In Alabama, only a physician may prescribe a controlled substance for weight loss. Ala. Admin. Code r. 540-X-17-.03 reserves Schedule III, IV and V drugs used for weight reduction to an MD or DO, and requires that physician to be present at the facility when prescribing. A CRNP or PA may prescribe non-controlled weight-loss drugs, which is where GLP-1s sit.
That one rule decides how you staff an Alabama weight-loss program. The rest of Chapter 540-X-17 decides how you run it. Everything below is the text of the Alabama Administrative Code as published on October 1, 2026.
The chapter splits your formulary into three tiers
| Drug class | Who may prescribe for weight loss | Key condition | Rule |
|---|---|---|---|
| Schedule II stimulants and amphetamine-like anorectics | Nobody | A physician “shall not” order, prescribe, dispense or administer them for weight control or obesity | r. 540-X-17-.02 |
| Schedule III, IV and V controlled substances (phentermine is Schedule IV) | MD or DO only | Physician present at the facility when prescribing, ordering or dispensing; no call-in prescriptions | r. 540-X-17-.03 |
| Non-controlled drugs | MD, DO, PA, CRNP or CNM | PA, CRNP and CNM must follow the chapter’s guidelines and standards that apply to physicians | r. 540-X-17-.03(1) |
Phentermine is a Schedule IV drug under 21 C.F.R. § 1308.14(f). Semaglutide and tirzepatide do not appear in the federal controlled substance schedules, so they fall in the third row.
Phentermine belongs to the physician, on site
Rule 540-X-17-.03 is short and has three parts.
First, “only a doctor of medicine or doctor of osteopathy licensed by the Medical Licensure Commission of Alabama” may prescribe, dispense or administer a Schedule III, IV or V drug for weight control, weight loss, weight reduction or treatment of obesity. A CRNP or PA with a Qualified Alabama Controlled Substances Certificate still cannot write phentermine for weight loss. The certificate does not change this chapter.
Second, a written prescription or order must be signed by the prescribing physician “on the date the medication is to be dispensed or the prescription is provided to the patient.” Electronic prescriptions must meet the federal rules for electronic controlled substance prescribing. The prescription “shall not be called in to a pharmacy by the physician or an agent of the physician.”
Third, the physician “shall be present at the facility” when he or she prescribes, orders or dispenses the drug. A director who signs remotely on the day your CRNP sees the patient does not satisfy that sentence.
The rest of the phentermine workflow is written down too
The chapter uses “should” for most of what follows, and r. 540-X-17-.01(4) says the Board will not discipline a physician for deviating from the guidelines “if good cause is shown.” Treat them as the standard your charts will be measured against.
- Initial evaluation by the prescribing physician. History, physical, appropriate tests and referrals, recorded before the first prescription (r. 540-X-17-.04(1)(a)).
- A qualifying patient. BMI of 30 or above, or BMI above 25 with at least one comorbidity, or body fat of at least 25% for men or 30% for women, or abdominal girth of at least 40 inches for men or 35 inches for women (r. 540-X-17-.04(1)(b)).
- No more than a 35-day supply (r. 540-X-17-.05(1)).
- An in-person re-evaluation at least every 35 days, with weight, blood pressure and pulse recorded. A PA or CRNP may perform it, and the physician should then personally review the record before the drug continues (r. 540-X-17-.05(2), (4), (5)).
- Stop at 70 days without progress, and stop for tolerance, pregnancy, signs of substance abuse or diversion (r. 540-X-17-.07).
What a CRNP or PA may prescribe, and on what terms
A CRNP, CNM or PA “may prescribe non-controlled drugs” for weight reduction. The rule adds that the prescriber “shall comply with the guidelines and standards of this Chapter” that apply to MDs and DOs. That brings the evaluation, patient-selection and record standards along with the prescription.
For non-controlled drugs the chapter sets its own refill rule. Under r. 540-X-17-.05(6):
- Five refills are allowed “after an initial prescription and one follow up visit for an in-person re-evaluation.”
- The five refills “shall not extend past a period of six (6) months from the date of issue of the original prescription.”
- Continued prescribing must follow any FDA Risk Evaluation and Mitigation Strategy.
Read that against a subscription GLP-1 program. The rule contemplates an in-person re-evaluation before the refills, and a six-month ceiling on them. A program built on a single video intake and automatic monthly renewals does not match that sequence on its face.
Alabama’s telehealth statute adds a separate trigger. The Board’s summary of Ala. Code §§ 34-24-700 to 707 says that when a physician or practice group provides telehealth services more than four times in 12 months to the same patient for the same condition without resolution, the patient must be seen in person within 12 months or referred to a physician who will. A video visit with a physician, PA, CRNP or nurse physically with the patient counts as in person for that purpose.
Compounded GLP-1s raise a separate CRNP question
A CRNP’s legend drug authority runs through r. 540-X-8-.11. The drug type, dosage, quantity and refills must be authorized in the approved protocol. The rule offers a shortcut: that requirement “may be met” if prescriptions follow standard recommended doses and do not include FDA non-approved drug products or off-label medications. FDA states that compounded drugs are not FDA-approved.
So a compounded semaglutide or tirzepatide prescription does not fit the shortcut. It needs to be addressed in the collaborative protocol and formulary itself. Paragraph (2)(c) of the same rule says drugs without FDA approval “may be prescribed through protocol registration” in an IRB or Expanded Access clinical trial. The rule does not say whether that is the only route.
Settle that with Alabama counsel before a CRNP signs for a compounded product. For PAs, r. 540-X-7-.28 requires the drug type, dosage, quantity and refills to be authorized in the Board-approved job description and formulary.
HCG and unvalidated products are named in the rule
Rule 540-X-17-.06(2) says obesity treatment “should be based on evidence-based medicine.” It then names names: the Board considers the promotion and use for weight reduction of controlled and non-controlled substances “which have not been scientifically validated to be of questionable benefit (e.g., HCG, etc.),” and says their promotion and use “is under scrutiny by the Board for possible sanctions.”
That sentence covers non-controlled products too. If your menu includes HCG or anything else marketed for weight loss without validation, the Board has told you in a rule where it is looking.
Where MDside differs from common practice
An NP-run program with a medical director on file can fit a GLP-1-only menu, subject to the protocol and refill conditions above. It cannot fit phentermine. MDside’s position on weight management programs in Alabama is that scheduled anorectics are prescribed only by a physician who is physically at the site, and that a remote signature does not meet the rule. See clinical standards.
What this means for you
Sort your Alabama menu into the three rows of the table before you hire. If phentermine is on it, you need a physician in the building on prescribing days, and your Alabama medical director arrangement has to be priced and scheduled for that. If you are GLP-1 only, a CRNP or PA can prescribe, provided the protocol covers the drug and the first in-person re-evaluation is on the calendar. Decide who examines the patient and where. Then read what an NP can run without a physician against your actual roster.
Frequently asked questions
Can a nurse practitioner prescribe phentermine in Alabama?
No, not for weight loss. Ala. Admin. Code r. 540-X-17-.03(1) allows only an MD or DO to prescribe a Schedule III, IV or V controlled substance for weight control, weight reduction or obesity. Phentermine is Schedule IV. A CRNP or PA may prescribe non-controlled drugs for weight loss and must follow the same chapter’s guidelines and standards.
Can a CRNP or PA prescribe semaglutide or tirzepatide for weight loss in Alabama?
Yes, as non-controlled drugs. Rule 540-X-17-.03(1) permits a PA, CRNP or CNM to prescribe non-controlled drugs for weight reduction, following the chapter’s standards for physicians. The drug must also be authorized in the CRNP’s collaborative protocol or the PA’s approved job description and formulary. Compounded versions need specific attention in that protocol.
Does the physician have to be on site to prescribe phentermine in Alabama?
Yes. Rule 540-X-17-.03(3) says the prescribing or ordering physician “shall be present at the facility” when prescribing, ordering or dispensing a controlled substance for weight reduction or treatment of obesity. The prescription must be signed on the date it is provided or dispensed, and it may not be called in to a pharmacy.
How many refills are allowed for non-controlled weight-loss drugs in Alabama?
Five. Under r. 540-X-17-.05(6)(a), five refills are allowed after an initial prescription and one follow-up visit for an in-person re-evaluation, and they may not extend past six months from the date of the original prescription. Continued prescribing must also follow any FDA Risk Evaluation and Mitigation Strategy for the drug.
—
This is general information, not legal advice. Rules vary by state and change. Confirm your own facts with counsel.