While tremendous strides continue to be made in the growth and adoption of telehealth services, significant legal obstacles remain. Among these obstacles are state drug prescribing laws. In many states, physicians cannot lawfully prescribe drugs during a telehealth encounter, except in very limited circumstances. For example, California requires that physicians perform a “physical exam” before prescribing drugs, and explicitly outlaws prescribing on “the internet” without a prior examination. These restrictions vary from state to state, but many share certain characteristics, such as the following:
- In several states the law says that physicians cannot prescribe medication without first performing a “physical” examination (e.g. Alabama, Massachusetts, Tennessee and California). This physical examination requirement is generally interpreted to mean that the physician must have an in-person encounter with the patient, but this is not necessarily the case everywhere.
- Some states only limit telehealth prescribing to certain classes of drugs. For example, Minnesota’s prescribing law requires that the physician complete an “in person examination” before prescribing controlled substances, muscle relaxants, and certain other classes of medication. Louisiana has a similar restriction for certain controlled substances, but not other classes of drugs.
- Many states now have prescribing laws that explicitly prohibit prescribing solely based on an internet questionnaire (e.g. Louisiana and Mississippi) or internet consultation (e.g. Oregon).