Hey, Daniela, here and welcome to the spa marketing Made Easy podcast if you offer medically assisted weight loss in your practice. First, what a wild year it’s been. And second, I am so glad you’re here, because my friend Courtney is going to shed so much light on this topic from a legal perspective, there’s so much incredible information in this episode, I really just want to jump right in, so I’m going to read Courtney’s bio. I know you’ll love her as much as I do, and I truly hope that this episode helps you.

So Courtney is a corporate attorney turned medical aesthetics insider who knows the industry from both sides of the syringe. After serving as founder and legal architect of a fast growing aesthetics company, she made the pivot from building her own to helping other providers build theirs, minus the legal landmines.

Now as the founder of Court Approved Aesthetics, she brings attorney-trained tools, AI innovation and harder than insight into the Med Spa world. She’s here to share what she’s learned, sometimes the hard way, so that you can grow with confidence, clarity and a whole lot fewer compliance headaches. She’s incredible. And again, I hope this episode helps you.

All right. Miss Courtney, welcome to the Spa Marketing Made Easy Podcast. I’m so, so excited to have you here, and you are someone that I categorize as a fast friend, because when we first we it was, was it Paulina or Jacqueline? Yeah, Paulina. Okay, so Jacqueline introduced me to Paulina. Paulina introduced me to you in the web of our small industry. And we got on the phone and talked about Dolly Parton and our kids for 25 minutes, and then had to go,yeah. And I so funny. It’s like, one of my most favorite meetings. And I love when meetings go that way, because my husband at the end was like, how did it go? I’m like, How’d the business meeting go? I’m not sure. I didn’t attend the business meeting, but my really great friend, Daniela, that I’ve known for years, that I just met, and that’s like, my most favorite meetings, because, you know, I think so quickly in the industry, and as an attorney, people come into this with a lot of expectations, and so one of the biggest compliments that I’ve I received a few times, is that someone I’m someone you feel like you’ve known for years, like that’s amazing, because that’s a lot of you know, perceptions and expectations that are just broken down. Because I think people number one, or when someone tells me I’m fun, because attorneys are not fun and they’re not personable.

So engineers kind of have their own category as well that like attorneys have, and I fully agree that, like, I wouldn’t look at you and just peg you as an attorney, but you’re also you’re different, like, you’re a spa owner, you’re a business owner, you’re like, there’s all of these things an attorney is just like a small piece of you as a whole. And so yes, I’m sure that you can get into that very analytical mode, and you can get into that space, but there’s more to you than that one little thing.

So yeah, I completely agree. One of the things I say pretty often is that compliance is great, but compliance actually lives in your operations. So I can spout the law and tell you what it is all day long, but it still leaves you the question of like, Okay, now what so wearing those hats and knowing, you know what in the in the trenches of being a business owner and a med spa owner of what does this actually look like? Okay, here’s the statute, here’s the reg, here’s the flow chart.

Now let’s put on our business owner hat and be like, how do we make this makes sense and make it not have a million different, you know, gates and funnels, and we don’t have team burnout. And it’s that’s my favorite part of the job, is taking, like, the legal but then putting it into action and putting it into a way that actually makes sense and doesn’t cause a burnout and leads to, like, more profit and businesses.

So talking about how to make this make sense, that really leads us into our topic today, very well. We’re talking about glps and what the heck is going on with them? There’s, you know, there has been this massive growth over the past couple of years where we’ve seen practices, you know, attract a whole new demographic of patients. We’ve seen phenomenal results. We’ve seen just increased profit margins.

It’s like a win, win, win, win, win across all boards, and we started this year in. A in our community talking about medically assisted weight loss and glps and how we’re, you know, if you’re not on that bandwagon, then get in that bandwagon, because it’s, it’s the thing right now, and it’s profit and all of the things. And then we had tirzepatide taken off the shortage list. We had some aglutide taken off the shortage list. And there’s practices that are getting cease and desist letters. Nobody knows what to do. And so many people in our industry, or at least in our community, were rule followers, were people pleasers, where, you know, there’s these kind of we’re recovering people pleasers, I’ll say, and we want to make sure that we have everything lined up in a row. But it’s, it’s scary and hard to understand, what is the right thing to do. And so when you suggested this as a topic, I thought, Okay, I am not an attorney. I’m not going anywhere near that conversation. Like, I know, you know, it’s like, that is out of my scope. And let’s bring somebody in that, you know, you’re in it. You’re you have a med spa, you are an attorney. So let’s, you teach compliance to other med spas, so I want to hear your perspective. Where is the place that we should start with this?

Yeah, so I did an hour and a half master class on this topic. So anytime someone asked me to speak on it, I’m like, let me condense down an hour and a half master class. Because one of the things that I am so passionate about is I want anyone who works with me, who listens to me, who gives me the time of day to walk away and to be more informed than 90% of the rest of the people in the industry until they can convince the 90% to come, you know, get the same lecture, because I could give you the the quick and easy answer, like we have three lines, here’s the answer for your your problem, but then you don’t know the why. You don’t have any type of protection or reassurance. And what I found is people want the answers, but what they actually want is like, put their head on their pillow at night to feel confident in the answer. And I had a meeting with a new potential client a couple of weeks ago, and the meeting started with, I’ve asked this question to two different attorneys, and I’ve received two different answers. And I was like, well, I might give you a third answer, but I’m going to give you the backstory first, which a lot of people in the legal world, when you’re hiring an attorney, you don’t want to pay someone $500 an hour to spend an hour and a half talking about this topic to help you understand the answer.

But in my opinion, it’s almost as important as a business owner to get that back information than the answer itself. So I really like to start with like, how did we get here so we can get our arms around the whole topic. So one of the things I hear pretty often in the world of GLP ones is, well, we, we were able to compound these before. And so that’s, you know, the first thing that, and especially in the master class that we walked through, was, yes, this is the normal trajectory.

So compounded drugs are are then picked up by pharmacies, and we pharmacies or manufacturers, and manufacturers pour boat loads of money into getting them FDA approved, and then they are given a patent. They’re giving given trademarks over their name and the the, you know, the image and the they have a trademark on the actual like, syringe that’s used, and that is what pulls them from being able to be compounded. But absolutely, these medications were, you were able to compound them prior to a big company picking them up, pouring boatloads of money into it.

So I’ve heard, I’ve heard people say, Well, they’re adding B 12, or they’re adding, you know, something else that that modifies it some percentage, and so they feel that it should be something that’s reasonably different. Is that true? Or is that not true?

Yeah, it’s the material copy argument. So now that we you know the the drugs went on the shortage list, then they came shortage going on the shortage list allows compounders to compound it. Everyone knows they came off of it, and now we are in this okay, we know we cannot make the identical copy which we were allowed to while they’re on the shortage list. But what can we make? And when I say we as in the compounding pharmacies. So if we could draw a chart, you have Eli Lilly, novo nordis up at the, you know, at the top of this chart, the FDA is underneath them, and then the compounding pharmacies. And I have a chart that kind of depicts this. There’s no line that connects novo nordis to the compounding pharmacies. You have to go through the FDA. There’s actually a case on. In Florida, where essentially novo nordis sued, it might have been Eli Lilly, one of the two sued a compounding pharmacy, and the Court essentially says, like, sit down. Not your job. That’s the FDA job to regulate compounding pharmacies.

So what a compounding pharmacy now is trying to get around is that they are not making a material copy of this medication. So they are saying adding B 12 or b6 or glycine is another one that is it takes it out of the material copy requirement that the FDA has. Ultimately, what I tell my clients, who are practitioners, is not really your problem, unless you’re compounding because you’re not making any material copy. So when we get to practitioners, the other side of that chart is at the top, you have your governing body, whoever it is, your Board of Medicine, your Board of Nursing, your Board of Cosmetology, providers, that’s who oversees providers. But again, there’s no connection between compounding pharmacies to the providers other than ordering. There’s no connection from Eli Lilly to the providers.

We providers are responsible to their boards. That’s who oversees their license. And I spend a lot of time on this topic, because one of the things I hear, and I’ve heard, is that, well, what if we just don’t call them patients, what if we call them clients, and instead of giving acts, instead of giving prescription medication, we’re giving access to material that can, you Know, insert whatever over the counter, yeah, yeah. Like, it’s not I’m like, No, I want you to lean in as heavy as you can, and I will stand in front of you once we say this, that this is the practice of medicine.

We are prescribing medications to treat patients for various reasons, and we are using our medical judgment to create those prescriptions. So we believe that someone needs this version of medication would be six for the following reasons we need. We believe someone needs this version would be 12 for the following medical reasons, because I do not have any say in the practice of medicine, because that is not within the scope of my license, Novo Nordisk, Eli Lilly, have no say in the practice of medicine that is not within the scope of their license.

So they cannot come in and tell you what you can and cannot prescribe to your patients. That is up to the Board of Medicine, or the Board of Nursing, or whoever, whatever board you are, you are responsible to. So so one of the things, like, again, I spend a lot of time, like, on this exact slide, to say, at the end of the day, what we’re talking about is your liability is good old fashioned negligence. Like, are you treating patients the way that you believe they need to be treated?

Let me, let me give an example, and you can explain because you mentioned in the beginning some of these drugs are covered by patents or trademarks, and if I’m a spa like my company, auto esthetics is trademarked. So if somebody else brought that use that name, I could send them a cease and desist letter. Is it not parallel that Eli Lilly, or there’s other, any of these other companies that own these patents or trademarks, can’t they come after a spa using that? If so they they wouldn’t be able to use the name ozempic or Moreno or anything like that. But if you use the name semaglutide, or is that the generic like, that’s generic enough that we can use semaglutide or tricep, and so as long as we’re only using those names, that’s not what the trademark is protecting.

Correct,correct, yeah. So, yep. So the trademark that, so they have a patent over the formula and the argument for, like, the formulation, that is, if you can, you know, divide in that kind of flow chart that is on the side with Eli Lilly, novo nordis, FDA, compounding pharmacies, that is where the patent lives. Now you can have some connection between the practice, the provider, and these manufacturers, Eli Lilly novo nordis, if you are fringing on their trademark. And that’s one of the things I tell everyone, is there’s nothing I can do to help you on that. And they have absolutely filed lawsuits for people saying, we prescribe semaglutide, aka Ozempic, or we we prescribe the FDA-approved version of semaglutide. No, you don’t.

You prescribe the compounded version of semaglutide. The FDA approved version of semaglutide is ozempic, and so they’re saying, then you’re infringing on their actual trademark. They’ve put in all the and the the money into and actually, there’s a case is just filed within the past month in California where they are arguing. It’s against mochi health, and mochi Health’s various entities where they on their website, they advertise that they offer the compounded version and that they offer the the FDA approved version, the the semaglutide, that ozempic.

But what they actually discovered, whenever they were doing, or it’s their belief, is that that kind of was like a bait and switch situation, where you put it on your website. Sure, it’s an offering that you offer, but you never, ever prescribe the actual FDA-approved version. You always prescribe the compounded version. And so you were just kind of writing in on the coattails of all of this money and research put into these trademarked, easily recognizable names. But then the moment you got a patient in the door, you switched them to the compounded version really quickly. And so they’ve that lawsuit is not over that they prescribed a compounded version. It’s that you used our trademark to draw in traffic and then we didn’t benefit from it at all.

So like, if you’re going to, if you’re going to use anything recognizable to us that we own, we have to benefit from it in some way, in the trademark, in the trademark world. So I tell people, like that’s that’s the same case for Addo esthetics, Ford Motor Company. This is not, this is not new to the practice of medicine. If the company has something that they’ve invested a lot of money in, and they protect it, whether that be Nike, let’s do it. You can’t just put slept. Let’s do it on everything those because it has such brand recognition and that they seek to protect it. And so yeah, you will get a cease and desist if you are probably a lawsuit. I know quite a few people who have gotten a lawsuit, one here in Tennessee because they were using the aka semaglutide, aka ozempic, in their marketing.

Can we say medically assisted weight loss? Yes. Okay, so what happens if you get a cease and desist letter?

So I’ve looked at a few, and what I help practices do is decide, is this worth it to you? I cannot do anything, literally nothing to protect someone from getting sued. And I tell you, this is my my job. I have a license to be skeptical. It’s what they put on your my diploma that’s hanging behind my license to be skeptical, in cynical. If you have something related to your spa on the back of your car, I would be wary of every single person who drives next to you on the interstate and slams on the brakes too hard in front of you, because these they might assume that you’re a business owner who has lots of money. So there’s nothing I can do to protect you from getting sued, but what we can talk about is what ultimately your liability would be, and then in that so we have, you know, the liability is a legal piece, but from the the the timeline of being sued to liability in that is a huge business judgment. So I have clients who it’s only 10% of their practice medically assisted weight loss, or any type of weight loss program where these drugs would be involved, is such a small portion of their practice, like is that business judgment of hiring an attorney to respond to a lawsuit or hiring an attorney to do something.

Is that worth it to you? And I have many who have said, No, we really didn’t even have, like, a full program. This isn’t even our passion. We’re really passionate about more, you know, skin care and longevity type health, and we can just pivot our business model. But then I have some that is 80 to 90% of their practice, yeah, and so yes, that business, that business judgment decision, lives between the lawsuit being filed and liability.

So, and that’s, I think, the biggest piece that practices have to decide at the end of the day, because if you’re just prescribing the medications, you’re following within your scope of your license, I’m not really concerned. I’ve reviewed the demand letters, the domain letter argument, they they have four points, and I have a not I think it’s nice, nice video discussing this.

But the the argument they make for medical practices is so outlandish where they’re trying. I mean, it’s a far reaching argument, and so I’m not overly concerned with providers just prescribing the medication within the scope of their license, and if they feel confident standing in front of the board of their peers, the Board of Nursing, the Board of Medicine, and defending the way that they medically treated a patient, which they should every single time they medically treat a patient, then I’m not super concerned by them. Now they probably will get a letter, so you have to decide what to do. I have a lot of clients who are sending have hired an attorney to send back a letter. Editor that essentially says, this is the practice of medicine.

We are active within the scope of our license. We are getting drugs from one of the sources that we are allowed to, which is a 503, a pharmacy under the FDA as a provider. So you know, we’re not getting drugs from overseas, or we’re not getting drugs from not vetted sources. We’re getting them from a state licensed facility, a pharmacy, and that we are acting within our scope and prescribing them according to our clinical judgment. Now the pharmacy holds a different bag of liability because they hold the identical copy bag of liability. The practice owner itself owns a lot of liabilities around like marketing. So how we’re making sure that you aren’t inferring the correct term, yes, language,yes, yeah, so you practice under liability is about scope, and making sure that they’re treating patients according to what is a reasonable judgment and medicine and the marketing piece of it, and the marketing piece of it, and making sure that you’re not infringing on any trademarks, and then the compounding pharmacy holds the patent liability.

So do you think the next phase that we’re going to see, if this is like a long term strategy with these pharmaceutical companies that have invested so much money. They’re kind of, you know, getting rid of some of the fringe by just scaring people with the cease and desist letters, is the next strategy step for them actually going after the compounding pharmacies.

And, okay, and so I think the next strategy is going to be they haven’t had a ton of success in going after the compounding pharmacies, like I said in that case in Florida, the judge was like, this is the FDA job. So what I’ve seen for next strategy so far is that they compounding pharmacies are putting pressure on the FDA to protect its patent and to be truly transparent. I feel really conflicted because I am a mom of three children, and I want my children to grow up in a world where we are continuing to advance medicine, and that is why we have patents, that’s why we protect people for their investments. So I definitely see it. I also see the tremendous benefits to patients themselves. I just met with a client who is prescribing very, very small doses to one of her patients who has atypical bulimia, and it is now helping.

They’re using it in conjunction with some therapy, but it’s helped kind of quieten some of the the issues that manifest in a more physical way so they can deal with the issues that are more internal. And I mean, that’s real people, real problems, real medication helping out. So I see it from both sides, and I really do understand where kind of practice owner is coming from, even just strictly on a clinical side, but then on a I see it on Eli Lilly’s and novo nordis site too.

But the what I’ve seen so far is going pushing, putting pressure on the FDA to go after compounding pharmacies. And the new, the newest, is that now these compound these manufacturers are sending letters to state boards, because, again, the state board is who the provider is responsible to. So the state board says it is not okay in this state to prescribe these compounded medications for these reasons. Well, now the provider has direct guidance that says, I can no longer prescribe these medications. So would that be because they’re considered they’re using them off label, or is it something that they’re trying to do within scope, like, only MDS are able to do this, or because, like, how could they say that if, if another MD could prescribe it and get it from their pharmaceutical company, right?

Yeah. So the letter to is actually a letter to the Georgia Board that was sent by, I can’t I think it was Eli Lilly, but it might have been novo nordis, but they’re both making, both companies are making the same argument that compounded drugs are not safe, so you should not allow even though we prescribe, not we, but providers prescribe compounded drugs for all types of cases. But we should not allow compounded drugs in this specific instance, or you should not across your state, you should essentially say, if you prescribe a compounded drug and one of your patients gets hurt, it’s considered like de facto negligence, according to the board, and so they’re trying to put pressure, and they’ve they’ve out in their letter, they’ve outlined that, you know, they do have a patent, and they’ve outlined, like, the history, but really leaning into like, these medications aren’t safe for patients. That’s the stance. That’s how they’re trying to appeal to. The board, and I explained it to some people that I work with, I try to use, you know, as many examples as I can that are totally outside, out of left field, but to make it make sense. So like I said, I have three children, and so what I I said, it’s the equivalent of I would be the board, in this case, as their mother.

And we all know children love to tattle on each other, and so one of my children is acting like the manufacturer, and they are tattling on not just one of them, but they’re like, look at those compounding pharmacies. Look at that, mom. Did you see them, the compounding pharmacy and the provider, and they’re teaming up together, and they’re causing all kind of mischief. You should do something about it, mom. And so now, as the board the mother in the situation, I have to figure out what I want to respond back to my child that’s tattling, because they have no oversight over the other two. And they, you know, they’re not the parent. And then the two children who are acting independently, but allegedly they’re, they’re, you know, colluding together.

What I want to do about, you know that, and that’s where the board is at. At this point, we’ve had a few boards Washington. There’s one in the south Mississippi, I believe, who have said no more compounded semaglutide or treeside within our state. So I think that’s the next kind of route that the manufacturers are going to go try to appeal to the boards.

And then, do you, I know this is very speculative, but do you believe that these manufacturers are going to try and sell their FDA approved the ozempic or Merino or whatever, directly to med spas. Or are they going to go directly to patients? Because what I’ve seen is that they’re selling directly to patients at the same price that they would be selling to medical spas, but there’s pharmacies. I personally know people that have bought ozempic Or these actual name brand drugs online without having to have a good faith exam without like maybe it was a bad website. I don’t know. I don’t know all of the details there, but like, how are people getting it online without having medical oversight in any way? That seems like a whole other can of worms.

That’s like, what’s happening here?

Yeah. I mean, and that’s one of the things I talk about pretty often, is this is why we can’t have nice things, because we’ve got people who are going off into left fields like we’re not talking about the provider who either sees their patients in person every single appointment, or they see their patient in person once and then they see them again, you know, in six months, but they have some checkups in between. We’re not really talking about people who are doing it objectively, the right way, and that we’ve seen it in other areas, like we’ve seen it in other types of management for even something as simple, as simple as, you know, acne treatment, where you go in, you get an assessment, and then you’re prescribed some antibiotics. Let’s see how it works for you. And then we’ll take down your if you had any symptoms, have you had any improvement?

And then we’ll pivot your treatment plan. People who are doing it kind of in that, the fashion that we’re all used to in medicine. We’re not really talking about them, but what’s going to happen is, what always happens is that, and I like to use the word always, but in the legal world, it is. What always happens is, we kind of have this over correction where we are actually targeting the people who are doing things wildly inappropriately, wrong. Yes, mochi health is one example of that doing things wildly incorrect, and then people who are doing it actually okay, and it they end up getting caught up in the storm for all of it. So I don’t know this specific website.

I know of a few where you have a medical director who’s licensed in all 50 states, and they have one mid level, and the mid level is doing a good faith exam, not in real time, and then it’s getting shipped straight to their door. I mean, I will just tell you, I I come from a place of being a business owner and an attorney, and so I understand that operationally we are so we’re in the business of risk. Business is risk, and if you wanted no risk, I would tell you to shut down your business, because that’s just where we’re at. And so you have to make like, a risk assessment and risk tolerance in each one of these decisions, which that’s where I was saying. You know, between liability and the lawsuit, there’s a lot of business judgment that exists. And. Air, and you have to really weigh the risk associated to your business. Is it worth it for you, not from a liability standpoint, but just from, like, having to hire an attorney, but I will all the clients that I work with, there’s, I don’t, we don’t really risk. I don’t allow a lot of like, risk of compliance.

So what I’ve seen from the way those websites work is we’re not operating compliantly. We’re operating only using our business hat and legal and compliance lives in your operations. It has to you can wear them each at once or both simultaneously, but you don’t get to just throw one away and feel like we’re making as much money as we possibly can out of this, because that’s when we’ve taken the medicine out of the corporate practice in medicine, and we’re just operating, operating as a corporation, like we’re selling widgets. And, you know, even me, someone who’s not a provider, I’m my clients don’t go down that route. You don’t have to. You can. You can be a very, very profitable, very successful Med Spa, and be totally compliant. And think I’ve seen it happen over and over and over again, and you’ll be standing at the end.

So what do you think when you’re talking with your practices that it’s, you know, 60% plus of their revenue is medically assisted weight loss. And they are doing this, you know, having them come in weekly for weigh ins and having the check ins. And they’re doing it with a lot of care and intention. What advice are you giving to them? Is this something that you know, in the next five years, you think is going to dwindle out because of all of this? Should they be transitioning into HRT? Should that, you know, like, what is the I know it’s all risk, but gosh, there’s some places that are doing multiple seven figures. Just,yeah, yeah. Actually, I, I know. So the favorite thing for an attorney to say is it depends. And really, in this world, in the GOP world, one world, I really don’t feel it depends. I really feel so sure in the way to do that there is a way with a couple of options once you go down that single path.

There is a way to do it that is compliant for now and that we can if your state board decides to change their opinion, then, of course, we need to shift. We need to pivot some some portion of your industry, some portion of your business to have another offering to your clients and be ready to pivot. Should they should you need to? But one of the biggest things that I have to help clients overcome is their mindset around GLP, one medication. So what, what I saw, and what I what I’ve seen for the past few months is that people were charging the it’s the perception that they were up charging medication, when all actuality they were not. They were just not sending an itemized bill. So if you tell me that you have a patient come into your office every single week, let’s just take that for example, if I was in a an actual office. Well, my insurance copay is $40 so I would have a $40 charge every single week when I came into that office. So $160 of your up charge.

Take that off. Okay, now take the cost of the medication off. What are you left with? $20 you made on it at the end of the day. That is not an up charge. That is having, you know, covering the staff who injected, that’s covering the alcohol swab like that is totally an administrative fee. I’m not sure that you at the end of the day, like, made a ton of money on that procedure. But because we were doing what I have, you know, witnessed is it was just one single charge we were doing double the cost of the medication that the practice owners believe that they were truly making so much money on the medication. It’s like, yes, but you’re what you haven’t put into that whole equation is you nothing about you. And let’s break that down and add all of your value into it. Because whether you want to place $1 on it or not, I will force you to place $1 on it, put my arm around you and make you say that like a minimum, any any practice I walk into, it’s a $40 slap every single time. So do not tell me that you’re worth less than that, and that’s the negotiated insurance rate, and don’t tell me that you can’t justify that.

So what I help practice owners do is separate the two out. What is your medical advice, your medical program worth? What value do you bring to patients? Do you have nutrition help? Are you running their labs? Are their labs included? Are you doing follow ups? Are you offering. And other services in addition to it, like helping with volume loss, and you’re giving them, like, a full patient assessment, how often are they coming in? Let’s put all of that down on paper, and then you have the medication over here to the side. Like, charge them what they would be charged for the medication, sure, but what does it cost to be a patient of yours, what is it? What is your experience that you bring that’s so different from everyone else? Because I can go spot a spa and get the 503, a compounded version of Sima glutai, but I cannot go spot a spa and get you. So what is that worth? And that conversation makes people very uncomfortable, because they’re like, Well, no, they don’t need to pay for me. I’m like, You are you? Are it?

So if we take that concept into med, spas are cash basis, and that’s why so many providers move from medical into cosmetic and go into and I say medical and cosmetic in the term, when I used to work at plastic surgeons offices or DERM offices, there was the medical side where we did skin cancers and skin checks and those things. And the cosmetic side is what we kind of overall look at as medical esthetics, right? So we build completely different on the medical side, just like you were saying, but on the cosmetic side, wouldn’t things like Latisse, that used to be a glaucoma medication, or even the neuromodulators that were using that had a medical purpose, whether that was for migraines or incontinence or hyperhidrosis, or any of these types of things, wouldn’t we then to have to bill in a completely separate way? So in this business legal hat. So if I’m putting on a legal hat, then we should be yet the answer is yes. The difference between the business and legal hat, for me is when you’re talking about Latisse and you’re talking about Botox, which is historically billed by the unit somewhere between 10 to $15 and we are separating out those charges, we also don’t have the pressure from need knowing that we might have to prove ourselves out at some point. So I think that additional level of detail and having them truly separated and itemizing that for transparency for patients is really brought on by the pressure of the industry and the pressure from these manufacturers. And so that’s where I think you can get into wearing both hats. It’s kind of like a cya type of, yeah, like for Botox, the industry is 10 to 15 units, or 10 to $15 per unit, is pretty standard from what I’ve seen. And you don’t have the same need to cya when it comes to, okay, here’s what I charge. How people reflect their additional experience for Botox is they just up their unit charge, but not, not necessarily the same. Need to go into detail on the invoice for transparency for patients, because you don’t have the same like outside pressure in this world, I would absolutely like in the GLP one world, I think you have to cya and you’re charting. You have cya every single step where I’m like, Okay, imagine this. We’re in front of your board. I’m representing you, and we are proving out that you provided excellent patient care to this individual. What would you need? You need good charting. You need good consents, good transparency in your pricing, to show that you are not profiting from pushing them to one medication versus another, like I have practices that I work with that prescribe both medications compounded and the ones covered by insurance, but the cost to work with you should be the same, regardless, and that’s, I don’t think that you you know, 10 years from now, we won’t be doing that, because we won’t have this outside pressure in the world of medical esthetics, you know, in cash based businesses, we’ll still be doing it in insurance billing based businesses. That’s because it comes with all the federal regulations.

What do you think about hormone replacement therapy? Because it’s that kind of goes hand in hand with medically assisted weight loss. We’re seeing a lot of people coupling those two. Do you feel like there will be any pressure on because there’s a few main companies in that as well, and there’s also compounded right in the way that people are helping so is that if we’re trying to be kind of future oriented, and how can we be less risk averse, or be less have less risk in our business without closing it? What are those things that we need to be looking forward or is this just very specifically a GLP issue because of the shortage list type of thing?

I think this issue specifically is more related to the GLP one problem, because you’ve got such big players who are protecting their patents what it seems at all costs, and they’re coming at it from every single angle, from the hormone replacement side, what I think the biggest risk on that is, more often than not, it introduces a controlled substance, because testosterone is a controlled substance, so making sure that you are a practice is compliant in how they see their patients, who’s seeing their patients. And then I think the risk, you know, on the spectrum of things that we offer in med spas, with like, you know, a facial being the lowest level of risk. It’s a controlled substance for various reasons, but you it does come with some additional risk to patients. So what I’ve the biggest thing that I’ve seen for providers is that they are taking some one day course on hormone replacement therapy and thinking that they’ve got it on lock, and you’re like, you have to defend that you prescribed the right concoction to this patient based on their blood work and like, Do you feel confident in your skills and ability. So I’ve seen some kind of concerns from that area, and I’ve heard concerns from nurse practitioners who their practices have asked them to just roll out hormones, and they’re like, I don’t I don’t feel comfortable because I am a I am in the med spa space. I am not in the functional wellness space. I am not treating people who have Hashimotos like that is not something I’m comfortable with within my license and that as a business owner, you know, as a non licensed business owner practitioner, I have to be really respectful, like if one of my providers that works with my company says that that’s within their scope to say, I don’t feel comfortable. I need additional education or additional training to be able to treat patients. Because what they’re essentially saying to me is, I don’t feel if you ask me, Is this the right treatment?

I don’t really know. I don’t I don’t have any clinical reason to back it up, because I’m not educated on it enough. So that’s the biggest risk I see for HRT, is we’re really getting into functional wellness and making sure that our providers are comfortable with functional wellness, especially if you’re going from strict cosmetic and they do filler and botox now you’re talking about like real internal stuff. And that is a very different business model, which requires training from the top down, whoever’s you know, your medical director, your nurse practitioner, your RN, whoever is helping in that, that field. It’s a new service, offering anything else that I’m not asking about, glps, that or GOP ones that people that you found in your research and trainings that you’ve been working on?

Yeah, I think the biggest, the thing has been discussed pretty recently goes back to Okay, so now, when I finish the talk and someone feels comfortable or they don’t, you know, they make that business choice, okay, one way or the other. Okay, so now they make the choice that we’re going to continue. Now, where can I get it from? So we know we cannot get it from a 503 B pharmacy. There it is very clear that 503 B pharmacies cannot produce that, and that’s the pharmacy that produces like in office. Use big vials. They have it on the shelf. You call them up and you order 12. Cannot do that anymore, but what we can do is a 503 a pharmacy can make a patient specific medication. So if you call up a 503 A and say, I need to order medication for Courtney Walker, like, oh, yeah, we already have one ready. No, that’s impossible, because you’re supposed to make it for Courtney Walker. So where can we get it from? I think is a huge issue.

How do we vet a pharmacy? How do I make sure it’s reputable? I go to their website and they have not an about they don’t have an About Me section. It just started yesterday, and you can’t order. You can only order over the phone, and they don’t send you any type of email confirmation. Seems pretty sketchy to me. So betting the pharmacies and and knowing that you where you can get it from, as far as, like, pharmacy versus, I have a lot of questions about research based labs, where you get these, not just, not just GOP ones, but you get other peptides. And it comes to you in your office and it says, not for human use. Can you use that on humans? And I’m like, no, no, you cannot. The FDA is pretty clear as a provider where you can get medications from for human use and for peptides, which includes GLP one, so you need to stick to 503, and. Pharmacies and steer away from research based labs.

One, because you’re not allowed to get them there, according to the FDA. But two, tell me this argument like, think forward. You’re standing in front of the Board of Medicine, and you’re defending a negligence, something that says, not for human and why you used not for human use medication for humans like I am not unless you want to pay me a lot of money, I’m not taking that case on. So it because it’s all it comes back down to you have to have good clinical judgment and sound clinical judgment and feel really confident in your decisions, which is why I am so I am beyond passionate about the practice of law. I get really fired up about it.

I put my hand up and swore an oath to protect the Constitution, and I will not let an outside business tell me that I can’t represent my client the way that I need to represent my client. Now, if my own board tells me that I can’t do that. Okay, sure, they control my license. I’ll listen to them. But I can’t imagine a, you know, Microsoft all of a sudden coming in and being like, No, you can’t do that for your clients anymore. That’s not You’re not allowed to represent them in that way. I’m like, This is my license, and I’m going to represent them in the way that I see fit, and according to the board that governs my licensure in the court system, like you have no say in this. And that is essentially what is going on here, which is why I just really lean into like helping practices and providers protect that, because we need that’s where we get into good medical judgment, good medical outcomes for clients so far beyond Med Spa world, like all the way down to hospitals. We don’t want business to come into medicine, because that’s when we can taint, you know, that’s cynical, that’s skeptical. I have a license to do that. That’s where business, business comes in, and it can really, really mess with stuff, because you’re not so often people stop thinking about what’s best for the patient, or thinking about the best treatments, and they are then going into like, what makes the most money, or how do I profit out of this the most and that’s why we have so many laws and regulations corporate practice of medicine, clearly delineating the two, because we want and even for medicine, for law, there are other professions where we want to make sure that the in person, who’s the patient or the client or whoever, that we’re protecting them from kind of that infiltration of business. In a lot of ways,this was so much incredible information. You are just brilliant, my dear.

Thankyou. Thank you. I could go on and on, I mean, and I have for months, it’s like the number one thing, what people want to talk about, but it’s totally fine, and I get it. And then I have people who because, you know, one of the things I said at the beginning is I, I want the best thing that someone could say to me is that like they feel confident in their decision, whatever that decision is, so I want people to put their head down at night, and maybe they get a letter down the road, but at least they’re prepared.

They know the risks. They’ve made a very calculated and intelligent decision for their business, and just giving them that confidence is like, I feel like, truly, that’s one of my purposes in life, is to help businesses navigate kind of a wild west, a gray area in medical esthetics, in so many ways, but there is a way to do it where you don’t go to sleep every night being like, they’re coming for me, they’re probably not. But even if they do, we will have like, I’m from Tennessee, so we will have a cheese board ready and some sweet tea, and you’ll be like, welcome party, roll out the red carpet. Come in and see whatever you want.

Oh, my goodness. Okay, so where can people find you, follow you, stay in touch with you, get into your world. Where’s the best place? Yeah, I think the best place is on Instagram for the most like live action content. It’s court approved esthetics. I do a segment that people really enjoy a lot. It’s called Whiteboard Wednesday, where I just pull out a whiteboard and start, you heard it here some like doing charts. And really, I’m a visual learner, so really breaking things down, obviously, all that’s for free. And I try to do like, legal updates and stuff over on there. And then, if anyone’s ever interested in working with me, then it’s https://courtapprovedaesthetics.com/

Wonderful. Well, we’ll get all of those links below this episode. I so appreciate you and your expertise, and this was such an incredible episode. Be sure to check out https://courtapprovedaesthetics.com/. And of course, if you want to keep this conversation going, head over to the spa marketing Made Easy Facebook group, and I’ll catch you on the next episode.