Compliance Issues When Prescribing Controlled Substances via Telemedicine

State laws and rules addressing prescribing controlled substances via telemedicine typically fall into three categories:

• States expressly “allowing” telemedicine prescribing of controlled substances without a prior in-person examination;
• States expressly “prohibiting” telemedicine prescribing of controlled substances or prohibiting it unless the prescriber conducted a prior in-person examination; or
• States that are “silent” and neither expressly allow nor prohibit telemedicine prescribing of controlled substances.

Currently, approximately 15 states fall into the first category and have laws or rules explicitly allowing prescribing controlled substances via telemedicine without a prior in-person exam. However, states that explicitly allow the practice often have limitations on the situations when such prescribing is allowed or other requirements that a prescribing physician must meet prior to prescribing controlled substances (e.g., informed consent requirements, patient disclosures). Although a state may allow telemedicine prescribing of controlled substances generally, or allow it in certain situations, there may also be drug-specific restrictions on prescribing, refills, and checking state prescription drug monitoring
databases (e.g., suboxone, opioids).

Approximately 12 states fall into the second category and have laws or rules explicitly prohibiting telemedicine prescribing of controlled substances or prohibit it unless there is a prior in-person examination. For example, New Hampshire prohibits prescribing substances classified in schedule II through IV unless the “prescriber has an in-person practitioner-patient relationship,” with subsequent in-person examinations “at intervals appropriate for the patient, medical condition, and drug, but not less than annually.”