6]

Further, we appreciate that the Guidance notes, “Any medication indicating ‘for research purposes only’ or other similar statement is unlawful to possess by IV hydration clinics and med spas and is both a violation of state and federal law regardless of patient ‘consent’”.[7]  The compounding of the investigational drug retatrutide has expanded dramatically over the past months, a trend that will likely repeat for future drugs after positive clinical data are announced.  The widespread compounding of unapproved drugs while they are still under clinical investigation puts patients at risk and threatens the foundation of drug development that depends on the creation of rigorous evidence to assess safety and effectiveness before new drugs reach patients.  Patients deserve treatments supported by rigorous evidence, not unauthorized products marketed before the development process is complete.

Beyond the guidance itself, we urge the Board to scrutinize potentially false or misleading marketing of compounded drugs by med spas, hydration clinics, and similar facilities. This can include the marketing of compounded drugs in ways that fail to disclose any meaningful risk information to prospective patients, and creates the impression that certain entities are licensed pharmacies when they are not. The mass marketing of compounded drugs induces demand for these products beyond the limited, gap-filling role compounding is intended to play in our health care system.

CEBM commends the Board for its leadership in protecting Virginia patients and urges the Boards to finalize the Guidance.  In addition, CEBM encourages the Boards to support legislation that would enhance the ability of the Boards to oversee med spas and IV hydration clinics. One example of such legislation is the National Association of Boards of Pharmacy (NABP) “Model Medical Spa Oversight Act,” which would require site licensure, specific inspection schedules, and adverse event reporting, all of which will enhance patient safety.[8] Additional legislation would further strengthen the Boards’ ability to take effective action to protect Virginians and ensure that patients receive high-quality care and medication regardless of the setting.

Thank you for your consideration.

Sincerely,

John Hertig, PharmD, MS, CPPS, FASHP, FFIP (Chair of CEBM) 

Michael Stepanovic, PharmD, MS

Dr. Adonis Saremi, MD, MS, DABOM           

Donney John, PharmD

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" width="195" height="35" />                                                                                                Malcolm Broussard, BS Pharm, LHD (hon), FLSHP     

Elizabeth Johnson, PharmD, FAPhA

Lisa Robin, MLA