Short answer: no, not in most states. GLP-1 telehealth care — intake, clinician review, prescribing, and follow-up — happens entirely through secure messaging in 43 of 50 states. Seven states (Arkansas, Mississippi, North Dakota, New Mexico, Rhode Island, South Dakota, and West Virginia) plus Washington, D.C. currently require one live video visit before a clinician can prescribe. Which group you're in depends only on where you live.
The short answer
No video call is required in 43 of 50 states — your entire GLP-1 telehealth visit, from intake through prescribing, happens by secure message. Seven states plus Washington, D.C. require one live video visit to establish the provider-patient relationship before a clinician can prescribe. This is a state telehealth law, not a provider's choice, and it can change — check the current list before you start.
Why does this even vary by state?
Telehealth is regulated state by state, not federally. Each state medical board sets its own rules for what's required to establish a provider-patient relationship — some accept a thorough written intake and secure messaging as sufficient, others require real-time audio-video contact at least once. GLP-1 prescribing follows whatever that state's general telehealth rule says; there's no GLP-1-specific carve-out.
That means the same telehealth company can be fully async in one state and require a video visit in the next, purely based on where the patient is physically located at the time of their visit — not where the company is headquartered.
Which states require a video visit?
As of this writing, seven states plus Washington, D.C. require a live video visit before a clinician can prescribe a GLP-1 through telehealth: Arkansas, Mississippi, North Dakota, New Mexico, Rhode Island, South Dakota, and West Virginia — plus Washington, D.C. Everywhere else — 43 of 50 states — the entire process can happen asynchronously, by message, with no call to schedule.
This list is not static. States add and remove synchronous-visit requirements as their telehealth laws change, and it has changed more than once in recent memory. Rather than memorizing a list that can go stale, check the live tracker:
- GLP-1 telehealth rules by state — an always-current tracker for all 50 states plus D.C., with sources and a changelog of what's changed and when.
- State-by-state GLP-1 directory — availability, video-visit requirements, and other specifics for your state.
Check your state's requirement
Start a short intake and you'll see immediately whether your state needs a video visit — most don't.
Start your intake →What does async (message-only) care actually look like?
"No video call" doesn't mean less clinical review — it means the same review happens in writing instead of on a call. A typical async visit looks like:
- You complete a written intake. Medical history, current medications, prior GLP-1 use, and your goals — usually 5–10 minutes from a phone.
- A US-licensed clinician reviews it. They must be licensed in the state where you're physically located, which is why your state matters for both eligibility and visit type.
- They decide whether treatment is appropriate. Based on your history, not automatically approved because you submitted a form. If something in your intake needs more detail, the clinician follows up by message.
- If prescribed, a licensed pharmacy fills and ships it. Ongoing dose adjustments and side-effect questions continue by message too, without a new visit each time.
Nothing about the async format skips a step — it just replaces "get on a call" with "answer these questions in writing," which most patients find faster to schedule around.
Does a video visit change what my clinician evaluates?
No. In sync-required states, the video visit doesn't add extra screening — it satisfies a state-law requirement for real-time contact before your clinician can prescribe. The same intake questionnaire, medical history review, and prescribing decision happen either way; a live video visit in a sync-required state is simply how the provider-patient relationship gets established there.
Does this apply to every visit, or just the first one?
The synchronous-visit requirement in these jurisdictions is about establishing the provider-patient relationship — typically the first prescribing decision. Rules on follow-up care vary, so if you're in one of the sync-required states, it's worth confirming with your specific provider whether renewals also require a video visit or can continue by message once your relationship with a clinician is established.
What if I move, or I'm traveling when it's time for my visit?
Visit type is based on where you're physically located at the time of your visit, not your home address or billing address. If you're temporarily in a sync-required state — traveling, visiting family — that visit may need to be synchronous even if your home state doesn't require it. If you're unsure, message your care team before your visit is due rather than assuming.
Already a Pallas patient?
Message your care team through the patient portal with questions about your visit type or upcoming renewal.
Go to your patient portal →How do I verify a provider is telling me the truth about this?
Two checks take a minute each: look up the provider in LegitScript's public certification database (see our explainer on what LegitScript certification means), and cross-reference their stated video-visit requirement against your state's actual rule using an independent source like our telehealth rules tracker rather than taking a single company's word for it. A provider that gets your state's requirement wrong — in either direction — is a sign their compliance isn't being kept current.
Frequently asked questions
In most states, no. 43 of 50 states allow the entire GLP-1 telehealth process — intake, clinician review, and prescribing — to happen asynchronously by secure message. Seven states (Arkansas, Mississippi, North Dakota, New Mexico, Rhode Island, South Dakota, and West Virginia) plus Washington, D.C. require one live video visit before a clinician can prescribe.
As of this writing: Arkansas, Mississippi, North Dakota, New Mexico, Rhode Island, South Dakota, and West Virginia, plus Washington, D.C. This list is maintained by each state's telehealth rules and can change — check the live tracker at our GLP-1 telehealth rules page for the current list before you start.
Telehealth is regulated at the state level, not federally. Each state medical board sets its own rule for what establishes a valid provider-patient relationship — some accept a thorough written intake and secure messaging, others require real-time audio-video contact at least once. GLP-1 prescribing simply follows whatever that state's general telehealth rule requires.
No — the clinical review is the same either way. A US-licensed clinician still reviews your full medical history, current medications, and goals, and still makes an individualized decision about whether treatment is appropriate. The video visit requirement in certain states is a state-law formality for establishing the provider-patient relationship, not an additional layer of screening.
It's generally about establishing the provider-patient relationship, which typically means the first prescribing decision. Rules on follow-up visits vary by provider and state, so if you're in a sync-required state, confirm with your specific care team whether renewals also require video or can continue by message.
Visit type is based on where you're physically located at the time of your visit, not your home address. If you're temporarily in a state that requires a video visit, that visit may need to be synchronous even if your home state doesn't require it. Message your care team ahead of time if you're unsure.
The bottom line
For the large majority of patients — 43 of 50 states — GLP-1 telehealth care never requires a video call: intake, clinician review, prescribing, and follow-up all happen by secure message. Seven states (AR, MS, ND, NM, RI, SD, WV) plus Washington, D.C. require one live video visit to establish care. The rule is set by your state, not by any individual provider, and it can change — check the live tracker for your state before you start, and see our full guide to how online GLP-1 prescriptions work for the rest of the process.
See if you qualify in a few minutes
Pallas's intake is asynchronous in most states — complete it by message, and a US-licensed clinician will let you know if GLP-1 treatment is appropriate for you.
Start your intake →