How to continue Topamax after moving to Florida

If you’re struggling with Binge Eating Disorder (BED) and wondering whether you can get help through telehealth, you’re not alone. Millions of Americans are now turning to virtual healthcare for mental health and eating disorder treatment—and the good news is that telehealth is a fully legal, accessible, and effective way to receive medication for BED in 2026.

This guide will walk you through everything you need to know about getting BED treatment online, including which medications are available, how telehealth prescribing works, what the laws say in your state, and how to find safe, quality care.

Understanding Binge Eating Disorder and Why Medication Matters

Binge Eating Disorder is the most common eating disorder in the United States, affecting approximately 2.8 million adults. Unlike bulimia, BED involves episodes of consuming large amounts of food in a short period while feeling out of control—but without purging behaviors.

To be diagnosed with BED, you typically experience:

• Recurrent episodes of eating significantly more food than most people would eat in a similar timeframe
• Feeling a lack of control during these episodes
• Eating until uncomfortably full, eating when not physically hungry, or eating alone due to embarrassment
• Feeling distressed, guilty, or depressed after binge eating
• Binge eating at least once a week for three months

While therapy—particularly Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT)—remains the gold standard for BED treatment, medication can be a valuable tool, especially when combined with counseling and nutritional support.

Free consultations available with select providers only.

Get a free consultation

And find an affordable, caring specialist.

Find a provider

Free consultations available with select providers only.

Yes, You Can Get BED Medication Through Telehealth—Here’s Why

The short answer: Absolutely. The medications commonly used for Binge Eating Disorder—Topamax (topiramate) and Wellbutrin (bupropion)—are not controlled substances. This is crucial because federal telehealth restrictions that make headlines (the Ryan Haight Act) only apply to controlled medications like stimulants or opioids.

For non-controlled medications like those used for BED:

• No federal law requires an in-person visit before prescribing
• Telehealth providers licensed in your state can evaluate you and prescribe these medications entirely online
• You can have prescriptions sent to your local pharmacy or through legitimate mail-order services

The DEA’s telehealth prescribing flexibilities (extended through December 31, 2026) focus on controlled substances—meaning access to BED medications has remained stable and open throughout the pandemic and beyond.

The Two Main Medications for BED Available via Telehealth

Topamax (Topiramate)

What it is: Topiramate is FDA-approved for seizures and migraine prevention, but it’s commonly prescribed off-label for Binge Eating Disorder.

How it helps BED: Research suggests topiramate can reduce binge frequency and help with impulse control. Many patients also experience some weight loss, which can be beneficial for those whose BED has contributed to obesity-related health concerns.

What to know:

• Starting dose: Providers typically start low (25mg) and gradually increase to minimize side effects
• Common side effects: Tingling in hands/feet, taste changes, cognitive effects (‘brain fog’ at higher doses)
• Important warnings: Not recommended during pregnancy due to increased risk of birth defects, including cleft palate. If you’re of childbearing age, your provider will discuss contraception
• Monitoring needed: Regular check-ins to assess side effects, especially cognitive changes and kidney stone risk

Telehealth availability: ✅ Fully available via telehealth in all 50 states

Wellbutrin (Bupropion)

What it is: Bupropion is FDA-approved for depression and smoking cessation but is also used off-label for BED.

How it helps BED: Studies show bupropion can help reduce binge eating episodes and may help with the depression or anxiety that often accompanies BED.

What to know:

• Contraindications: Do not use if you have a history of bulimia, anorexia nervosa, or seizure disorders—the risk of seizures is significantly elevated in these cases
• Black box warning: Like all antidepressants, carries a warning about increased suicidal thoughts in people under 25—close monitoring is required, especially when starting
• Common side effects: Dry mouth, insomnia, increased energy (can be activating), decreased appetite
• Avoid: Alcohol and combining with other medications that lower seizure threshold
• Monitoring needed: Blood pressure checks (can increase BP), mood monitoring, especially in the first few weeks

Telehealth availability: ✅ Fully available via telehealth in all 50 states

Why These Medications and Not Vyvanse?

You might have heard that Vyvanse (lisdexamfetamine) is the only FDA-approved medication specifically for BED. That’s true—but there’s a catch for telehealth: Vyvanse is a Schedule II controlled substance (a stimulant), which means it faces much stricter telehealth prescribing rules.

Currently, most legitimate telehealth platforms do not prescribe Vyvanse for BED due to:

• Federal and state restrictions on controlled substance prescribing
• Heightened regulatory scrutiny following enforcement actions against telehealth companies that inappropriately prescribed stimulants
• The need for more intensive monitoring and often an in-person relationship

If your provider determines you’d benefit from Vyvanse, they’ll typically refer you to an in-person specialist. For now, topiramate and bupropion remain the primary telehealth-accessible options for BED medication.

State-by-State Telehealth Prescribing: What You Need to Know

While federal law doesn’t restrict telehealth prescribing of non-controlled medications, state laws vary. The good news? Most states have made pandemic-era telehealth flexibilities permanent or near-permanent.

States with No In-Person Visit Required

These states allow providers to prescribe BED medications based entirely on a telehealth evaluation, with no mandatory in-person visit:

California – No in-person requirement. A 2025 law (AB 1503) even allows asynchronous (non-video) telehealth evaluations for prescribing if it meets the standard of care.

New York – No in-person needed for non-controlled medications. (Note: NY’s 2025 rule requiring in-person visits applies only to controlled substances.)

Texas – No in-person requirement for non-controlled meds. NPs and PAs can prescribe under physician delegation.

Florida – Allows telehealth prescribing of non-controlled medications with no in-person visit.

Michigan – No specific in-person requirement; telehealth permitted if standard of care is met. (Bonus: Michigan achieved full NP independence in 2025.)

Wisconsin – Allows telehealth prescribing without in-person visits. (Wisconsin also recently granted NPs full practice authority.)

Delaware – Fully remote prescribing permitted under the state’s Telehealth Act.

South Carolina – No explicit in-person requirement; providers must provide an ‘appropriate evaluation,’ which can be conducted via telemedicine.

States Requiring Periodic In-Person Follow-Up

A small number of states require patients to be seen in person if treatment continues long-term:

Alabama – If you have more than 4 telehealth visits in 12 months for the same condition, you must have an in-person visit within that year. This can be with a collaborating provider, not necessarily your telehealth prescriber.

Georgia – Requires an attempt at an in-person exam at least annually for ongoing telemedicine care. Initial evaluation can be done via telehealth.

New Hampshire – Recently updated (August 2025): allows telehealth prescribing without initial in-person visit, but requires an in-person exam within 12 months for continued treatment.

Important note: Even in these states, the in-person visit can often be satisfied by seeing any local provider (your primary care doctor, for example), not necessarily the telehealth prescriber. Many telehealth platforms will help coordinate this if you’re in one of these states.

Who Can Prescribe BED Medication via Telehealth?

Licensed Physicians (MDs and DOs)

All states allow physicians to prescribe these medications via telehealth, provided they’re licensed in your state.

Nurse Practitioners (NPs)

This is where it gets interesting. 34 states plus DC now grant NPs Full Practice Authority—meaning they can evaluate patients and prescribe medications independently, without physician oversight.

States with full NP independence include:

• Recently joined (2023-2025): Michigan, Wisconsin, Louisiana, Kansas
• Established: California, New York, New Hampshire, Connecticut, Colorado, and many more

In states without full practice authority (like Texas, Florida, Georgia, Alabama), NPs can still prescribe BED medications but must do so under a collaborative agreement with a physician. This is a behind-the-scenes arrangement—you’ll still receive the same quality care, but there’s a supervising physician involved in the practice.

Physician Assistants (PAs)

PAs can prescribe non-controlled medications in all states, though they work under physician supervision. The level of autonomy varies by state, but for BED medications, this rarely affects patient access.

Bottom line: Whether you see an MD, DO, NP, or PA via telehealth, you can receive these BED medications as long as the provider is licensed in your state and follows appropriate protocols.

How Klarity Health Makes BED Treatment Accessible

At Klarity Health, we understand that getting help for Binge Eating Disorder shouldn’t be complicated or unaffordable. That’s why we’ve built a telehealth platform designed specifically for mental health and eating disorder care that removes common barriers:

• Provider availability: Connect with licensed mental health prescribers in your state—often within 24-48 hours
• Transparent pricing: Know exactly what you’ll pay before your appointment, with no hidden fees
• Insurance and cash pay: We accept most major insurance plans and offer affordable self-pay rates for those without coverage or who prefer not to use insurance
• Comprehensive care: Our providers don’t just prescribe—they partner with you on a treatment plan that may include therapy referrals, nutritional guidance, and ongoing monitoring

Getting started is simple: complete a brief assessment, schedule your video appointment, and meet with a provider who specializes in eating disorders and mental health.

What to Expect During Your Telehealth BED Evaluation

A legitimate telehealth evaluation for BED should be thorough—typically 30-45 minutes for an initial appointment. Here’s what providers will assess:

Your Eating Patterns and History

• Frequency and nature of binge eating episodes
• Foods typically consumed during binges
• Emotional triggers and patterns
• Any history of other eating disorders (bulimia, anorexia)
• Previous treatments attempted

Mental Health Screening

• Depression, anxiety, or other mood disorders
• History of trauma or PTSD
• Suicidal thoughts (especially important before starting antidepressants like Wellbutrin)
• Substance use

Medical History

• Seizure history (critical for Wellbutrin screening)
• Pregnancy status or plans (essential for Topiramate)
• Current medications and supplements
• Kidney function, liver health
• History of migraines, diabetes, or metabolic conditions

Safety Screening

Your provider will also screen for conditions that might make telehealth inappropriate, such as:

• Severe medical instability requiring in-person monitoring
• Active suicidal ideation needing immediate intervention
• Severe purging behaviors suggesting bulimia rather than BED

Who Should NOT Get BED Medication via Telehealth

While telehealth works for many people, certain situations require in-person care:

❌ History of bulimia or anorexia with purging – Wellbutrin is contraindicated due to seizure risk

❌ Uncontrolled seizure disorder – Both medications can affect seizure threshold

❌ Pregnancy or trying to conceive – Topiramate carries significant fetal risks; Wellbutrin requires careful consideration

❌ Severe medical complications – Unstable vital signs, electrolyte imbalances, or other urgent medical needs

❌ Need for controlled medications – If your provider determines you need Vyvanse or other controlled substances, you’ll likely need in-person evaluation

❌ Acute suicidal crisis – Requires immediate in-person or emergency care, not telehealth

Understanding Off-Label Prescribing

You might wonder: if these medications aren’t FDA-approved specifically for BED, is it safe?

Yes. Off-label prescribing is both legal and extremely common in medicine—especially in psychiatry and eating disorder treatment. Here’s why:

• Evidence-based: Multiple clinical studies support the use of topiramate and bupropion for BED
• Standard practice: Major medical organizations and eating disorder specialists regularly use these medications
• Regulatory approval: The FDA approves medications for specific uses, but doctors can legally prescribe them for other conditions based on medical evidence

Your provider should explain:

• Why they’re recommending this medication
• The evidence supporting its use for BED
• Alternative options available
• Expected benefits and risks

Red flag: If a provider prescribes medication without explaining the rationale or discussing alternatives, seek a second opinion.

Prescription Monitoring Programs (PMPs) and Privacy

Many patients worry about privacy when getting medication through telehealth. Here’s what you need to know:

For BED medications (non-controlled): Most states do not require providers to check the Prescription Monitoring Program database before prescribing topiramate or bupropion. These databases track controlled substances to prevent abuse.

What providers may check: Even without legal requirements, responsible providers might:

• Review your medication history to avoid drug interactions
• Check for duplicate prescriptions
• Verify you’re not on medications that contraindicate BED treatment

Your privacy is protected: HIPAA laws apply to telehealth just as they do to in-person care. Your medical information remains confidential.

Red Flags: How to Spot Unsafe Telehealth Services

The telehealth boom has unfortunately attracted some bad actors. Here’s how to protect yourself:

Warning Signs of Questionable Services

🚩 Guaranteed prescription before evaluation – Legitimate providers can’t promise medication until they’ve assessed you

🚩 No real-time video visit – While some states allow asynchronous care, a proper BED evaluation typically requires interactive discussion

🚩 5-minute ‘evaluation’ – A thorough assessment takes time; rushed appointments often skip critical safety screening

🚩 No discussion of therapy or alternatives – Medication alone isn’t the standard of care for BED; good providers discuss comprehensive treatment

🚩 Shipping medication directly – Legitimate prescriptions go through licensed pharmacies, not directly from the company

🚩 Prescribing controlled substances too easily – Any service offering stimulants or benzodiazepines with minimal evaluation should raise concerns

What Good Telehealth Looks Like

✅ Thorough intake process – Detailed questionnaires about your medical and mental health history

✅ Licensed, credentialed providers – Clear information about who you’ll see and their qualifications

✅ Informed consent – Written explanation of telehealth limitations, privacy policies, and treatment approach

✅ Comprehensive treatment planning – Discussion of medication plus therapy, nutrition, and lifestyle changes

✅ Regular follow-up – Scheduled check-ins to monitor progress and adjust treatment

✅ Clear communication channels – Ability to message your provider or access nurse support between visits

✅ Coordination with your existing care – Willingness to communicate with your therapist, dietitian, or primary care doctor

Costs, Insurance, and Affordability

Insurance Coverage

Most insurance plans cover telehealth visits for mental health and eating disorders at the same rate as in-person care. This typically includes:

• Initial evaluation
• Follow-up medication management visits
• The medications themselves (though copays vary)

Important: Verify your coverage before your first appointment. Some plans require:

• Pre-authorization for certain medications
• Use of in-network providers
• Documentation of medical necessity

Cash Pay Options

If you don’t have insurance or prefer not to use it, many telehealth platforms (including Klarity Health) offer transparent cash-pay pricing:

• Initial evaluation: Typically $150-$300
• Follow-up visits: Usually $99-$150
• Medication costs: Varies by drug and pharmacy
• Generic topiramate: Often $20-50/month without insurance
• Generic bupropion: Usually $15-40/month without insurance

Money-saving tips:

• Ask for generic versions (much cheaper than brand-name)
• Use GoodRx or similar discount programs at your pharmacy
• Check if your pharmacy has in-house discount programs
• Ask your provider about 90-day prescriptions (often more cost-effective)

Klarity Health’s Approach to Affordability

At Klarity Health, we believe cost shouldn’t prevent you from getting help:

• Transparent pricing posted upfront—no surprise bills
• Accept most major insurance plans including Medicare
• Competitive self-pay rates for those without insurance
• Flexible scheduling to fit your life and budget

Follow-Up Care and Long-Term Management

BED treatment isn’t one-and-done. Here’s what ongoing care typically looks like:

Initial Phase (Months 1-3)

• Week 2-4: First follow-up to assess medication tolerance and side effects
• Monthly visits: Monitor symptom improvement, adjust dosage if needed
• Therapy integration: Ideally start or continue CBT or DBT alongside medication

Maintenance Phase (Months 3-12)

• Visits every 4-8 weeks: Continue monitoring progress
• Dose optimization: Find the lowest effective dose
• Address barriers: Problem-solve around challenges to recovery

Long-Term Management

• Some states require periodic in-person visits (see state-specific rules above)
• Medication may be continued as long as beneficial – there’s no arbitrary time limit
• Gradual discontinuation when appropriate – never stop topiramate suddenly (seizure risk); taper carefully

Refills and Prescription Management

Good news: Since these aren’t controlled substances, providers can typically:

• Write prescriptions with multiple refills (often 6-11 months’ worth)
• Allow you to request refills through patient portals
• Send prescriptions electronically to your pharmacy of choice

You won’t need a new prescription every single month, but you will need periodic follow-up appointments to ensure the medication remains safe and effective.

Combining Medication with Other BED Treatments

The most effective approach to BED combines multiple strategies:

Psychotherapy

Cognitive Behavioral Therapy (CBT) is the gold-standard treatment for BED. It helps you:

• Identify triggers for binge eating
• Develop healthier coping strategies
• Challenge distorted thoughts about food, weight, and self-worth
• Establish regular eating patterns

Dialectical Behavior Therapy (DBT) is also highly effective, particularly for:

• Emotional regulation
• Distress tolerance
• Mindfulness practices

Nutritional Counseling

Working with a registered dietitian who specializes in eating disorders can help you:

• Normalize eating patterns
• Reduce food restriction (which often triggers binges)
• Build a healthier relationship with food
• Plan balanced meals and snacks

Support Groups

Connecting with others who understand BED can be incredibly valuable:

• Eating Disorders Anonymous (EDA)
• Overeaters Anonymous (OA)
• Online support communities
• Local eating disorder support groups

Klarity Health providers can help connect you with these resources as part of your comprehensive treatment plan.

Recent Policy Updates (2025-2026)

The regulatory landscape continues to evolve. Here’s what’s happened recently:

Federal Level

• DEA extended telehealth prescribing flexibilities through December 31, 2026 for controlled substances (doesn’t affect BED medications directly, but shows continued commitment to telehealth access)
• No in-person requirement for non-controlled medications – this has never changed and remains stable

State Level

New Hampshire (August 2025): Removed older telehealth barriers; now explicitly allows Schedule II-IV prescribing via telehealth with annual in-person follow-up

New York (May 2025): Implemented new rules requiring in-person visits before prescribing controlled substances—but specifically exempted non-controlled medications

California (2025): Expanded definition of ‘good faith exam’ to include asynchronous telehealth, making access even easier

Michigan and Wisconsin (2025): Both granted full practice authority to nurse practitioners, expanding the pool of providers who can independently prescribe BED medications

What this means for you: Telehealth for BED medications is more stable and accessible than ever, with no expected policy changes that would restrict access in 2026 and beyond.

Frequently Asked Questions

Q: Can I use telehealth for BED treatment if I live in a rural area?
A: Absolutely. Telehealth is particularly valuable for people in rural or underserved areas. As long as your provider is licensed in your state, your location within that state doesn’t matter.

Q: What if I don’t have a webcam or smartphone?
A: Some providers may allow phone-only visits, though video is generally preferred and required in some states. Many telehealth platforms work on tablets, laptops, or smartphones—most people can find an option that works.

Q: Will my employer or family find out I’m getting BED treatment?
A: Your medical information is protected by HIPAA. Telehealth services maintain the same privacy standards as in-person care. If you use insurance, an Explanation of Benefits may be sent to the policyholder, but it won’t include diagnosis details.

Q: Can I see a therapist and medication provider through the same platform?
A: Many platforms, including Klarity Health, offer both prescribing providers and therapists, making coordinated care easier.

Q: What if I’m already on other medications?
A: Be sure to tell your telehealth provider about all medications, supplements, and over-the-counter drugs you take. They’ll check for interactions before prescribing.

Q: How long does it take for BED medications to work?
A: Effects vary. Some people notice reduced binge frequency within 2-4 weeks; for others, it may take 6-8 weeks to see full benefits. Patience and consistent follow-up are important.

Q: What if the medication doesn’t work or causes side effects?
A: Contact your provider immediately if you have concerning side effects. There are alternatives available, and dosages can often be adjusted.

Taking the Next Step

If you’re ready to explore medication for Binge Eating Disorder, here’s how to get started:

1. Research reputable telehealth platforms that specialize in mental health and eating disorders (like Klarity Health)

2. Verify the provider is licensed in your state and has experience treating BED

3. Gather your medical history – having information about current medications, allergies, and previous treatments will make your evaluation more efficient

4. Prepare questions about treatment options, costs, and what to expect

5. Schedule your initial evaluation – most platforms allow same-week or next-week appointments

6. Be honest and thorough during your assessment – the more your provider knows, the better they can help

7. Follow through with recommended treatment – medication works best when combined with therapy and lifestyle changes

Why Klarity Health Is a Smart Choice for BED Treatment

Choosing Klarity Health for your Binge Eating Disorder care means:

• Fast access to specialized providers who understand eating disorders and mental health
• No insurance runaround – we accept most plans and offer straightforward cash pricing
• Convenient video appointments that fit your schedule, with options for evening and weekend visits
• Integrated care approach – we can connect you with therapists and other resources
• Ongoing support – not just one-time prescriptions, but a partner in your recovery journey

Getting help for BED doesn’t have to be complicated or expensive. With telehealth, effective treatment is more accessible than ever—and providers like Klarity Health are making it easier to take that first step toward recovery.

Ready to Start Your BED Treatment Journey?

You deserve compassionate, evidence-based care for Binge Eating Disorder—and you don’t have to leave your home to get it. Whether medication, therapy, or a combination approach is right for you, telehealth makes it possible to connect with specialized providers quickly and affordably.

Visit Klarity Health today to schedule your initial evaluation with a licensed mental health provider who can assess your needs and create a personalized treatment plan. With transparent pricing, provider availability within days (not months), and acceptance of both insurance and cash pay, there’s no better time to prioritize your health and well-being.

Recovery from Binge Eating Disorder is possible—and it starts with taking that first step.

Citations

1. U.S. Department of Health and Human Services. (2026, January 2). DEA extends telemedicine prescribing flexibilities through December 31, 2026. https://www.hhs.gov/press-room/dea-telemedicine-extension-2026.html

2. Sheppard Mullin Richter & Hampton LLP. (2025, August). Telehealth and in-person visits: Tracking federal and state updates to pandemic-era telehealth exceptions. https://www.sheppardhealthlaw.com/2025/08/articles/telehealth/telehealth-and-in-person-visits-tracking-federal-and-state-updates-to-pandemic-era-telehealth-exceptions/

3. Center for Connected Health Policy. (2025). State telehealth laws and reimbursement policies: Online prescribing. https://www.cchpca.org/topic/online-prescribing/

4. Health Jobs Nationwide. (2025). State-by-state guide: Expanding roles for PAs and NPs updated 2025. https://blog.healthjobsnationwide.com/state-by-state-guide-expanding-roles-for-pas-and-nps-updated-2025/

5. DailyMed, National Library of Medicine. (n.d.). Bupropion hydrochloride extended-release tablets—Full prescribing information. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=1b69c253-4740-44b0-be63-6c20834540b6&type=display

📅 Research Currency Statement
Verified as of: January 4, 2026

• DEA Rules Status: COVID-19 telehealth prescribing flexibilities remain in effect through December 31, 2026 (fourth extension). No federal in-person requirement exists for non-controlled medications.

• States Verified: Researched 10+ key states (AL, CA, DE, FL, GA, NH, NY, TX, MI, WI) with latest information as of late 2025. State board sites and 2025 legislative updates were checked where available.

• Sources newer than 2024: 80%+ of sources are from 2025 (many late-2025) or updated to 2025. Older sources (2024) were used only when confirmed still accurate by newer references.

• ⚠️ Flagged for follow-up: Alabama and South Carolina NP scope changes (legislation discussed in 2025 but final status unclear—assume no full independence yet pending confirmation). Monitor DEA’s pending final rule on telehealth prescribing (expected by end of 2026). Verify any temporary state waivers for expiration/extension beyond 2025.

Source:

• https://www.hhs.gov/press-room/dea-telemedicine-extension-2026.html#:~:text=patients%20to%20receive%20prescriptions%20for,while%20permanent%20rules%20are%20finalized
• https://www.sheppardhealthlaw.com/2025/08/articles/telehealth/telehealth-and-in-person-visits-tracking-federal-and-state-updates-to-pandemic-era-telehealth-exceptions/#:~:text=extended%20telemedicine%20prescribing%20waivers%20through,prescribing
• https://blog.healthjobsnationwide.com/state-by-state-guide-expanding-roles-for-pas-and-nps-updated-2025/#:~:text=Full%20practice%20authority%20legislation%20reached,12
• https://natlawreview.com/article/telehealth-and-person-visits-tracking-federal-and-state-updates-pandemic-era?amp=#:~:text=coordination%20with%20the%20U,prescribing
• https://telehealth.hhs.gov/providers/telehealth-policy/prescribing-controlled-substances-via-telehealth#:~:text=The%20Drug%20Enforcement%20Administration%20,through%20December%2031%2C%202025
• https://natlawreview.com/article/telehealth-and-person-visits-tracking-federal-and-state-updates-pandemic-era?amp=#:~:text=Prior%20to%20the%202024%20waiver,access%2C%20and%20diversion%20control%20measures
• https://www.cchpca.org/topic/online-prescribing/#:~:text=If%20a%20physician%20or%20practice,resolution%2C%20the%20physician%20shall%20either
• https://www.cchpca.org/topic/online-prescribing/#:~:text=Prescribing%2C%20dispensing%2C%20or%20furnishing%20dangerous,the%20appropriate%20standard%20of%20care
• https://www.cchpca.org/topic/online-prescribing/#:~:text=constitutes%20unprofessional%20conduct,the%20appropriate%20standard%20of%20care
• https://blog.healthjobsnationwide.com/state-by-state-guide-expanding-roles-for-pas-and-nps-updated-2025/#:~:text=California%20leads%20the%20most%20important,12