Prescribing Policy & Pharmacy Standards

Governing Entities: United Medical Group, PLLC · YourMD.Online, LLC
Policy Owner: Teja V. Surapaneni, MD, MS, ABIM — Medical Director
Last Updated: April 29, 2026 · Version: 2.0
Effective: May 1, 2026

1. Controlled Substance Policy

Absolute Prohibition

YourMD Telehealth does NOT prescribe, dispense, recommend, or facilitate the prescribing of any DEA-scheduled controlled substances. This prohibition is absolute, applies to all providers, and has no exceptions.

Prohibited Substances

Permitted Non-Controlled Medications

Enforcement

• The YourmdRx e-prescribing system excludes all controlled substances from the prescriber catalog.
• Any prescriber who circumvents this policy faces immediate termination and state medical board reporting.
• Pharmacy partners must reject any YourMD prescription for a controlled substance and notify the Medical Director immediately.

2. Prescriber Qualifications & Obligations

Credentialing Requirements

• Active, unrestricted medical license in every state where they see YourMD patients
• Board certification (ABIM, ABFM, or equivalent) or board eligibility
• Active NPI (individual) and DEA registration
• Malpractice insurance coverage
• No active disciplinary actions or federal program exclusions
• Completion of YourMD prescriber orientation

Before Prescribing

• Conduct a proper clinical evaluation via video, audio, or chat
• Review intake, medical history, allergies, and current medications in the EHR
• Confirm identity and state of residence
• Verify no contraindications exist
• Obtain informed consent and document the clinical rationale in a SOAP note

Prescriber Prohibitions

• No controlled substances through or on behalf of YourMD
• No prescriptions without a documented patient encounter
• No pre-signing or auto-signing prescriptions
• No prescribing for patients in unlicensed states
• No prescribing for self, family, or friends through the platform
• No accepting gifts or incentives from pharmacy partners

3. Approved Formulary Overview

Weight Management

FDA-approved branded GLP-1 receptor agonists for chronic weight management (Wegovy®, Zepbound®) routed through manufacturer-direct programs (NovoCare® Pharmacy, LillyDirect™) or retail pharmacies of patient choice. Adjunctive compounded medications: ondansetron (anti-nausea support), low-dose naltrexone, B12/MIC lipotropic injections, L-carnitine. Compounded GLP-1 medications are not prescribed under any circumstances (see Section 15).

Diabetes Care

FDA-approved branded GLP-1 receptor agonists for Type 2 diabetes (Ozempic®, Mounjaro®, Rybelsus®, Trulicity®, Victoza®). Oral agents: metformin (immediate-release and extended-release), metformin combination products. Other classes when clinically indicated: SGLT2 inhibitors, DPP-4 inhibitors. Routed through manufacturer-direct programs or retail pharmacy of patient choice (see Section 16).

Sexual Wellness

Sildenafil and tadalafil (capsules, troches, RDT) · oxytocin · PT-141/bremelanotide · apomorphine · topical formulations

Hair Restoration

Finasteride oral and topical · minoxidil (foam, spray) · combination formulations · dutasteride · ketoconazole shampoo · spironolactone

Dermatology

Tretinoin (all strengths) · tretinoin combinations · hydroquinone · azelaic acid · doxycycline (short courses)

Peptide Therapy

Sermorelin (injectable, troche, nasal) · PT-141 · GHRP-2 · AOD9604. Note: BPC-157 is NOT in the current formulary due to FDA Category 2 classification.

Longevity & Optimization

Rapamycin/sirolimus (weekly dosing) · metformin/metformin ER · atorvastatin · DHEA · NAD+ · methylene blue · melatonin

Wellness Injectables

B12 methylcobalamin · MIC/Lipo-B · L-carnitine · glutathione · vitamin D3 · GAC · NAD+

4. Patient Safety Standards

Clinical Safety Checks (built into YourmdRx)

• Allergy cross-reference: Hard stop if documented allergy matches the selected medication
• Drug interaction check: Hard stop for contraindicated combinations (e.g., PDE5 inhibitor + nitrate)
• Contraindication flags: GLP-1 + MTC/MEN2 → BLOCK · GLP-1 + pregnancy → BLOCK · Finasteride + female of reproductive age → BLOCK · Tretinoin + pregnancy → BLOCK
• Dosing validation: Maximum dose limits enforced per FDA labeling for branded products and per established compounding standards for compounded products
• Duplicate therapy check: Alert if patient already has an active Rx for the same drug class

Adverse Event Reporting

1. Patient reports via portal, phone, or consultation
2. Prescriber documents in EHR encounter note
3. If serious: Medical Director notified within 24 hours, FDA MedWatch filed, pharmacy partner notified with lot details (compounded products) or manufacturer pharmacy notified (branded products)
4. Replacement product shipped at pharmacy’s cost if quality-related

5. Pharmacy Partner Standards

Compounding Pharmacy Partners

• Maintain active pharmacy licenses in all states where they ship to YourMD patients
• USP <795> and USP <797> compliance (verified by annual audit or PCAB/ACHC accreditation)
• HIPAA compliance + BAA with United Medical Group, PLLC
• Certificate of Analysis (COA) per batch, third-party potency and sterility testing
• Process prescriptions within 48 hours of receipt (24 hours preferred)
• Ship direct-to-patient with cold-chain packaging for temperature-sensitive products
• Discreet packaging (no pharmacy name or medication details visible on exterior)
• Replace damaged, lost, or temperature-compromised shipments at pharmacy’s cost
• Never market directly to YourMD patients without written authorization
• Route all clinical questions from patients back to the prescribing YourMD provider
• Acknowledge in writing that GLP-1 prescriptions will not be received from YourMD under any circumstances

Manufacturer-Direct Pharmacy Programs

YourMD prescriptions for FDA-approved branded medications may be routed through manufacturer-direct pharmacy programs at patient request:

• NovoCare® Pharmacy (Novo Nordisk) — for Novo Nordisk products
• LillyDirect™ (Eli Lilly) — for Eli Lilly products

These programs are state-licensed pharmacies operated by or in partnership with the manufacturers. YourMD is not a partner, agent, or affiliate of NovoCare® or LillyDirect™ and has no financial relationship with the manufacturers.

Retail and Mail-Order Pharmacies

Patients may direct prescriptions to any state-licensed retail or mail-order pharmacy of their choice. YourMD has no preferred retail pharmacy and receives no consideration from any retail pharmacy.

6. Multi-State Prescribing

As of May 2026, YourMD prescribers are licensed in: Nevada (NV), Washington (WA), Oregon (OR), and Wisconsin (WI). The YourmdRx system enforces state-based routing — if a prescriber is not licensed in the patient’s state, the Rx button is disabled.

7. Patient Disclosures

Prescribing Disclosure: All medications are prescribed by board-certified physicians after a thorough clinical evaluation. YourMD physicians exercise independent clinical judgment and may decline to prescribe based on your health profile. Individual results vary. YourMD Telehealth does not prescribe controlled substances. If you are experiencing a medical emergency, call 911.

About FDA-Approved Medications: Some of your medications — including all GLP-1 receptor agonists prescribed through YourMD — are FDA-approved branded products manufactured by the labeled pharmaceutical company and dispensed by a state-licensed pharmacy. FDA-approved drugs have been evaluated by the FDA for safety, efficacy, and manufacturing standards. Your prescription will be filled by either the manufacturer’s direct pharmacy program (such as NovoCare® or LillyDirect™), a retail pharmacy of your choice, or a licensed mail-order pharmacy — at your direction.

About Compounded Medications: Some treatments are compounded specifically for you by a licensed compounding pharmacy based on your physician’s prescription. Compounded medications are not commercially manufactured drugs — they are custom-prepared using pharmaceutical-grade ingredients. While the individual ingredients are FDA-approved, the specific compounded formulation has not been evaluated by the FDA for safety, efficacy, or manufacturing standards. YourMD does not compound GLP-1 medications under any circumstances; all GLP-1 prescriptions are filled with FDA-approved branded products.

No Controlled Substances: YourMD does not prescribe controlled substances including but not limited to: opioid pain medications, benzodiazepines (Xanax, Ativan, Valium, Klonopin), stimulants (Adderall, Ritalin, Vyvanse), sleep medications (Ambien, Lunesta), testosterone, phentermine, ketamine, or tramadol. If you need these medications, please contact your primary care physician or specialist.

8. Policy Review

This policy — including Sections 9 through 16 below — is reviewed annually by the Medical Director, within 30 days of any FDA regulatory change affecting compounding, within 30 days of new pharmacy partner onboarding, and within 7 days of any adverse event resulting in hospitalization or death. All prescribers re-acknowledge annually (see Section 14, Prescriber Independence Attestation).

9. Pharmacy-Agnostic Clinical Decision-Making

YourMD Telehealth clinical decisions are made independently of pharmacy operational logistics. This separation is foundational to our prescribing model and is formalized as follows:

• A YourMD physician evaluates the patient, forms a diagnosis, and selects a treatment based on clinical indication, contraindications, patient history, and published evidence — without regard to which pharmacy will fill the prescription.
• Pharmacy routing occurs ONLY after a clinical decision has been made. Pharmacy selection is an operational and logistical matter handled by the YourmdRx smart router based on factors including state licensure, product availability, shipping logistics, BAA status, and patient choice — not clinical considerations.
• No pharmacy partner has any input, influence, or veto over clinical prescribing decisions.
• No pharmacy partner pays YourMD, United Medical Group, or any prescriber any fee, commission, rebate, referral payment, or other consideration for selecting that pharmacy over another.
• No pharmaceutical manufacturer pays YourMD, United Medical Group, or any prescriber any fee, commission, rebate, referral payment, or other consideration for prescribing a particular branded product.
• No prescriber compensation is tied to pharmacy volume, pharmacy selection, manufacturer selection, or specific product selection. Prescribers receive only their agreed clinical compensation for independent medical judgment rendered.
• YourMD maintains relationships with multiple pharmacy partners at all times to prevent functional dependency on any single pharmacy and to preserve clinical routing flexibility.

This pharmacy-agnostic architecture protects the independence of medical judgment required by state medical practice acts and the AMA Code of Medical Ethics Opinion 1.2.6 (“Prescribing and Dispensing Drugs and Devices”), which prohibit prescriber arrangements that compromise independent clinical judgment.

10. Compounding Regulatory Framework

YourMD Telehealth operates within the compounded-medication framework established by Sections 503A and 503B of the Federal Food, Drug, and Cosmetic Act (FD&C Act) and corresponding state pharmacy practice acts. GLP-1 medications are excluded from compounding under YourMD’s branded-only GLP-1 policy (Section 15) regardless of regulatory framework.

503A Patient-Specific Compounding

All compounded medications prescribed through YourMD Telehealth are compounded pursuant to Section 503A as patient-specific preparations. This means:

• Every compounded prescription is issued in the name of an identified patient based on an individualized clinical assessment by a licensed physician.
• No compounded medication is prepared in anticipation of a prescription or in bulk for later assignment to patients.
• Compounding occurs only after a valid prescription is received by the pharmacy.
• Formulations are selected based on individual patient factors including dosing requirements, contraindications to commercially available formulations, tolerability, and clinical history.

Quality and Sourcing

• Active pharmaceutical ingredients used by YourMD pharmacy partners are sourced from FDA-registered facilities.
• Pharmacy partners maintain USP <795> (non-sterile) and USP <797> (sterile) compliance verified by PCAB/ACHC accreditation or equivalent third-party audit.
• Each compounded batch is accompanied by a Certificate of Analysis with third-party potency and sterility testing as applicable.

Distinction from FDA-Approved Products

Compounded medications are not FDA-approved drugs. YourMD Telehealth does not represent, and does not authorize any representation, that compounded products are:

• Equivalent to, interchangeable with, generic versions of, or substitutes for any FDA-approved drug
• Evaluated by the FDA for safety, efficacy, bioavailability, or manufacturing quality
• Approved by the FDA for any indication or use
• Subject to the same testing, labeling, or post-market surveillance as FDA-approved products

Compounded medications are appropriate when an individual patient’s clinical needs cannot be adequately met by an FDA-approved commercial product, as determined by the treating physician in exercise of independent medical judgment.

11. Manufacturer and Regulatory Communications

YourMD Telehealth maintains a formal process for receipt and response to communications from pharmaceutical manufacturers, regulatory authorities, state medical boards, state pharmacy boards, and other authorities asserting claims relating to compounded products.

Receipt and Routing

• All manufacturer communications (including cease and desist letters, demand letters, trademark claims, and litigation-adjacent correspondence) are routed within 24 hours to the Medical Director and external regulatory counsel.
• All FDA communications (warning letters, Form FDA-483 observations, inspection reports) are routed within 4 hours to the Medical Director and preserved per FDA record-retention guidelines.
• All state board communications are routed within 24 hours to the Medical Director and acknowledged in writing within 72 hours.

Good-Faith Response

• YourMD does not ignore manufacturer communications. Every letter receives a written acknowledgment within 14 days.
• YourMD cooperates in good faith with lawful regulatory inquiries while preserving all legal defenses.
• Documentation related to any communication is preserved pending resolution. No records relating to a communication are destroyed or altered while the matter is active.

Pharmacy Partner Coordination

• When a manufacturer communication implicates a pharmacy partner, YourMD promptly notifies the affected partner and coordinates response strategy.
• Pharmacy partners are required by their BAA and pharmacy partnership agreement to notify YourMD within 48 hours of any manufacturer communication affecting YourMD patients or prescriptions.

No Self-Admission

No YourMD prescriber, officer, employee, or agent responds substantively to a manufacturer communication without review by external counsel. Responses to manufacturer demand letters are drafted by or with counsel.

12. No Representations of Equivalence

YourMD Telehealth prohibits — internally, in marketing, in patient communications, and through any agent, employee, or contractor — the following representations:

• That any compounded medication is equivalent to, interchangeable with, bioequivalent to, or a substitute for any FDA-approved drug.
• That any compounded medication produces the same clinical outcomes, efficacy, safety profile, or tolerability as any specific FDA-approved drug.
• That compounded medications are generic versions of any FDA-approved drug.
• That results from clinical trials of FDA-approved drugs (including but not limited to the STEP trials for semaglutide and the SURMOUNT trials for tirzepatide) represent or predict the clinical outcomes of compounded products.
• That any compounded medication is “approved,” “authorized,” “endorsed,” or similar language by the FDA.
• Comparative pricing claims against specific named FDA-approved drugs (e.g., “get the same benefits as [branded drug] at a fraction of the cost”) are prohibited.

Patient communications, marketing materials, intake flows, advertisements, and SEO content are periodically reviewed for compliance with this section. Any team member or contractor who identifies non-compliant content is required to escalate to the Medical Director.

13. Intellectual Property

YourMD Telehealth respects the intellectual property rights of pharmaceutical manufacturers and uses third-party trademarks only in accordance with this policy.

Permitted Use of Pharmaceutical Brand Names

Pharmaceutical brand names may be used in YourMD content only under the following conditions:

1. Accurate description of products YourMD actually prescribes. YourMD may use brand names of FDA-approved branded products that YourMD prescribes (currently including Wegovy®, Ozempic®, Zepbound®, Mounjaro®, Rybelsus®, Trulicity®, Victoza®) on the treatments page, in clinical guides, in patient education materials, in patient-facing intake flows, and in clinical documentation. Use must be accurate, descriptive, and limited to information about the product itself (indication, mechanism, dosing, fulfillment pathway).
2. Educational or comparative content disclaiming compounded substitution. When discussing FDA-approved branded products in the context of YourMD’s branded-only GLP-1 policy, brand names may be used to clearly inform patients which products YourMD does and does not provide.
3. Clinical documentation. Brand names may always appear in patient medical records, prescriptions, prior authorization correspondence, insurance correspondence, and medical record transfers, where accurate clinical reference is required.
4. Clinical continuity. Brand names may appear in patient-specific clinical communications (such as care plans, refill confirmations, and provider messages) where the patient’s prescribed medication is named for clinical clarity.

Required Trademark Attribution

All marketing and patient-facing surfaces using pharmaceutical brand names must include the following attribution, published in the site footer:

Wegovy®, Ozempic®, Rybelsus®, Victoza®, and Saxenda® are registered trademarks of Novo Nordisk A/S. Zepbound®, Mounjaro®, and Trulicity® are registered trademarks of Eli Lilly and Company. NovoCare® is a registered trademark of Novo Nordisk Inc. LillyDirect™ is a trademark of Eli Lilly and Company. KwikPen™ is a trademark of Eli Lilly and Company. YourMD Telehealth and United Medical Group are not affiliated with, endorsed by, or sponsored by Novo Nordisk or Eli Lilly.

Prohibited Use

• Use suggesting affiliation, partnership, or endorsement between YourMD and any pharmaceutical manufacturer beyond YourMD’s role as a prescriber within the manufacturer’s open prescriber network.
• Equivalence claims. Use of brand names in conjunction with claims of equivalence, interchangeability, or substitutability with compounded products (this remains prohibited under Section 12).
• Comparative pricing claims that suggest a YourMD compounded product is equivalent to or a substitute for a branded product. This remains prohibited.
• SEO content using brand names as primary keywords for unrelated content. Brand names may appear in SEO meta where they accurately describe the page content, but cannot be used as bait-and-switch keywords driving traffic to compounded or unrelated content.
• Use of brand-related slogans, logos, or design elements trademarked by the manufacturer.

Generic Active Ingredient Names

Use of generic active ingredient names (semaglutide, tirzepatide, liraglutide, dulaglutide) remains permitted in all contexts where clinically appropriate.

Manufacturer Communications

If YourMD receives any communication from a pharmaceutical manufacturer regarding use of their trademarks, the communication is routed and handled per Section 11 (Manufacturer and Regulatory Communications). YourMD will modify or remove brand-name usage promptly upon receiving a substantiated objection from a manufacturer.

14. Prescriber Independence Attestation

Each YourMD prescriber executes and annually re-executes a written attestation confirming the following:

• I exercise independent medical judgment in every prescribing decision I make through the YourMD platform, based solely on the clinical needs of the individual patient.
• No portion of my compensation is tied to the volume of prescriptions I write, the selection of any particular pharmacy, or the selection of any particular product.
• I have not received, and will not receive, any payment, rebate, discount, referral fee, commission, gift, or other consideration from any pharmacy partner or pharmaceutical manufacturer in connection with my prescribing activity on the YourMD platform.
• I understand that pharmacy routing after a prescription is signed is an operational function of the YourmdRx platform and does not affect my clinical judgment.
• I understand and comply with the No Representations of Equivalence policy (Section 12) and Intellectual Property policy (Section 13) in all patient communications, including clinical documentation, video/audio/chat encounters, and follow-up correspondence.
• I understand and comply with the Branded-Only GLP-1 Prescribing Policy (Section 15) and will not authorize, recommend, or facilitate any compounded GLP-1 prescription under any circumstance.
• I have received training on the Manufacturer and Regulatory Communications policy (Section 11) and will route any communication I receive from a pharmaceutical manufacturer to the Medical Director within 24 hours.
• I understand that violation of any provision of this policy may result in termination of my privileges on the YourMD platform and reporting to the applicable state medical board.

Attestations are retained in the prescriber credentialing file for the duration of the prescriber relationship plus seven (7) years.

15. Branded-Only GLP-1 Prescribing Policy

Scope

This section applies to all GLP-1 receptor agonist prescriptions issued through the YourMD Telehealth platform, regardless of indication (chronic weight management, Type 2 diabetes, or other) and regardless of the prescribing pathway.

Branded-Only Prescribing

YourMD Telehealth prescribes only FDA-approved branded GLP-1 receptor agonists. YourMD does not prescribe, recommend, or facilitate the prescribing of compounded GLP-1 medications under any circumstances.

FDA-Approved for Chronic Weight Management

• Wegovy® (semaglutide injection, Novo Nordisk)
• Zepbound® (tirzepatide injection, Eli Lilly)

FDA-Approved for Type 2 Diabetes

• Ozempic® (semaglutide injection, Novo Nordisk)
• Mounjaro® (tirzepatide injection, Eli Lilly)
• Rybelsus® (oral semaglutide, Novo Nordisk)
• Trulicity® (dulaglutide injection, Eli Lilly)
• Victoza® (liraglutide injection, Novo Nordisk)

No Compounded GLP-1 Prescribing

YourMD does not authorize prescriptions for compounded semaglutide, compounded tirzepatide, compounded liraglutide, compounded dulaglutide, or any other compounded GLP-1 receptor agonist — regardless of patient request, compounding pharmacy availability, manufacturer shortage status, insurance coverage limitations, cost considerations, or any other circumstance.

Off-Label Use of FDA-Approved Branded GLP-1 Medications

YourMD physicians may prescribe FDA-approved branded GLP-1 medications off-label when all of the following conditions are met:

1. Sound clinical rationale documented in the patient record, supported by published evidence, recognized clinical practice, or accepted standard of care.
2. Patient-specific evaluation — not based on protocol, default, or platform routing.
3. Patient informed consent — the patient has been informed the medication is prescribed off-label, what that means, and implications for insurance and manufacturer savings programs.
4. On-label alternative considered — when an FDA-labeled product for the patient’s specific indication is available, accessible, and clinically appropriate, the on-label product is preferred. Off-label use is considered only when on-label use is not feasible, not appropriate, or when both physician and patient determine the off-label option is the better clinical choice.
5. Documentation of consideration. The physician documents in the medical record what on-label alternatives were considered and the clinical reasoning for selecting the off-label option.

Specific Off-Label Scenarios

Off-label use of Ozempic® or Mounjaro® for weight management may be considered when: (a) the patient has comorbid Type 2 diabetes; (b) Wegovy® or Zepbound® is unavailable due to FDA-recognized manufacturer shortage; (c) patient has a documented affordability barrier and on-label alternatives have been exhausted; or (d) other patient-specific clinical reason is documented in the medical record.

Physicians must counsel patients that manufacturer savings cards for Ozempic® and Mounjaro® generally require a Type 2 diabetes diagnosis; off-label use for weight management typically does not qualify, and insurance coverage of off-label weight management use is typically not available.

Prohibited Practices

• Falsification of diagnosis. Asserting a Type 2 diabetes diagnosis the patient does not have to qualify for insurance coverage or manufacturer savings cards constitutes insurance fraud and is grounds for immediate termination and reporting to relevant authorities.
• Off-label prescribing without documentation. Off-label prescriptions without documented clinical rationale, patient consent, and consideration of on-label alternatives are non-compliant.
• Pre-selection of off-label products as a default driven by economics or convenience rather than individual clinical evaluation.

Pharmacy Routing

Branded GLP-1 prescriptions are routed through NovoCare® Pharmacy (Novo Nordisk products), LillyDirect™ (Eli Lilly products), or state-licensed retail/mail-order pharmacies of the patient’s choice. The LifeFile pharmacy adapter used for compounded medications is not used for branded GLP-1 prescriptions.

Technical Enforcement

The branded-only GLP-1 policy is enforced through five technical safeguards: (1) database CHECK constraint preventing GLP-1 product entries flagged as compounded; (2) prescriber catalog filter excluding all compounded GLP-1 entries; (3) prescription validator rejecting GLP-1 Rx routed to a compounding pharmacy; (4) pharmacy adapter hardcode preventing GLP-1 product codes in compounding API payloads; (5) pharmacy account configuration requiring acknowledgment that GLP-1 prescriptions will not be received. Prescribers have no override option.

16. Diabetes Care Program

The Diabetes Care Program is a consult-based clinical program for patients with diagnosed or suspected Type 2 diabetes. It is structured as a per-visit clinical service, not a subscription or guaranteed-prescription product.

Scope of Services

• Initial consultation ($99): Comprehensive metabolic evaluation, lab review, treatment plan, prescribing where clinically appropriate.
• Follow-up consultations ($49): Every 3 months minimum for active medication management, with A1C and lab review, dose adjustment, and care plan revision.
• Refill review ($25): Chart-only review for stable patients between scheduled consultations.

Eligibility

• Adults 18 years of age or older
• Confirmed or suspected Type 2 diabetes (existing labs, prior diagnosis, or initial labs ordered through the program)
• Resident of NV, WA, OR, or WI
• Not pregnant
• No history of medullary thyroid carcinoma or MEN2 syndrome (for GLP-1 candidates)
• Willing to obtain labs every 3 months

Approved Formulary

FDA-Approved GLP-1 Receptor Agonists for Type 2 Diabetes

• Ozempic® (semaglutide injection) · Mounjaro® (tirzepatide injection) · Rybelsus® (oral semaglutide)
• Victoza® (liraglutide injection) · Trulicity® (dulaglutide injection)

First-Line Oral Therapy

• Metformin (immediate-release and extended-release) · Metformin combination products where clinically appropriate

Other Classes When Clinically Indicated

• SGLT2 inhibitors (empagliflozin, dapagliflozin, canagliflozin)
• DPP-4 inhibitors (sitagliptin, linagliptin)

Excluded from the Diabetes Care Program

• Insulin therapy. YourMD does not initiate insulin therapy via telehealth. Patients requiring insulin are referred to in-person endocrinology or primary care for initiation.
• Type 1 diabetes management. Referred to specialty endocrinology care.
• Diabetic ketoacidosis or hyperglycemic crisis. Require emergency in-person care. Patients directed to call 911 or visit an emergency department.
• Pediatric diabetes. YourMD treats adults 18 and older only.

Required Documentation

• Recent A1C (within 12 months for established patients, current for new patients)
• Lipid panel (within 12 months)
• Comprehensive metabolic panel including eGFR, creatinine, ALT, AST
• Current medications including any insulin
• Documented Type 2 diabetes diagnosis

Pharmacy Routing

Diabetes Care Program prescriptions route to the patient’s pharmacy of choice — manufacturer-direct programs (NovoCare®, LillyDirect™), retail pharmacies, or state-licensed mail-order pharmacies. The LifeFile compounding pharmacy adapter is not used for the Diabetes Care Program.

Section 17 — Hypertension Care Program

Scope and Eligibility

YourMD offers a telehealth-based Hypertension Care Program for adult patients with documented Stage 1 or Stage 2 essential hypertension (JNC 8 / ACC/AHA 2017 criteria). The program provides physician-supervised antihypertensive prescribing, medication titration, and lifestyle counseling. Patients must be able to monitor home blood pressure (home BP monitor required or provided via referral).

Formulary

First-line agents consistent with ACC/AHA 2017 and JNC 8 guidelines:

• ACE inhibitors: Lisinopril, ramipril, enalapril
• Angiotensin receptor blockers (ARBs): Losartan, valsartan, olmesartan
• Calcium channel blockers (CCBs): Amlodipine, felodipine
• Thiazide / thiazide-like diuretics: Chlorthalidone, hydrochlorothiazide
• Beta-blockers (adjunct / comorbidity-driven): Metoprolol succinate, carvedilol (not preferred as first-line unless compelling indication such as heart failure or prior MI)
• Combination products: Amlodipine/benazepril, losartan/HCTZ (patient convenience; must meet individual component eligibility)

Mineralocorticoid receptor antagonists (spironolactone, eplerenone), alpha-blockers, and direct renin inhibitors are not offered in the Hypertension Care Program without specialist co-management.

Eligibility Criteria

• Age 18–75. Patients >75 require additional cardiovascular risk stratification.
• Documented BP ≥130/80 mmHg on at least two separate readings OR prior documented diagnosis of hypertension
• No current acute decompensation (see Hard-Gate Criteria below)
• eGFR ≥30 mL/min/1.73m² (ACE inhibitors / ARBs require ≥30; lower thresholds for CCB/thiazide)
• Not currently pregnant or planning pregnancy within 90 days (ACE inhibitors and ARBs are teratogenic — Pregnancy Category D/X)
• No prior bilateral renal artery stenosis

Required Baseline Labs

• Basic metabolic panel (BMP): serum potassium, sodium, creatinine, eGFR, BUN, glucose
• Urinalysis with microalbumin/creatinine ratio (for ACE inhibitor / ARB candidacy)
• Fasting lipid panel (within 12 months)
• ECG if patient reports palpitations, syncope, or prior cardiac history

Labs must be current (within 12 months for established patients; current within 30 days for new patients initiating antihypertensives). The prescribing physician may waive a lab requirement when a compelling clinical reason exists; the waiver and rationale must be documented in the SOAP note.

Monitoring and Follow-Up

• Home BP log reviewed at every encounter (target: 2 readings/day × 7 days before visit)
• BMP repeated within 4–6 weeks of ACE inhibitor / ARB initiation or dose increase (potassium and creatinine monitoring)
• Annual fasting lipid panel
• Medication titration: step-up at 4–6 week intervals if target BP not reached

Hard-Gate Criteria (Ineligible — Refer or Escalate)

Pharmacy Routing

Antihypertensive prescriptions are routed to the patient’s preferred pharmacy (retail or mail-order). Standard YourMD pharmacy routing rules apply. Compounded antihypertensives are not offered. The controlled-substance prohibition (Section 1) applies fully.

Section 18 — Cholesterol Care Program

Scope and Eligibility

YourMD offers a telehealth Cholesterol Care Program for adult patients with documented dyslipidemia or elevated cardiovascular risk per ACC/AHA 2019 guidelines. The program covers statin initiation and titration, non-statin adjuncts, and lifestyle counseling. Prescribing is risk-stratified using the Pooled Cohort Equations (PCE) 10-year ASCVD risk score.

Formulary

• High-intensity statins: Atorvastatin 40–80mg, rosuvastatin 20–40mg (primary agents for ASCVD risk ≥20% or established ASCVD)
• Moderate-intensity statins: Atorvastatin 10–20mg, rosuvastatin 5–10mg, simvastatin 20–40mg, pravastatin 40–80mg, lovastatin 40mg
• Low-intensity statins: Simvastatin 10mg, pravastatin 10–20mg (generally reserved for statin-intolerant patients who cannot tolerate moderate/high intensity)
• Non-statin adjuncts (second-line, must have documented statin trial): Ezetimibe 10mg (monotherapy or combination with statin)
• Fibrates (triglyceride-predominant dyslipidemia): Fenofibrate, gemfibrozil — only when triglycerides ≥500 mg/dL or as adjunct per physician judgment

PCSK9 inhibitors, bile acid sequestrants, lomitapide, and bempedoic acid are not offered without specialist (lipidology / cardiology) co-management.

Eligibility Criteria

• Age 21–75 (adults under 21 require pediatric cardiology referral for familial hypercholesterolemia)
• Fasting LDL ≥70 mg/dL in high-risk patients, or LDL ≥100 mg/dL in any adult, or clinical ASCVD diagnosis
• No active liver disease (transaminases >3×ULN — statin contraindicated)
• Not currently pregnant or breastfeeding (statins are Pregnancy Category X)
• Thyroid function documented within 12 months (hypothyroidism is a reversible cause of dyslipidemia)

Required Labs

• Fasting lipid panel (total cholesterol, LDL, HDL, triglycerides, non-HDL) — current within 12 months
• ALT / AST (liver function) before statin initiation and at 12 weeks after initiation
• TSH (to rule out secondary hypothyroid dyslipidemia)
• Fasting glucose or HbA1c (statins modestly increase diabetes risk; document baseline)
• CK (creatine kinase) baseline if patient reports myalgia, heavy exercise, or hypothyroid history

Monitoring and Follow-Up

• Repeat fasting lipid panel 4–12 weeks after statin initiation or dose change
• Annual lipid panel once at target
• Patient education on myopathy symptoms (unexplained muscle pain, weakness, dark urine) — instruct to discontinue statin and contact physician immediately
• Transaminase check at 12 weeks; routine ongoing monitoring not required unless symptoms develop

Hard-Gate Criteria (Ineligible — Refer or Escalate)

Pharmacy Routing

Statin and non-statin prescriptions route to the patient’s preferred retail or mail-order pharmacy. Compounded lipid agents are not offered. The controlled-substance prohibition (Section 1) applies fully.

Section 19 — Heart Failure Co-Management Program

Scope and Purpose

YourMD offers a limited Heart Failure Co-Management Program for patients with stable, compensated heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF), NYHA Functional Class I or II only. This program is strictly adjunctive to an established in-person cardiologist or primary care relationship — YourMD does not serve as the sole managing physician for heart failure. The program scope is limited to: (a) GDMT (guideline-directed medical therapy) medication refills and titration monitoring under cardiologist co-management; (b) telehealth symptom check-ins and weight/symptom trending; (c) lifestyle counseling and medication adherence support.

Formulary (GDMT Only — Continued Prescriptions)

YourMD may continue and titrate (but not initiate de novo without cardiology clearance) the following GDMT agents in NYHA Class I–II patients with documented echocardiogram and established cardiologist relationship:

• ACE inhibitors / ARBs: Lisinopril, enalapril, ramipril; losartan, valsartan (as in Section 17, with same renal monitoring requirements)
• Angiotensin receptor-neprilysin inhibitors (ARNIs): Sacubitril/valsartan (Entresto®) — continuation and titration only; initiation requires cardiology attestation in chart
• Beta-blockers (evidence-based HF agents): Carvedilol, metoprolol succinate, bisoprolol
• Mineralocorticoid receptor antagonists (MRAs): Spironolactone, eplerenone — with potassium and renal monitoring per cardiology plan
• SGLT2 inhibitors (HF indication): Dapagliflozin (Farxiga®), empagliflozin (Jardiance®) — FDA-approved for HFrEF and HFpEF; continuation under established plan
• Diuretics (stable patients): Furosemide, bumetanide, torsemide — stable dose continuation only; dose changes require same-day physician contact

Ivermectin, digoxin, hydralazine/nitrate combinations, and IV inotropes are not offered via telehealth.

Eligibility Requirements

• Documented heart failure diagnosis (HFrEF EF <50% or HFpEF with documented diastolic dysfunction)
• Echocardiogram within 24 months confirming diagnosis and ejection fraction
• NYHA Functional Class I or II only (asymptomatic or mild symptoms with ordinary activity)
• Active cardiologist or PCP managing heart failure — YourMD must have name and contact of managing physician on file
• No hospitalization for heart failure decompensation within 90 days
• Current weight log (daily weights required; patient must own a scale)
• BMP and BNP / NT-proBNP within 6 months

Monitoring Requirements

• Daily weight monitoring by patient; standing instructions to contact YourMD if weight increases >2 lbs in 24 hours or >5 lbs in 1 week (early decompensation sign)
• BMP (potassium, creatinine, BUN) every 3–6 months for patients on ACE inhibitor / ARB / MRA / SGLT2
• BNP or NT-proBNP at each YourMD visit (ordered via Everly Health or uploaded from cardiologist)
• Symptom questionnaire (KCCQ-12 or equivalent) at every encounter

Hard-Gate Criteria (Ineligible or Emergent Escalation)

Pharmacy Routing

Heart failure GDMT prescriptions route to the patient’s preferred retail or mail-order pharmacy under standard YourMD routing rules. Compounded heart failure medications are not offered. The controlled-substance prohibition (Section 1) applies fully.

Section 20 — Triage, Referral, and Emergency Standards

Purpose

This section establishes the universal triage, emergency escalation, and specialist referral standards applicable across all YourMD clinical programs. These standards govern all telehealth encounters — DTC programs (weight loss, men’s health, hair loss, dermatology, peptides, women’s health) and chronic disease programs (hypertension, cholesterol, heart failure, diabetes).

Emergency Escalation Protocol (All Programs)

When a patient’s intake responses, vital signs, or encounter findings meet any hard-gate criterion specified in Sections 1–19, the following steps apply:

1. Immediate on-screen notification: The patient is shown a prominently displayed emergency message instructing them to call 911 or go to the nearest emergency room. The message is specific to the clinical finding (e.g., “Your blood pressure reading is in the hypertensive emergency range. Please call 911 or go to the nearest emergency room immediately.”).
2. Patient acknowledgment recorded: The platform captures a timestamped acknowledgment that the patient saw the emergency message and the text of the message shown. This record is stored in the triage event log.
3. Intake session flagged: The intake session is marked with urgency = er_referral and status = referred_out. No prescription or treatment recommendation is issued.
4. Physician notification: The on-call YourMD physician receives a same-session alert for all er_referral triage events. The physician reviews the patient record and may attempt outbound contact within 2 hours during business hours (9 AM – 9 PM PT, 7 days/week).
5. Audit logging: All triage events are written to the yourmd_triage_events table with IP hash, user agent, trigger category, trigger value, and outcome for compliance review and quality improvement.

Specialist Referral Standards

When a patient requires specialist referral (non-emergent), the following documentation must be completed before the referral is issued:

• Clinical reason for referral documented in SOAP note (minimum: chief complaint, relevant history, current medications, pertinent labs, and specific clinical question for the specialist)
• Receiving specialist name, NPI, and facility address recorded in the referral record where known
• Patient verbal or written consent that a referral disclosure including their PHI summary will be transmitted to the specialist (HIPAA §164.530(c))
• Urgency classification: routine (within 4–6 weeks), urgent (within 1 week), or emergent (same day / ER)

Mandatory Referral Triggers (All Programs)

The following clinical findings require mandatory specialist referral regardless of program:

• Chest pain with exertional component or radiation to arm/jaw → cardiology (urgent or emergent depending on acuity)
• Suspected new malignancy (unexplained weight loss >10% body weight, palpable mass, abnormal labs) → oncology (urgent)
• Active suicidal ideation or plan → emergency psychiatric evaluation (emergent)
• LDL ≥250 mg/dL without prior statin trial → lipidology / cardiology (routine)
• Triglycerides ≥500 mg/dL → physician review + gastroenterology / lipidology as indicated
• eGFR <30 mL/min/1.73m² → nephrology (urgent)
• NYHA Class III–IV heart failure → cardiology (urgent)
• BP ≥180/120 mmHg → emergency room (emergent)
• Hemoglobin A1c ≥12% at intake → endocrinology co-management (urgent)
• Any presentation where the prescribing physician cannot safely manage the clinical complexity via telehealth alone

Physician Scope Limitations and Non-Delegation

YourMD physicians may not delegate the clinical judgment required for triage escalation to non-physician staff or automated systems. Automated triage (smart intake engine) identifies candidates for escalation and presents them to the physician queue; the final determination to issue a referral, write a prescription, or escalate to the ER is the attending physician’s alone. Clinical staff may relay physician instructions but may not independently modify referral classifications.

Documentation Requirements for All Referrals and Escalations

• Referral records retained per HIPAA minimum 6-year retention standard (10 years for minors until age of majority + 3 years)
• Emergency escalation triage events retained indefinitely in the yourmd_triage_events audit table
• For ER escalation events: the attending physician documents the escalation in the encounter note within 24 hours
• All referral disclosures signed by patient prior to PHI transmission to receiving provider

Medical disclaimer: This document is for informational purposes and describes YourMD’s internal clinical standards. It does not constitute legal advice. For questions, contact compliance@yourmd.online.