Indiana lawmakers are weighing new guardrails around drug compounding amid warnings that patients are receiving powerful prescription treatments in settings that operate largely outside state oversight.
Central to a bill in flux are medical spas — businesses that market cosmetic, wellness or lifestyle treatments while also administering prescription drugs, often by injection or infusion. Those services can range from Botox injections to hormone therapy and compounded weight-loss drugs, like GLP-1 products.
The proposal would require medical spas to register with the state, submit to inspections and meet new oversight standards, while tightening requirements for pharmacies that compound customized medications.
Senate Bill 282, authored by Sen. Ed Charbonneau, R-Valparaiso, and sponsored in the House by Rep. Brad Barrett, R-Richmond, was heard Tuesday by the House Public Health Committee, where physicians, pharmacists and industry representatives offered starkly different views on how far possible state regulations should go.
Lawmakers did not vote on the bill, but Barrett said amendments and committee action are expected before Thursday’s deadline.
The measure cleared the Senate in January in a 47-1 vote after undergoing significant revisions there, including narrowing provisions that initially drew concern from physicians and pharmacists.
“This is a blossoming market,” Barrett said. “We don’t want to shut down the ability of people to come in with focused attention on an issue and get treatment and have a relationship with a provider. I’m trying to back off a little bit on that, with the idea that over the next couple, three years, we can really fine tune that.”
What the bill would do
Under the Senate-passed version of Senate Bill 282, a medical spa is specifically defined as a facility or practice that offers medical health care services, prepares or administers prescription drugs — including intravenous, intramuscular or subcutaneous delivery — and markets itself as being focused on cosmetic, aesthetic, wellness or longevity treatments.
Services explicitly covered include Botox and dermal fillers, weight-loss therapies, hormone treatments, hair-loss services and parenteral nutrient infusions.
The med spa industry is a multi-billion dollar industry, and it is gaining in popularity — and trust me, it is the Wild, Wild West.Bloomington dermatologist Dr. Carrie Davis
Hospitals, physician offices and other facilities already licensed by the state would not fall under the definition, however.
Beginning Jan. 1, 2027, medical spas would also be required to register with the Medical Licensing Board of Indiana in order to operate.
Each facility would need to designate a “responsible practitioner” — a licensed professional with prescriptive authority and appropriate training — who must be physically present for enough time to ensure compliance with state requirements.
The bill would additionally prohibit medical spas from providing treatments outside of their registered location, a physician’s office or another licensed health care facility.
Serious adverse events would have to be reported to the appropriate professional licensing board within five days.
The Medical Licensing Board would serve as the primary enforcement authority and have authority to inspect facilities, investigate complaints and take disciplinary action. Operating an unregistered medical spa could result in fines of up to $5,000, and denying inspectors access would itself constitute a violation.
Registration applications would be required to identify all prescription drugs used at the facility, including compounded medications.
Multiple bill supporters told lawmakers that those distinctions matter because medical spas are increasingly offering treatments that carry real medical risks — but without consistent state oversight.
Bloomington dermatologist Dr. Carrie Davis told the committee that the booming med spa sector has outpaced rules meant to protect patients.
“The med spa industry is a multi-billion dollar industry, and it is gaining in popularity — and trust me, it is the Wild, Wild West,” she said. “It seems that anyone and everyone is doing these treatments, and they are doing them anywhere and everywhere, and people are being harmed.”
Davis said she and her colleagues routinely treat complications from cosmetic procedures that were done by poorly trained or unsupervised staff.
“We have seen patients with burns, permanent discoloration and scarring of their skin from laser procedures,” she continued, flagging “serious risks” for filler injections, including side effects like blood vessel blockages that can lead to permanent scarring and blindness. “You have to be able to recognize those complications when they occur and treat them immediately to mitigate the consequences.”
Davis argued that the bill’s requirements for on‑site supervision and clearer lines of responsibility are necessary — and do not amount to overreach.
“It is common sense to require that individuals who are performing procedures are doing so under the supervision of licensed practitioners and that they have the proper training in the procedures that they’re performing. That’s just common sense,” Davis said. “Patients are at risk, and we have seen patients harmed already.”
Kristin Jones, president and CEO of the Indiana Life Sciences Association, further linked stronger rules to both safety and Indiana’s economic base.
“Beyond providing a stopgap when medications may be in short supply, some compounders are profiteering off a surge in demand for weight loss medications,” she said. “They may use cheap, unapproved ingredients from foreign sources like China that do not meet U.S. standards for quality or purity, and they market these products to unknowing consumers as equivalent to branded medicines.”
Cardiologist Dr. Anthony Bashall emphasized that uncertainty about what patients are actually receiving makes it harder to safely use those powerful new weight‑loss drugs.
“What does all this discussion mean? It’s when a patient tells me they spent $1,000 on a compound, and they go, ‘Why am I not losing weight?’ And I can’t answer that question, because I don’t know what’s in there,” he said. “Another patient turns around and says, ‘I’m having side effects.’ But is it the traditional side effects we expect to hear, or does it have to do with the quality and purity of the compound that’s being put?”
Compounding concerns
Drug compounding — the practice of creating customized medications tailored to individual patients — has drawn increased scrutiny nationally as compounded versions of popular weight-loss drugs have proliferated.
Indiana’s proposed legislation would add new state-level compliance language for pharmacies engaged in compounding by tying state pharmacy law more closely to federal requirements under the Food, Drug, and Cosmetic Act.
Supporters told lawmakers Tuesday that the changes are intended to clarify oversight and ensure patient safety, not to ban compounding outright.
But pharmacy representatives cautioned lawmakers against language they said could unintentionally restrict legitimate compounding practices that serve patients with unique medical needs.
Several noted that earlier versions of the bill were significantly broader and said Senate changes helped clarify that the intent was compliance and oversight, rather than outright prohibition.
Anthony Westmoreland, founder and CEO of Westmoreland Pharmacy in New Albany, pointed to previous bill language about the types of bulk drug substances that could be sourced — including a requirement that compounders buy ingredients directly from the original manufacturer.
“That,” he told lawmakers, “was pretty much a non-starter. It’s impossible. A lot of the original manufacturers don’t exist anymore,” and GLP‑1 manufacturers “have stated publicly that they would never sell to a compounding pharmacy to be able to take care of patients that need that unique solution.”
A committee amendment discussed Tuesday — but not yet adopted — would further refine definitions and streamline registration requirements.
Barrett called it a response to concerns raised during the Senate process and said additional amendments could still be filed before a vote.
“This bill has already been narrowed significantly from where it started,” Barrett said, noting that stakeholder feedback led lawmakers to focus on registration and accountability rather than broader restrictions on medical practice.
Pharmacy groups urged the committee to take a similar approach with any new language.
“We believe that a good approach is, there’s a lot of federal regulation, there’s a lot of state regulation, there’s a lot of international standards that exist. Let’s empower the Board of Pharmacy, which has the expertise in compounding… to give them that authority to get that oversight,” said Darren Covington, executive vice president of the Indiana Pharmacy Association.
But he warned that “any kind of language that would prohibit what is currently legitimate, compounding practices” would be “concerning.”
“Whatever we do, we want to make sure we’re not impeding legitimate compounding practice, which there is a lot of patient need,” Covington said.
Ryan Hayes, co‑owner of Pure Pharmacy in Fishers, said the draft amendment circulated Tuesday appeared to go beyond what passed the Senate and could affect access if not carefully tailored.
“There are some specific terms that are very concerning to us, and we think would remove patient access to legitimately compounded medications,” he testified.
Hayes told the committee his pharmacy already buys active ingredients from FDA‑registered manufacturers and tests every sterile batch before dispensing.
“We think the version that came out of the Senate was very good — it maintained access to legitimate, legal, compounded medications for Hoosier patients,” he said. “We are concerned that this new language could eliminate that access and force patients and prescribers to seek their medications elsewhere.”
Indiana Capital Chronicle is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Indiana Capital Chronicle maintains editorial independence. Contact Editor Niki Kelly for questions: info@indianacapitalchronicle.com.
