It’s time for an update on what to consider before opening and investing in a medical spa.
As we’ve written in Part I and Part II of our series, state laws and regulations are constantly evolving for medical spas. As states increasingly regulate this area owners and operators should be aware of current or potential state laws affecting their scope of practice, licenses and registrations, and other key elements.
Arizona
On February 10, 2026, Arizona introduced HB 4047 regarding the licensure of medical spas. The bill contains a number of elements common to legislation in other states, including:
Licensing Requirements
Each medical spa location that “prepares, handles, stores, administers, dispenses, distributes, or otherwise uses any prescription medication at its facility or in connection with providing services shall obtain and maintain a license from” the State Board of Pharmacy (the “Board”).
Inspections
Submission of an application for a license constitutes permission for the Board or its authorized agent to enter and inspect the facility.
Prescription Medication
The bill provides that a medical spa:
- Is to be considered a “dispenser” under the federal Food, Drug & Cosmetic Act (FD&C Act);
- May not acquire or receive prescription medicines from any person unlicensed to distribute or transfer such medications;
- Must meet certain requirements for storage, supervision, and security of such medications.
Public Database of Medical Spas
To be maintained by the Board.
Responsible Person
Each licensed medical spa shall have a designated “responsible person” who is physically present for a sufficient amount of time to carry out the duties of ensuring that the medical spa complies with the would-be law.
“Serious Adverse Event” Reporting
A medical spa shall notify the Board within five (5) business days after a “serious adverse event,” as defined in the bill. These would include death, a life-threatening adverse event, hospitalization, “persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions,” congenital abnormality or birth defect, or any event that may require medical or surgical intervention.
Deceptive and Unfair Trade Practices
A medical spa engages in deceptive trade practices if it misrepresents that a prescription medication:
- Is of a particular standard, quality, or grade;
- Has sponsorship, approval, characteristics, ingredients, uses, benefits, or quantities;
- Has approval by the U.S. Food and Drug Administration (FDA); or functions similarly to another drug approved by the FDA.
Enforcement
If passed, the bill would provide the Board with enforcement authority. The Board would be required to maintain a public record of disciplinary actions involving licensed medical spas operating in the state, subject to state confidentiality laws.
Florida
In January 2026, Florida’s SB 1728/HB 1429, “The Medical Spa Prescription Drug Oversight Act,” was introduced in the Florida Senate—owing in part to concerns over medical spas preparing and administering prescription medications either at the spa or in connection with providing services.
Licensing Requirements
Identical to Arizona’s, Florida’s bill would require that “each medical spa” with prescription medication at its facility or in connection with providing services must obtain and maintain a license” from the state’s Board of Pharmacy (the “Board.”)
Definition
Florida’s bill defines “medical spa” as “any facility or practice that offers medical or health services and that holds itself out as a facility or practice focused on cosmetic or lifestyle treatments, such as weight loss, wellness, longevity, or cosmetic or aesthetic health services.” Such services include, but are not limited to, “the preparation, administration, or dispensing of prescription drugs for weight loss, botulinum toxin injections, hormone therapies, or parenteral nutrient therapies.”
Prescription Medication
Identical to Arizona’s, the Florida bill provides that a medical spa:
- Is to be considered a “dispenser” under the federal Food, Drug & Cosmetic Act (FD&C Act);
- May not acquire or receive prescription medicines from any person unlicensed to distribute or transfer such medications;
- Must meet certain requirements for storage, supervision, and security of such medications.
Responsible Person
Similar to Arizona, a licensed medical spa in Florida would be required to designate a “responsible person”—defined as a licensed health care provider with supervising authority—who is physically present for a sufficient amount of time, to ensure compliance with the bill. Such “responsible person” in Florida would oversee the security and control of prescription drugs, along with the medical spa—a distinction also found in the Arizona bill.
Inspections, Public Databases, Serious Adverse Events.
Similar to the Arizona bill.
If passed, Florida’s law would take effect July 1, 2026.
Indiana
Indiana recently introduced SB 282 which, if passed, will require the registration of medical spas with the state’s Medical Licensing Board of after January 1, 2027. It also requires the Medical Licensing Board (the “Medical Board”) to establish and maintain a public database of medical spas; and requires medical spas to report serious adverse events to the Medical Board no later than five (5) days afterwards.
A medical spa in Indiana would designate a “responsible practitioner” with prescriptive authority and “who has education in training in the health care services and treatments being performed and medications being dispensed or administered in the medical spa.” The practitioner would ensure that each person working at the medical spa would be licensed to perform the services and treatments performed and is properly trained in those services and treatments.
The medical spa would be prohibited from providing “health care services and lifestyle treatments in a location other than the medical spa, a physician’s office, or other health care facility.” Like other laws, the bill allows the Medical Board, or a person contracting with the Medical Board, to inspect a spa that has at least applied for registration.
Iowa
On January 20, 2026, Iowa introduced its HSB 591, entitled “A bill for an act establishing the medical spa oversight Act and making penalties applicable.” The Iowa legislation requires a business operating as a medical spa, providing wellness services, or handling storing administering, dispensing, or distributing prescription drugs to be licensed by the state Board of Medicine. “Wellness services” include, but are not limited to, Botox injections, laser hair removal, skin pigmentation treatment, microneedling, intravenous nutrient therapy, or intramuscular injections of vitamins, minerals, or other nutrients.
Prescription Drugs and Devices
Iowa’s proposed legislation mirrors Arizona and Florida in containing provisions for the storage, supervision, and security of prescription drugs, and also prescription devices.
Responsible Persons
Like Arizona and Florida, a “responsible person”—defined as a person licensed under Chapter 148 (Medicine and Surgery) or 155A (Pharmacy)—shall be designated to ensure that the medical spa complies with the law and all subsequent rules and regulations.
Inspections; Serious Adverse Events
The bill also provides that the submission of a license application gives the Board of Medicine the right to inspect the proposed spa facilities and audit the proposed services; and that the Board must maintain a database of medical spas. Medical spas are required to report serious adverse events within five (5) days of the event.
Deceptive and Unfair Trade Practices
The Iowa bill mirrors Arizona’s and Florida’s by making clear that a medical spa commits an unfair trade practice if it:
- Misrepresents that a prescription drug is of a particular standard, quality, or grade;
- Misrepresents that a prescription drug or wellness service has sponsorship, approval, characteristics, ingredients, uses, or benefits that it does not have;
- Misrepresents that a drug or wellness service is approved by the FDA.
Penalties
If passed, HB 951 specifies that the Board of Medicine may bring an action for an injunction; and that the attorney general will commence enforcement proceedings at the Medical Board’s request. The Medical Board may impose an administrative penalty of up to $500 dollars per violation on a person who:
- Engages in a practice regulated under the bill without a current license;
- Employs an individual without a current license to act as a “responsible person”;
- Fails any component of a routine inspection or audit conducted by the board.
Massachusetts
Massachusetts’ H. 5087/HD 5568, “An Act Regulating the Operation of Medical Spas,” was introduced in the legislature of the Commonwealth of Massachusetts on January 27. The bill governs the licensing and registration of medical spas and ranks spa procedures into three categories: Level I, meaning within the scope of practice of a licensed electrologist, cosmetologist, or aesthetician; Level II, meaning minimally invasive with minor to moderate risk to patients; and Level III, meaning more invasive and of greater risk than Level II, involving the practice of medicine or nursing. The legislation would also establish a medical spa advisory committee; penalties for an unlicensed medical spa; or other noncompliance.
Clinical Director/Site Director
Would be required for medical spas licensed to provide Level II and Level III procedures and may be the same person. The clinical director would be present in the medical spa for at least 10 percent (10%) of the operating hours each month; each site director must be physically present in the medical spa during the hours of operation.
New York
Meanwhile, New York is increasing its focus on enforcement within the medical spa industry. In early January, New York’s Department of State issued a warning to consumers after more than 200 inspections of medical spa service providers alleged, for example, expired and suspected counterfeit products, controlled substances, unlicensed or unqualified staff, dirty needles, and unsanitary conditions.
Takeaways
As the body of state laws grows regulating medical spas, the applicability of these laws and regulations should be analyzed on a case-by-case basis. If you are considering opening or investing in a medical spa practice, you should note the key elements above and consult with a health care attorney to ensure compliance with state regulations.
Epstein Becker Green Staff Attorney Ann W. Parks assisted with the preparation of this post.
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