By Alex Thiersch, Founder and Chairman, AmSpa

The Indiana Senate recently passed Senate Bill 282, which includes wide-ranging medical spa regulatory requirements, with little opposition and even less discussion. AmSpa sent a letter to the House Committee on Public Health explaining our formal opposition to the bill based on its vagueness and the lack of involvement of the medical spa community. You can view that here.

**For those of you in Indiana who want to help, we’ve provided templated letters for you to send to your state representative or state senator, along with instructions on how to find your legislator.

Initially, our objection was straightforward: the bill was hastily drafted without meaningful input from industry representatives. The language showed a clear misunderstanding of how medical spas operate and of the real issues that need to be addressed.

With the help of a group of passionate Indiana med spas, we retained a lobbyist and dug deeper into the bill, seeking a seat at the table. At minimum, legislators should understand the industry they are attempting to regulate.

Once we dug into the proposed language of the bill—and what the opposition was looking to achieve—the reality became difficult to ignore.

Here’s the reality: SB 282 is not about patient safety. It is not about cleaning up bad actors. It is not even about regulating med spas.

This bill is about money—specifically, money generated from the sale of compounded GLP-1s. It is a push by large pharmaceutical manufacturers to consolidate the GLP-1 market by squeezing out competing compounding pharmacies. And medical spas are caught in the middle.

In this post:

• The GLP-1 Reality
• So What Does This Have to Do With Med Spa Safety?
• What Indiana SB 282 Does Not Do
• What Indiana SB 282 Actually Does
• The Verdict: This Isn’t About Patient Safety
• A Word to Those Who Support More Regulation

 

How We Got Here

It is no secret that SB 282 is being supported and driven by a major pharmaceutical manufacturer—Eli Lilly—which produces brand-name GLP-1 medications Mounjaro and Zepbound. Eli Lilly happens to be headquartered in Indianapolis. One of the first things we learned about SB 282 was that nothing could happen without first talking with Lilly lobbyists.

Eli Lilly is an absolute giant, but it doesn’t have much stake in our industry from a purely medical aesthetics standpoint. Yes, med spas are participating in the GLP-1 surge, but it’s hardly the only thing we do, or even close to the primary thing we do. Lilly isn’t even the largest pharmaceutical manufacturer in our industry.

So the obvious question is this: why would a major pharmaceutical manufacturer with no medical aesthetic products be the driving force behind a med spa safety bill? What interest would it have in ensuring that providers are trained and qualified in injectable treatments or laser resurfacing?

To be fair, if a bill ultimately improves patient safety and strengthens the industry, the motivation behind it may not matter. But that assumes the bill actually improves patient safety. If it doesn’t—or if it merely goes through the motions without addressing the underlying issues—then the real motivation becomes clearer.

I have no doubt that members of the Indiana legislature want to pass good law. They have good intentions. But without significant engagement from Indiana physicians and providers, this bill risks serving the interests of large pharmaceutical companies more than the interests of patients.

 

 

GLP-1 medications have been transformative. They have changed lives. The research behind them deserves recognition, and both Eli Lilly and Novo Nordisk have brought meaningful innovation to market.

They have also been hugely profitable. Both Lilly and Novo are public companies who release their financials every quarter and, given the passion surrounding GLP-1s, their earnings are discussed on the financial networks nearly every day. GLP-1s, as we know, have been good for business. 

At the same time, medical spas—like many physician practices—have responded to patient demand for GLP-1 medications as well. Med spas have distinguished themselves in the market by offering bespoke, personalized care.

That sometimes includes prescribing compounded GLP-1 medications through licensed compounding pharmacies in order to tailor dosing, adjust delivery, or combine medications to improve tolerability. When done in compliance with FDA regulations and filled through a properly licensed compounding pharmacy, this is fully legal.

Patients value the flexibility, and providers value the ability to individualize care. This individualized approach is not possible with the one-size-fits-all delivery system of branded GLP-1s.

Pharmaceutical manufacturers, however, have consistently opposed expanded use of compounded GLP-1s. Lawful compounding cuts into their market share, which affects profit. And that makes them…well, a bit crabby.

To be clear, there’s nothing wrong with commercial success or with wanting to expand market share. But Lilly and Novo Nordisk are not in danger of losing this market—even with compounding pharmacies involved, brand manufacturers still control an estimated 90% or more of the GLP-1 market. Ninety percent, however, is not one hundred percent.

That context matters.

 

 

As I mentioned above, this is the question. And the answer is, as far as I can tell, very little.

Pharmaceutical manufacturing is big business. Business at this level is war. Med spas in Indiana have become the opening battlefield in a broader dispute between brand-name manufacturers and the compounding pharmacy industry.

If you read SB 282 carefully, that becomes apparent.

 

 

Anyone serious about improving med spa safety knows where the real problems lie, and this is true in Indiana:

• Untrained, unauthorized, or unsupervised providers
• Improper ownership structures
• Counterfeit or improperly sourced products
• Inconsistent enforcement by licensing boards

 

If SB 282 were truly about safety, you would expect it to:

• Directly address unauthorized practice and training requirements
• Strengthen ownership compliance
• Target counterfeit product purchasing
• Clarify supervision standards
• Establish inspection or enforcement mechanisms

 

It does none of these things in a meaningful way.

Instead, its “safety” provisions restate requirements that already exist under Indiana law and, in doing so, create more questions than clarity. The bill says that a qualified practitioner must be on site an appropriate amount of time and that treatments must be supervised appropriately. Those obligations are already in place.

We need more clarity—and, most importantly, enforcement of existing rules—not pages of additional requirements that bad actors will also ignore.

 

 

What the bill does very effectively is create a broad public registry of who is providing which services and prescribing which medications—including compounded medications.

First, SB 282 defines “medical spa” so broadly that it may encompass virtually any practice seeking to improve a patient’s lifestyle or well-being: family practice, OB/GYN, dermatology, plastic surgery, urology, sports medicine, and internal medicine. All of these could fall under the bill’s definition.

Second, it creates a public database requiring each covered practice to register every “medical health care service” it intends to provide and every prescription drug “intended to be prepared, administered, dispensed, or otherwise used.” The bill specifically includes prescriptions to be filled at compounding pharmacies.

Third, it requires the name and license number of every practitioner to be submitted to the medical board.

The result is a law that has not materially strengthened or clarified training, delegation, or supervision laws for medical spas but does require every practice whose aim is to improve a patient's “lifestyle” to register every treatment, every drug, and every combination—along with every staffing change—in a public database.

All of this is required even though physicians, nurse practitioners, and physician assistants:

1. Already hold professional licenses
2. Already operate within a defined standard of care, and
3. Already register with the DEA to prescribe medication.

That is a significant shift. Nowhere—certainly not in other medical specialties—are providers required to preregister their treatments and prescriptions for inspection by the state.

Consider the practical questions this raises: What about off-label treatments? New treatment modalities? Combination therapies? Must these be preregistered before being prescribed? And if they are not registered in advance, are clinics subject to fines of up to $5,000 or revocation of registration, both of which are authorized under SB 282?

There are over 20,000 FDA-approved drugs. Can a med spa simply list them all? Can a practice state that it intends to provide “medical spa treatments” and satisfy the requirement? And if so, how does that meaningfully advance patient safety?

 

 

This bill is presented as a “med spa safety bill,” but it does not meaningfully address the core safety and compliance problems facing medical spas. There has been no meaningful involvement of medical spa physicians or providers and no substantive consultation with the industry.

It does, however, create a detailed public record of who is prescribing GLP-1 medications and whether those prescriptions involve compounding pharmacies.

When legislation is framed as a safety measure yet primarily functions as a tracking mechanism, it is fair to question whose interests are being served. That question becomes more pointed when the legislation is driven by the company that benefits most from that tracking.

 

 

We have heard from providers in Indiana who support stronger regulation. They are frustrated by unqualified providers giving the industry a bad name and unscrupulous operators sidestepping the rules at the expense of compliant practices.

We agree that the industry must become more professional and accountable. We support standardization, enforcement of existing laws, and removal of noncompliant operators. We are working toward more consistent regulation across the states. It is well past time that we hold ourselves to higher standards.

But we must be smart. Once this law is passed, it will be extremely difficult to change.

 

To Conclude…

Let’s oppose this bill not because we oppose commonsense regulation, but because regulation of medical practice should not be driven by pharmaceutical market competition.

If Indiana wants to strengthen med spa oversight, we are ready to help draft thoughtful, targeted legislation that truly improves patient safety.

Until then, SB 282 deserves serious scrutiny.