Telehealth Peptide Prescribing

The Ryan Haight Online Pharmacy Consumer Protection Act of 2008, enacted in response to the death of a California teenager who obtained controlled substances from an online pharmacy without a legitimate prescription, significantly expanded federal restrictions on prescribing controlled substances via the internet and telemedicine. Understanding the Ryan Haight Act is essential for any telehealth prescriber of controlled substances, such as testosterone (Schedule III), or for those practicing in states with specific telemedicine prescribing requirements.

The Ryan Haight Act's core provision generally prohibits prescribing a controlled substance via the internet, including video telehealth, unless the prescriber has conducted at least one in-person medical evaluation of the patient, subject to limited exceptions (PMID 34713386). This in-person requirement applies to DEA-controlled substances prescribed via telemedicine; somatropin (growth hormone) is not a federally scheduled controlled substance, but federal law makes distributing it for unapproved uses such as anti-aging illegal (PMID 15304532)). Exceptions to the in-person requirement are narrow and include, among others, telemedicine conducted while the patient is in a DEA-registered hospital or clinic or in the presence of a DEA-registered practitioner, certain Indian Health Service and VA situations, practitioners holding a DEA special telemedicine registration, and periods when the HHS Secretary has declared a public health emergency.

During the COVID-19 public health emergency, beginning March 16, 2020, the in-person evaluation requirement of the Ryan Haight Act was temporarily waived, allowing controlled substance prescribing via telemedicine without a prior in-person visit (PMID 34713386). This flexibility was accompanied by marked growth in telemedicine prescribing of controlled substances, such as stimulants for ADHD, during the pandemic (PMID 38764385). When the COVID-19 PHE ended in May 2023, the DEA temporarily extended the pandemic-era telemedicine flexibilities, after its earlier proposed rules for permanent telemedicine prescribing drew extensive public comment. The transition from the COVID-era flexibilities to a permanent DEA telemedicine framework has been repeatedly delayed through temporary extensions, so practitioners should verify the current rules. Practitioners who prescribe controlled substances (including GH) via telemedicine must monitor DEA regulatory developments in this space carefully.

Most therapeutic peptides used in clinical practice, including GH secretagogues (ipamorelin, CJC-1295, tesamorelin), GLP-1 agonists, and BPC-157, are not federally controlled substances and therefore are not subject to the Ryan Haight Act's in-person evaluation requirement. These peptides can be prescribed via telehealth following the applicable state medical practice laws for telemedicine (which generally require establishing an appropriate prescriber-patient relationship but do not require in-person visits for non-controlled substances). This is an important distinction that allows most peptide therapy to be conducted via telehealth without the specific Ryan Haight Act constraints.