FDA and state rules, for what you actually buy.

Must a pharmacy located in another state hold a license/registration from this state to ship prescriptions (including patient-specific 503A compounded preparations) to patients or practitioners here?

NRS 639.2328 requires a Board license for every pharmacy outside Nevada that dispenses prescriptions to patients in Nevada, including anyone selling drugs to Nevadans over the internet (NRS 639.23279). The applicant must be licensed in its home state and prove that its facility, records and operations comply with home-state law. It must name its managing pharmacist and at least one Nevada-registered pharmacist at the pharmacy who is responsible for every prescription sent to Nevada. The Board may require its own inspection (NRS 639.2328(3); 639.23284), and internet pharmacies also need Board certification (NRS 639.23288). A toll-free pharmacist line must run at least 5 days and 40 hours a week (NRS 639.23286). On the Board's pharmacy application, out-of-state applicants file their latest home-state inspection and a license verification. A pharmacy that does not do sterile compounding signs an affidavit that it will not ship sterile compounds into Nevada without written Board approval. Applicants shipping compounded parenteral products into Nevada may have to appear before the Board (NAC 639.215).

NRS 639.2328 was last amended in 2023. 'Registered pharmacist' means a pharmacist registered with the Nevada Board (NRS 639.015). The Board's application asks for the managing pharmacist's Nevada registration number only 'if applicable', but it requires at least one Nevada-registered pharmacist responsible for Nevada prescriptions. Licenses renew in October of even-numbered years. Applications are approved at Board meetings, and an appearance may be required.

May a 503A (traditional) pharmacy dispense or distribute compounded preparations to a practitioner for office use (administration in the office, not patient-specific)? The federal position is that 503A requires patient-specific prescriptions; this is what the state pharmacy act and board rules allow.

Under NAC 639.757(1), a pharmacy may compound without a manufacturer license only if the drugs are dispensed on a prescription or chart order and are not sold or provided to anyone other than the ultimate user or that user's agent. Quantities are limited to what fills current orders or what past patterns show will be needed. In a June 2, 2025 notice on compounded GLP-1s, the Board 'reminds 503A pharmacies that they are not permitted to sell compounded medications to practitioners.' It also cited the compounding rules as amended by LCB File R053-24 (effective Nov. 15, 2024). By contrast, NRS 639.268(2) lets practitioners and other authorized dispensers buy compounded drugs directly from an outsourcing facility without a patient-specific order. This matches FDA's view that office stock comes from 503B facilities.

The Board's June 2025 notice also told licensees to stop compounding tirzepatide and semaglutide injection products under FDA's shortage-resolution orders (503B semaglutide after May 22, 2025). It warned that wholesaling or distributing restricted drugs in Nevada without a license violates NRS 639.100, 639.233 and related rules.

Does the state require an FDA-registered 503B outsourcing facility located outside the state to hold a state license/registration (as an outsourcing facility, nonresident manufacturer, wholesaler or pharmacy) before shipping into the state?

NAC 639.6915 requires an outsourcing facility that compounds sterile drugs in Nevada or for shipment into Nevada to get a Board license as a manufacturer under NRS 639.100 and 639.233 and to meet 21 U.S.C. §353b. NRS 639.100(3) bars anyone from acting as a manufacturer without a Board license. The Board's Out-of-State Outsourcing Facility application requires the following: a $500 fee, a letter of good standing, the home-state license, recent state and FDA inspections, a DEA registration if applicable, Board approval at a meeting where an appearance is required, and a supervising pharmacist licensed by the Nevada Board. Under NAC 639.6916, an outsourcing facility does not need a pharmacy license unless it dispenses patient-specific prescriptions; then it needs a pharmacy license under NRS 639.230 or 639.2328.

NAC 639.6915 was last amended by R025-21, effective 4/11/2022. NAC 639.6912 defines an outsourcing facility as a sterile compounder. NRS 639.268(8), amended in 2023, defines one as a manufacturer compounding sterile or nonsterile drugs. The Board's application form is undated. Licenses renew in October of even-numbered years.

Has the state signed FDA's standard Memorandum of Understanding Addressing Certain Distributions of Compounded Human Drug Products (October 2020)? If not, FD&C Act §503A limits its 503A pharmacies' out-of-state distribution to 5% of total prescription orders (currently not enforced by FDA pending rulemaking).

Signing the standard MOU means the state board agrees to investigate complaints about compounded drugs its 503A pharmacies ship out of state and to identify and report to FDA pharmacies that distribute "inordinate amounts" interstate (more than 50% of their compounded prescriptions); in exchange, the statutory 5% out-of-state cap in FD&C Act §503A(b)(3)(B) does not apply to that state's pharmacies. FDA lists only Colorado, Kentucky and New Hampshire as signatories; Nevada is not among them. For a non-signing state, FD&C Act §503A(b)(3)(B)(ii) caps a 503A pharmacy's out-of-state distribution of compounded drugs at 5% of its total prescription orders. FDA now considers the October 2020 standard MOU suspended (it does not expect signatory states to carry out MOU activities and will not sign new ones) and is not enforcing the 5% limit until a final rule and an updated MOU are published; FDA's rulemaking (RIN 0910-AI71) listed a proposed rule for 11/2026 in the Fall 2025 Unified Agenda.

The FDA list of signed MOUs (current as of 2023-01-23) is older than 2 years, but FDA stopped entering new agreements under the 2020 MOU in October 2022, so no state can have signed since. The FDA "Compounding Information for States" page (current as of 2026-08-28) still describes the MOU as awaiting rulemaking. Pending: FDA proposed rule on 503A distribution (RIN 0910-AI71, NPRM projected 11/2026); H.R. 5316 (introduced 2025-09-11, referred to House Energy & Commerce) would remove the MOU provision from §503A.

Besides DEA registration, does the state require practitioners to hold a separate state controlled substance registration, license or permit to prescribe, administer or dispense controlled substances (e.g. testosterone, Schedule III)? "Conditional" means a state registration is needed only in some settings, such as keeping controlled-substance stock in the office.

NRS 453.226 requires every practitioner who dispenses controlled substances in Nevada to obtain a biennial registration from the State Board of Pharmacy, and NRS 453.056 defines 'dispense' to include prescribing and administering; the Board's application warns that dispensing, prescribing or administering without it is a category D felony (NRS 453.232). The Board's physician application (fee $200, rev. 01/05/2023) requires steps in order: Nevada PMP account, then the state CS registration, then DEA, and says an active state CS registration is required to complete the DEA application; registrations expire October 31 of even-numbered years. A separate registration is required at each principal place of business or professional practice where the practitioner dispenses (NRS 453.226(5)). Practitioners who dispense drugs from an office for a charge also need a Board Dispensing Practitioner registration ($300, per office, inspection required; NRS 639.23505, NAC 639.742-639.745).

Statute text is current; the fee and step order come from application forms revised 2023-01-05 and 2022-06-16 (older than 2 years - fees possibly stale). NP/PA: APRNs need a Board certificate of registration to prescribe (NRS 639.2351) and a separate one to dispense (NRS 639.1375); PAs use a separate 'PA Prescribe and CS Registration' application. Narrow exception in NRS 453.226(3)(d) for locum tenens/temporary-licensed physicians registered with DEA outside Nevada.

Must a prescriber query the state Prescription Drug Monitoring Program before prescribing, and does the mandate cover Schedule III drugs such as testosterone? "Yes" means a mandate that reaches Schedule III; "conditional" means a mandate limited to certain drugs (e.g. opioids or benzodiazepines) or situations; "no" means no prescriber query mandate.

NRS 639.23507(1) requires every practitioner other than a veterinarian, before issuing an initial prescription for a Schedule II, III or IV controlled substance or a Schedule V opioid, and at least once every 90 days thereafter for the duration of the course of treatment, to obtain and review a patient utilization report and check for duplicate ongoing prescriptions. Under subsection 2 a practitioner may skip the advance check for patients with cancer or sickle cell disease or in hospice or palliative care if it would unreasonably delay care, but must obtain the report as soon as practicable. A documented failed attempt when the system is unavailable counts as compliance, and the Board of Pharmacy must set alternative compliance methods for hospital emergency departments. The PMP is run by the Nevada State Board of Pharmacy with the Department of Public Safety.

Last amended 2019 (Stats. 2019 p. 2136) per the NRS history note. The statute is framed around issuing prescriptions; PDMP TTAC also lists NRS 453.164 and NRS 631.045 (dentists). Testosterone (Schedule III) is caught at the initial prescription and every 90 days.

May physicians dispense prescription drugs (not just administer them) directly to patients from their practice? "Yes" means allowed under standard rules (labeling, records, and at most a simple notice to the board); "conditional" means a separate dispensing registration, permit or license, or quantity, day-supply or drug-category limits; "no" means prohibited except narrow exceptions.

NRS 639.23505 bars a practitioner from dispensing any controlled substance or dangerous drug for human use while charging the patient for it unless the practitioner first obtains a certificate from the Nevada State Board of Pharmacy, pays the fee and issues a written prescription. In Nevada 'dangerous drug' covers prescription drugs generally, so the certificate effectively applies to all paid dispensing. A vendor summary reports a $300 fee and separate permits for APRNs and PAs.

Fee and separate APRN/PA permits from a vendor summary.

For a patient located in the state: must the prescriber hold this state's license (or a telehealth registration or special license), is an in-person exam required before prescribing (generally or for controlled substances), are there state limits on prescribing Schedule III drugs such as testosterone by telehealth, and is the state an Interstate Medical Licensure Compact member? "Yes" means a state license and the in-person standard of care apply (opioid-only or Schedule II-only limits are described but do not change the answer); "conditional" means extra state conditions such as a telehealth registration route, an in-person exam requirement, controlled-substance limits reaching Schedule III, or registration of telehealth businesses. Federal DEA rules apply on top.

(1) Before prescribing by telehealth to a patient in Nevada, a provider must hold a Nevada license, which may be a telemedicine license under NRS 630.261 (requires a full unrestricted license in another state, no prior discipline and ABMS specialty certification); telehealth providers are subject to Nevada law and board jurisdiction. (2) A relationship may be established by telehealth when clinically appropriate, so no in-person exam is required by statute. (3) For Schedule II-IV drugs prescribed for pain, Nevada requires a bona fide relationship, risk assessment, treatment plan and informed consent, and a meeting in person or by telehealth before further dose increases and at 90 days of continuous use (NRS 639.23911, 639.23913, per CCHP); these do not bar telehealth prescribing of testosterone for non-pain indications. (4) IMLC: member.

NRS 629.515 last amended 2025 and NRS 630.261 last amended 2025 (2025 Statutes). NRS 639.235 requires a Nevada pharmacist filling a Schedule II-IV prescription from a prescriber not licensed in Nevada to confirm a bona fide relationship (exam in person or by telehealth within the prior 6 months). The pain-treatment provisions (NRS 639.23911/.23913) were read via CCHP, not verified line by line. Osteopathic physicians are licensed separately under NRS chapter 633.

Who may administer botulinum toxin and dermal fillers (physicians, PAs, NPs, RNs, LPNs, estheticians, dentists), under what supervision (on-site vs available), and must a physician/NP/PA perform a prior good-faith exam?

The Nevada State Board of Nursing's practice decision on aesthetic/cosmetologic procedures (approved 2025-01-17) requires completion of an instructional program with a supervised practicum and demonstrated proficiency for each procedure, facility protocols approved by a qualified practitioner, informed consent, and an order for each individual intervention by a practitioner who has assessed the patient and established a bona fide relationship. Only the practitioner may control access to the drugs. In its Level III grid, neuromodulators and fillers (other than the under-eye, nasal, jawline and temporal zones) are within RN scope under direct supervision (NAC 632.048: the provider is periodically on site or available for immediate guidance). Fillers in the under-eye, nasal, jawline and temporal zones are within RN scope only under immediate supervision (NAC 632.059: the provider is physically present, directly observing or assisting). Biostimulators such as Sculptra in the temporal, mid-face and high-cheek areas are listed under direct supervision. None of these injectables is within LPN scope. APRNs with independent practice authority who meet training rules may inject without supervision.

Grid read from the board's PDF (Level III Advanced Procedures, Cosmetic Injectables) on 2026-09-23. Check the PDF for threads and other biostimulator rows before relying on them.

What does the state require for elective IV hydration/vitamin (incl. NAD+) therapy: who may start IVs, is a patient-specific order or good-faith exam required before a patient's first IV, are standing orders allowed, and are there rules for mobile IV services?

The Board of Nursing's practice decision on out-of-hospital administration of IV solutions and medications (approved 2020-11-18; re-approved 2025-03-19) requires an order from a qualified licensed practitioner who has assessed the patient before ordering. Only that practitioner may control and provide access to IV solutions and medications; after the order, the nurse may remove and possess only the specific items ordered for that patient and is responsible for transporting them per manufacturer guidelines, which bears on mobile IV services. The nurse must keep a patient record with the practitioner's and nurse's assessments and orders and check for contraindications; LPNs must meet the IV course requirements in NAC 632.475.

Does the state enforce the corporate practice of medicine doctrine (non-physicians may not own medical practices or employ physicians), and how does that affect med spa ownership?

Permit Health's 2025 guide classifies Nevada as strict, citing NRS 89.040 and 89.050 and Attorney General Opinion No. 2002-10; MedPath Compliance (reviewed 2026-06-20) also rates Nevada strict. Med spas therefore generally hold medical services in physician-owned professional entities managed by an MSO.

The nursing board's aesthetic decision also references licensed cosmetological establishments (NRS 644A) as possible settings.

Who may perform laser/IPL/RF aesthetic procedures (laser hair removal, resurfacing): physicians only, delegated to RNs/PAs, or licensed electrologists/estheticians/laser technicians with state certification?

In the Board of Nursing's 2025 aesthetic practice decision, Level II procedures (non-ablative laser hair removal, non-ablative skin treatment, IPL, HIFU) require a practitioner's order, informed consent, FDA-labeled equipment approved by the medical director, and 'laser certification and licensure for nurses, cosmetologists and aestheticians', with the provider available for direct supervision. Fractional ablative lasers are listed for RNs with immediate supervision (provider physically present) and not for LPNs; total ablative resurfacing and vaginal rejuvenation are not within nursing scope. The Board of Medical Examiners' advisory opinions page listed no laser opinion on 2026-09-23.

The 'laser certification' referenced is not defined in the fetched text. Rules for estheticians/cosmetologists under NRS 644A were not reviewed.

Does the state license clinical laboratories itself, beyond federal CLIA certification, including out-of-state labs that test specimens from the state?

NRS 652.080 bars operating, conducting or issuing a report from a medical laboratory without a Nevada license, and lets the state 'require a laboratory that is located outside of this state to be licensed' before it examines specimens collected in Nevada. Out-of-state licensure is therefore at the Division's discretion. Nevada also licenses laboratory directors and technical personnel (NRS 652.125).

Out-of-state labs: discretionary, so confirm with the Bureau of Health Care Quality & Compliance (nvhaclialab@nvha.nv.gov).

May consumers order their own lab tests without a practitioner order (direct access testing)? A practitioner-ordered panel is always fine; this matters for take-home and consumer test kits.

NRS 652.190 allows labs to examine specimens only at the request of licensed physicians or other persons authorized by law to use the findings, or at the request of 'any person' when the test uses a testing device or kit 'approved by the Food and Drug Administration for use in the home and which is available to the public without a prescription.' Nevada also licenses labs (NRS 652.080).

Has the state enacted a law or rule specifically about stem cell, exosome or regenerative-medicine therapies (notice/disclosure duties, permission for certain non-FDA-approved uses, or Right to Try extensions covering them)?

NRS 629.300-629.390 define 'nonembryonic cells' as autologous or allogeneic cellular material, including stem cells and immune cells, not obtained directly from human embryos. They authorize cell or tissue banks (NRS 629.360), administration by the person or by a licensed provider acting within the license (NRS 629.370), compounding (NRS 629.380), and importation and administration of such products (NRS 629.390). NRS 629.350 says the provisions do not indicate the activities' status under federal law. Separately, a 2023 Nevada law allows 'individualized investigational treatments' (e.g., gene therapies, ASOs). A 2025 bill (SB 128) encouraging clinicians to discuss stem cell therapy with arthritis patients was vetoed on June 10, 2025. Federal FDA rules still apply regardless of state law: stem cell, birth-tissue and exosome products are regulated by FDA, and a state law cannot make an unapproved biologic FDA-approved.

Enactment year not confirmed here (one compilation lists 2009). Nevada's state law does not override FDA requirements (NRS 629.350).

Does the state have cosmetic or sunscreen requirements beyond federal MoCRA, such as ingredient bans (PFAS, formaldehyde, phthalates), ingredient reporting, sunscreen-ingredient bans, or bans on selling animal-tested cosmetics?

NRS 598.993 prohibits the import, sale or offer for sale of cosmetic products tested on animals, subject to exceptions, and makes a violation a deceptive trade practice. Nevada does not appear on 2026 lists of states with PFAS-in-cosmetics laws.

The effective date was not shown on the statute index reviewed. Federal MoCRA and FDA cosmetic and OTC sunscreen rules apply in every state.