GLP-1 Receptor Agonists in Dermatology: Prescribing Frameworks, Access, and the Emerging Pipeline

The rapid expansion of glucagon-like peptide-1 receptor agonist (GLP-1 RA) approvals has created a complex regulatory and practice environment for dermatologists. No GLP-1 RA currently holds a United States Food and Drug Administration (FDA)-approved dermatologic indication; all prescribing for cutaneous conditions - including psoriasis, hidradenitis suppurativa, and wound healing - remains off-label. This chapter examines the regulatory frameworks governing GLP-1 RA use in dermatology, encompassing the current FDA-approved landscape, legal and professional standards for off-label prescribing, obesity medicine certification as a competency pathway, the compounding controversy, and access, cost, and reimbursement barriers. Particular attention is given to the Anti-Kickback Statute (AKS) implications of manufacturer copay cards for Medicare beneficiaries, the Treat and Reduce Obesity Act, and evolving patient assistance strategies. Multidisciplinary collaboration, adverse event surveillance, the next-generation incretin pipeline, and ethical and equity considerations are also addressed. Practical recommendations are provided to guide dermatologists in navigating prescribing authority, reimbursement, pharmacovigilance, and the evolving evidence base.