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, particularly those who prescribe Schedule III growth hormone or who practice in states with specific telemedicine prescribing requirements.

The Ryan Haight Act's core provision: it is unlawful to prescribe a controlled substance using the internet (including video telehealth) unless the prescriber has conducted at least one in-person medical evaluation of the patient before prescribing. This "valid prescription" requirement applies to all DEA-controlled substances prescribed via telemedicine, including Schedule III growth hormone (somatropin). Exceptions to the in-person requirement are narrow: (1) the prescriber is treating a patient in an emergency situation; (2) the prescriber is practicing telemedicine in the context of a health care system (e.g., a Veterans Administration provider treating a veteran at a VA facility); (3) the DEA has granted a special registration to prescribe controlled substances via telemedicine without an in-person visit (these special registrations have historically been very limited and narrow in scope); or (4) the Secretary of HHS has declared a public health emergency (as occurred during COVID-19, enabling the "COVID telemedicine exception" that temporarily allowed controlled substance prescribing without in-person visits).

The COVID-19 public health emergency exception: when the HHS declared the COVID-19 PHE in March 2020, the DEA simultaneously exercised its public health emergency authority under the Ryan Haight Act to allow controlled substance prescribing via telemedicine without prior in-person evaluation for the duration of the PHE. This exception enabled the explosive growth in telehealth prescribing that occurred during 2020-2023 — including GH prescribing via telemedicine. When the COVID-19 PHE ended in May 2023, the DEA extension provided a limited grace period for patients who had established telemedicine-based controlled substance relationships during the PHE, and issued proposed rules for a new "telemedicine special registration" process. As of 2024, the regulatory transition from COVID exception to the new telemedicine registration framework is ongoing. 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 — GH secretagogues (ipamorelin, CJC-1295, tesamorelin), GLP-1 agonists, BPC-157, and other compounded peptides — are not DEA-controlled substances and are therefore 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.