Prescriber Scope of Practice for Narcolepsy in New York

If you’re a psychiatrist or PMHNP considering treating narcolepsy patients remotely, you’re navigating one of the most complex intersections of telehealth law: prescribing Schedule II stimulants across state lines. The good news? It’s currently legal under federal policy through 2026. The bad news? State laws add layers of restrictions that can trip you up if you’re not careful.

Let’s cut through the confusion and talk about what you actually need to know to prescribe narcolepsy medications via telehealth — from DEA rules to state-specific landmines in Florida, Texas, New York, California, Pennsylvania, and Illinois.

The Federal Picture: Ryan Haight Act vs COVID Flexibilities

Here’s the reality: under normal circumstances, prescribing any controlled substance via telehealth requires at least one in-person medical evaluation under the Ryan Haight Online Pharmacy Consumer Protection Act of 2008. That’s federal law — specifically 21 U.S.C. §829(e) — and it was designed to prevent online pill mills.

For narcolepsy patients who need Schedule II stimulants (Adderall, Ritalin, Dexedrine) or Schedule III/IV medications (modafinil, sodium oxybate), that in-person requirement was a major barrier to remote care. Pre-2020, you either saw the patient face-to-face at least once, or you didn’t prescribe.

Then COVID happened. In March 2020, the DEA issued an emergency waiver allowing providers to prescribe controlled substances via telehealth without an in-person exam, as long as the prescription was legitimate and all other requirements (state licensure, DEA registration) were met. That waiver was supposed to be temporary, tied to the Public Health Emergency.

But here’s where it gets interesting: the DEA has now extended that flexibility four times. Most recently, in January 2026, HHS and DEA announced the telehealth prescribing allowance will continue through December 31, 2026, while the DEA finalizes permanent telemedicine rules (www.hhs.gov).

What this means for you right now:

• You can initiate and continue controlled substance prescriptions for narcolepsy via telehealth (video or, in some cases, audio-only) without ever meeting the patient in person
• This applies to Schedule II stimulants, Schedule IV modafinil/armodafinil, Schedule III sodium oxybate — the whole toolkit
• You must still follow standard prescribing practices: checking your state’s PDMP, documenting clinical rationale, using e-prescribing, maintaining the standard of care

The catch: This is a temporary policy. The DEA has been working on permanent telemedicine rules since 2022-2023. Initial proposals would have required an in-person visit after 30 days for Schedule II meds, or even prohibited telehealth initiation of stimulants entirely. After 38,000+ public comments objecting to those restrictions, DEA backed off and continues to ‘carefully consider stakeholder feedback’ (www.dea.gov).

Expect final rules sometime in 2025-2026. They’ll likely include some restrictions — maybe shorter initial prescriptions, maybe required follow-ups — but probably won’t be as draconian as the first draft. The DEA has already finalized narrow exceptions for buprenorphine (for opioid use disorder) and VA patients, suggesting they’re willing to carve out condition-specific allowances (www.dea.gov).

Bottom line: You have a stable runway through 2026. Use it. But plan for the possibility that starting in 2027, you may need hybrid care models — partnering with local clinics for initial in-person exams, or requiring patients to get their diagnostic sleep studies done in person anyway (which most do).

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State-by-State Breakdown: Where Narcolepsy Teleprescribing Gets Complicated

Federal law sets the floor, but states can impose additional restrictions. And boy, have some of them done that.

Florida: The Psychiatric Exception Problem

Florida’s telehealth statute (§456.47) explicitly prohibits prescribing Schedule II controlled substances via telehealth — with four narrow exceptions: treating a psychiatric disorder, inpatient hospital care, hospice, or nursing home residents (www.leg.state.fl.us).

Notice what’s missing? Narcolepsy.

Narcolepsy is a neurological sleep disorder, not a psychiatric disorder. Even though psychiatrists frequently manage it (especially the psychiatric comorbidities and medication side effects), Florida law doesn’t carve out narcolepsy as an approved indication for telehealth stimulant prescribing.

What this means:

• A Florida-licensed psychiatrist cannot legally prescribe Adderall or methylphenidate for narcolepsy via pure telehealth
• You’d need at least one in-person visit to start Schedule II meds
• Schedule IV modafinil is fair game via telehealth (the law only restricts Schedule II and III)
• PMHNPs face an additional hurdle: Florida limits APRN Schedule II prescribing to 7 days maximum unless the NP is a certified ‘psychiatric nurse’ managing a mental health disorder (www.flsenate.gov). Since narcolepsy isn’t a mental health disorder, the 7-day limit would apply even for qualified PMHNPs

The workaround: Many Florida telehealth providers start patients on modafinil remotely, or require an initial in-person consult with a local provider before continuing stimulants via telehealth. Some establish partnerships with Florida sleep centers or primary care clinics to handle the in-person component.

Texas: NPs Can’t Touch Schedule II (Except in Hospitals)

Texas has a blanket rule: APRNs and PAs cannot prescribe Schedule II controlled substances in outpatient settings. Period. The only exceptions are hospital inpatients (≥24-hour stay), emergency departments, or hospice facilities — and even then, the prescription must be filled at the hospital/hospice pharmacy (www.tmb.state.tx.us).

For narcolepsy care, this means:

• A Texas PMHNP cannot prescribe Adderall, Ritalin, or any other Schedule II stimulant to an outpatient, period
• The supervising physician would have to write those prescriptions themselves
• PMHNPs can prescribe modafinil (Schedule IV) under delegation
• Texas is also a restricted practice state — all NPs need physician supervision via a written prescriptive authority agreement

For psychiatrists: You have full authority. Texas allows telehealth establishment of a physician-patient relationship via two-way video (audio-only isn’t sufficient for controlled substance prescribing). The state bans telehealth prescribing for chronic pain management, but narcolepsy isn’t classified as chronic pain, so you’re clear (www.cchpca.org).

The workaround: Telehealth platforms operating in Texas typically staff psychiatrists (MDs/DOs) for Schedule II prescribing, or use hybrid models where NPs manage the ongoing care but loop in a physician for stimulant refills.

New York: Aligned with Federal Rules (For Now)

New York took an interesting approach in 2025: the state Department of Health finalized regulations that require an in-person exam before prescribing controlled substances via telehealth — unless you’re complying with federal law (www.nixonpeabody.com).

Translation: Since federal law currently allows telehealth controlled substance prescribing (via the DEA waiver), New York allows it too. If/when the DEA changes the rules and requires in-person exams, New York’s requirement automatically kicks in.

For now:

• New York psychiatrists can prescribe narcolepsy meds via telehealth without in-person visits
• Experienced PMHNPs (3,600+ hours of practice) have full practice authority in NY and can do the same
• You must check the I-STOP prescription monitoring program before every controlled substance prescription
• Electronic prescribing is mandatory

The bonus: New York is a full practice authority state for experienced NPs. A PMHNP with 3+ years of experience can diagnose narcolepsy, order sleep studies, prescribe stimulants or sodium oxybate, and manage the entire case independently — no physician collaboration required (www.rivkinrounds.com).

California: NP Independence is Here (With Conditions)

California implemented AB 890 in 2023, creating a pathway for NPs to practice independently after accumulating ≥4,600 hours of supervised clinical experience (roughly 3 years). Once qualified, these NPs can prescribe Schedule II-V controlled substances without physician oversight (rxagent.co).

Requirements for Schedule II authority:

• Complete required pharmacology coursework on controlled substances (including addiction risk education)
• Obtain a furnishing number from the California Board of Registered Nursing with Schedule II authority
• Maintain DEA registration

For telehealth: California has no state-imposed in-person exam requirement for controlled substances. The state defers to federal law. So under the current DEA waiver, California psychiatrists and independent NPs can prescribe narcolepsy medications via telehealth.

The catch: You must query the CURES prescription monitoring program before prescribing Schedule II-IV medications for the first time, and at least every 4 months for ongoing therapy. This is strictly enforced.

Pennsylvania: Collaboration Required, But Telehealth is Open

Pennsylvania is a restricted practice state for NPs (called CRNPs — Certified Registered Nurse Practitioners). All NPs need a collaborative agreement with a physician to practice and prescribe.

Schedule II limits for CRNPs:

• Maximum 30-day supply of Schedule II medications
• Physician must be consulted for continuation beyond initial prescription
• For Schedule III-IV: 90-day supply limit

Pennsylvania has no specific state prohibition on telehealth prescribing of controlled substances. The state defers to federal standards. So under the current DEA waiver, both psychiatrists and CRNPs can prescribe narcolepsy meds via telehealth.

Recent change: Pennsylvania removed the old 72-hour Schedule II limit for NPs in 2021, aligning with the 30-day standard. It’s still restrictive compared to independent practice states, but workable (www.pacodeandbulletin.gov).

Telehealth note: Pennsylvania allows telehealth initiation of buprenorphine for opioid use disorder (with in-person follow-up in 14 days), signaling openness to controlled substance telehealth in appropriate contexts (www.cchpca.org).

Illinois: Full Practice Authority (After You Earn It)

Illinois offers full practice authority to NPs who complete:

• Minimum 4,000 hours of clinical practice under a collaborative agreement
• 250 hours of additional continuing education in their specialty

Once you earn FPA, you can practice independently, including prescribing Schedule II-V controlled substances. Illinois requires a separate Mid-Level Practitioner Controlled Substance License from the state in addition to your DEA registration.

The nuance: Illinois law requires NPs with FPA to maintain a ‘consultation relationship’ with a physician if prescribing benzodiazepines or opioids. Stimulants for narcolepsy aren’t opioids, so this requirement likely doesn’t apply — but the law isn’t crystal clear (ilga.gov).

For telehealth: Illinois has no state restriction on controlled substance prescribing via telehealth. The state mandates:

• Electronic prescribing for all controlled substances (as of January 2023)
• Checking the Illinois Prescription Monitoring Program before prescribing
• Standard telehealth informed consent

Bottom line: Illinois is one of the most provider-friendly states for NP-led narcolepsy care via telehealth.

Psychiatrist vs PMHNP: Who Can Actually Treat Narcolepsy?

Legally, both psychiatrists and PMHNPs can diagnose and treat narcolepsy in most states — but the practical differences matter.

Psychiatrists (MD/DO):

• Full prescriptive authority in all 50 states for Schedule II-V medications
• No supervision or collaboration requirements
• Can practice across state lines via telehealth (if licensed in each state)
• Fewer regulatory headaches, especially in restricted practice states like Texas and Florida

PMHNPs:

• Authority varies dramatically by state (see table above)
• In full practice states (NY, CA, IL after qualification): can manage narcolepsy independently
• In restricted states (TX, PA): need physician collaboration, may face Schedule II limits
• In reduced practice states (FL): hit 7-day Schedule II limits for non-psychiatric conditions

The scope question: Is treating narcolepsy within a PMHNP’s scope of practice?

Generally, yes. Narcolepsy management overlaps heavily with psychiatric care:

• Stimulants (Adderall, Ritalin) are standard ADHD medications PMHNPs prescribe daily
• Antidepressants (SSRIs, SNRIs) are used for cataplexy
• Sodium oxybate requires REMS program enrollment, but so do some psychiatric medications
• Psychiatric comorbidities (depression, anxiety) are common in narcolepsy patients

That said, confirming a narcolepsy diagnosis typically requires polysomnography and Multiple Sleep Latency Testing — in-person diagnostic procedures you’ll need to coordinate with local sleep labs. Many telehealth providers partner with national sleep testing networks or require patients to get diagnostic studies done locally before starting treatment.

Malpractice consideration: If you’re managing narcolepsy outside your typical specialty area, document why. For a PMHNP, this might mean: ‘Patient’s narcolepsy was diagnosed by sleep specialist Dr. X in 2023 via MSLT; I am managing medications and psychiatric comorbidities within my training and competence.’ If the case involves complex neurological issues beyond medication management, refer or co-manage with a neurologist.

The Economics: Why Telehealth Platforms Make Sense for Narcolepsy Care

Let’s talk business. If you’re considering offering narcolepsy treatment via your own practice vs joining a platform like Klarity Health, here’s the economic reality:

DIY Marketing for Narcolepsy Patients:

• Google Ads for ‘narcolepsy treatment’ or ‘sleep disorder psychiatrist’ run $15-40+ per click
• Realistic cost per booked patient through PPC: $200-400+ (factoring in conversion rates, no-shows from cold leads)
• SEO takes 6-12 months of consistent investment before generating meaningful patient flow
• Directory listings (Psychology Today, Zocdoc) charge monthly fees AND you compete with hundreds of other providers
• Zocdoc charges per booking ($35-100+) plus monthly subscription
• Total monthly marketing spend to acquire steady patient flow: $3,000-5,000+ with uncertain ROI

The Klarity Health Model:

• Pay-per-appointment listing fee (similar to Zocdoc) — you pay only when a qualified patient books
• No upfront marketing spend or monthly subscriptions
• Pre-qualified patients already matched to your specialty and availability
• Built-in telehealth infrastructure (no separate EMR/platform costs)
• Both insurance and cash-pay patient flow
• You control your schedule — only pay when you see patients

Why this matters for narcolepsy specifically:

• Narcolepsy is rare (~1 in 2,000 people), so your local market is small
• Most narcolepsy patients are already looking for specialists willing to treat them
• Telehealth removes geographic barriers — your potential patient pool is the entire state (or multiple states if you’re multi-licensed)
• Patient acquisition cost is guaranteed and predictable, vs gambling thousands on marketing channels that may not convert

The math: Would you rather spend $4,000/month on marketing and hope to fill your schedule, or pay $X per qualified patient who books and shows up? For most providers, especially those starting out or scaling, the platform model removes all the risk.

Practical Compliance Checklist for Narcolepsy Teleprescribing

If you’re going to treat narcolepsy via telehealth, here’s what you actually need to do:

Federal Requirements (all states):

• [ ] Hold a valid DEA registration with Schedule II authority
• [ ] Use an e-prescribing system that meets DEA requirements (two-factor authentication, audit trail)
• [ ] Document a thorough clinical evaluation (history, mental status exam, review of diagnostic testing)
• [ ] Maintain standard of care equivalent to in-person treatment
• [ ] Monitor for abuse/diversion (review PDMP, track early refill requests)

State-Specific (check for your state):

• [ ] Licensed in the state where the patient is physically located during the telehealth visit
• [ ] Check state PDMP before prescribing (required in all six states covered here)
• [ ] Use video for initial controlled substance evaluation (required in TX; best practice everywhere)
• [ ] Obtain telehealth-specific informed consent if state requires
• [ ] Follow state-specific Schedule II limits (7 days in FL for NPs; 30 days in PA for NPs)
• [ ] Ensure NP collaborative agreement includes controlled substance authority (TX, PA, FL)

Narcolepsy-Specific Best Practices:

• [ ] Confirm diagnosis with sleep study results (MSLT showing mean sleep latency <8 min, ≥2 SOREMPs)
• [ ] Document prior treatments tried and failed (insurance often requires step therapy)
• [ ] Use validated screening tools (Epworth Sleepiness Scale, sleep logs)
• [ ] Monitor for medication misuse (stimulant diversion is real)
• [ ] Screen for and treat psychiatric comorbidities (depression in 30-50% of narcolepsy patients)
• [ ] Coordinate with local sleep specialists for complex cases (cataplexy, secondary narcolepsy)

For sodium oxybate (Xyrem/Xywav) prescribers:

• [ ] Enroll in the REMS program (FDA-mandated restricted distribution)
• [ ] Complete required prescriber training
• [ ] Counsel patients on serious risks (respiratory depression, CNS effects, abuse potential)
• [ ] Use central pharmacy designated by REMS program

What Happens When the DEA Rules Change?

Let’s game this out. The current telehealth waiver expires December 31, 2026. What’s likely to happen?

Scenario 1: DEA issues flexible permanent rules

• Allow telehealth initiation of Schedule II with some guardrails (maybe 30-day initial supply, required follow-up)
• Require in-person exam within 6-12 months for ongoing care
• Create special registration pathway for qualified telehealth prescribers
• Your move: Continue current practice with minor adjustments (schedule in-person follow-ups, or partner with local providers for annual visits)

Scenario 2: DEA reverts to strict Ryan Haight enforcement

• Require in-person exam before any Schedule II prescription via telehealth
• No grace period
• Your move: Pivot to hybrid model immediately — partner with local clinics/hospitals for initial exams; convert to ‘continuity of care’ telehealth only (you can’t start patients remotely, but you can continue existing patients if you saw them in-person at least once)

Scenario 3: DEA creates condition-specific exceptions (like buprenorphine)

• Narcolepsy added as an approved indication for telehealth stimulant prescribing (unlikely but possible)
• Your move: Business as usual

Most likely outcome: Something between Scenario 1 and Scenario 2. The DEA knows cutting off telehealth entirely would be politically and practically disastrous (millions of patients currently receiving care this way). Expect rules that allow telehealth prescribing with meaningful safeguards.

What you should do now:

1. Build relationships with local sleep centers and primary care clinics in states where you practice (easier to arrange in-person components if needed)
2. Track your patient outcomes rigorously (data showing safety and efficacy of telehealth narcolepsy care will inform future policy)
3. Join advocacy efforts (APA, AANP, telehealth coalitions) pushing for sensible permanent rules
4. Diversify your practice model — don’t rely 100% on pure telehealth if your entire patient panel is on Schedule II meds

Why Narcolepsy Care Needs More Providers (And Why You Should Consider It)

The gap between narcolepsy patient demand and available specialists is enormous:

The access problem:

• Estimated 200,000+ Americans have narcolepsy; only ~25% are diagnosed
• Average time from symptom onset to diagnosis: 10-15 years
• Shortage of sleep medicine specialists (most are in major metro areas)
• Long wait times for sleep clinic appointments (3-6 months typical)
• Many patients can’t take time off work for in-person daytime appointments

Why psychiatrists and PMHNPs are well-positioned:

• You already prescribe stimulants and understand their risks
• Narcolepsy patients often have psychiatric comorbidities you’re trained to treat
• Medication management is the cornerstone of narcolepsy treatment (not just sleep hygiene)
• Telehealth removes geographic barriers to specialized care

The patient quality difference:Narcolepsy patients, once diagnosed, are typically:

• Highly motivated to stay in treatment (medication dramatically improves quality of life)
• Lower no-show rates than many psychiatric populations
• Long-term patients (narcolepsy is lifelong)
• Often commercially insured or able to pay cash (higher reimbursement than Medicaid-heavy ADHD/depression panels)

Revenue potential:

• Initial evaluation: 60-90 minutes (CPT 99204/99205 + psychiatric diagnostic eval add-ons)
• Follow-ups: 20-30 minutes every 1-3 months for medication management
• Many patients need multiple medications (stimulant + nighttime med), increasing visit complexity/reimbursement
• Cash-pay rates for narcolepsy management: $200-400+ per visit

Compare that to the economics of acquiring ADHD patients through Google Ads (where you’re competing with every online ADHD mill) and the value proposition becomes clear.

Ready to Start Treating Narcolepsy Patients via Telehealth?

If you’re a psychiatrist or PMHNP looking to expand into narcolepsy care, here’s the smart path forward:

Step 1: Verify you’re legally compliant

• Confirm your state allows telehealth controlled substance prescribing (all six states covered here do, with FL restrictions)
• Ensure your DEA registration and state license are current
• If you’re an NP, verify your collaborative agreement includes Schedule II authority (if required in your state)

Step 2: Get educated on narcolepsy

• Review current treatment guidelines (American Academy of Sleep Medicine, Stanford Center for Narcolepsy)
• Understand diagnostic criteria (ICSD-3: excessive daytime sleepiness + MSLT findings)
• Learn medication options beyond stimulants (sodium oxybate, pitolisant, solriamfetol)

Step 3: Build your referral network

• Identify local sleep labs for diagnostic testing (or partner with national networks like Millennium Sleep Lab)
• Connect with neurologists/sleep specialists for complex cases
• Establish relationships for in-person exams if needed (depending on state/future rules)

Step 4: Join a platform that handles patient acquisitionInstead of spending thousands on marketing to attract a niche patient population, join Klarity Health’s provider network. You’ll get:

• Matched with pre-qualified narcolepsy patients already looking for treatment
• Guaranteed patients without upfront marketing costs
• Seamless telehealth platform with e-prescribing built in
• Support navigating state-by-state compliance
• Both insurance billing and cash-pay options

The alternative: Spend 6-12 months building SEO, burning thousands on Google Ads, listing on every directory, and hoping narcolepsy patients find you. Or pay a known fee per qualified patient and start seeing patients immediately.

Ready to expand your practice? Explore joining Klarity Health’s provider network and start connecting with narcolepsy patients who need your expertise.

FAQ: Narcolepsy Teleprescribing

Can I prescribe Adderall for narcolepsy via telehealth?

Currently, yes — under the DEA’s COVID-era telehealth waiver (extended through December 31, 2026). You can prescribe Schedule II stimulants like Adderall or Ritalin for narcolepsy via video visit without an in-person exam, as long as you’re licensed and DEA-registered in the patient’s state. Exception: Florida law prohibits Schedule II teleprescribing for narcolepsy (only allowed for psychiatric disorders), so you’d need at least one in-person visit there (www.leg.state.fl.us).

What happens in 2027 when the DEA waiver expires?

The DEA is expected to issue permanent telemedicine rules before the waiver expires. Likely scenarios: (1) telehealth prescribing allowed with some restrictions (e.g., shorter initial prescriptions, required follow-up), or (2) reversion to requiring an in-person exam under the Ryan Haight Act. Most experts expect a middle-ground approach given the political and practical realities of cutting off millions of patients from telehealth care.

Can PMHNPs treat narcolepsy independently?

Depends entirely on the state:

• New York, California (qualified NPs), Illinois (FPA-certified NPs): Yes, full independent practice including Schedule II prescribing
• Texas: No — NPs cannot prescribe Schedule II in outpatient settings at all
• Florida: Limited — NPs can only prescribe 7-day supply of Schedule II for narcolepsy (not a psychiatric disorder)
• Pennsylvania: Restricted — need physician collaboration; 30-day Schedule II limit

Do I need to see narcolepsy patients in person for sleep studies?

You don’t personally need to conduct the sleep study, but confirming a narcolepsy diagnosis typically requires polysomnography and Multiple Sleep Latency Testing — in-person diagnostic procedures. Most telehealth providers coordinate with local sleep labs or national networks. You can manage the medication part entirely via telehealth once the diagnosis is confirmed.

What’s the difference between modafinil and Adderall for narcolepsy teleprescribing?

Modafinil/armodafinil (Schedule IV): Fewer regulatory restrictions; can be prescribed via telehealth in all states including Florida. Lower abuse potential.

Adderall/stimulants (Schedule II): More heavily regulated; Florida prohibits teleprescribing for narcolepsy; Texas NPs can’t prescribe at all. Higher efficacy for some patients but more diversion risk.

Many telehealth providers start with modafinil to avoid state-level barriers, then transition to stimulants if needed (either via in-person visit or by coordinating with local prescriber).

How do I prescribe sodium oxybate (Xyrem) via telehealth?

Sodium oxybate is Schedule III with an FDA REMS (Risk Evaluation and Mitigation Strategy) program. You must:

1. Enroll in the REMS program as a certified prescriber
2. Complete required training on safe use
3. Prescribe through the central REMS pharmacy (Xyrem/Xywav have their own distribution systems)
4. Counsel patients on serious risks (respiratory depression, abuse potential)

Telehealth is allowed under current federal rules, but you’ll need to document thorough evaluation and ongoing monitoring. Some states may have additional requirements.

What are the PDMP requirements for narcolepsy medications?

All six states covered here (CA, TX, FL, NY, PA, IL) require checking the state prescription drug monitoring program before prescribing controlled substances. Specifics:

• California: Check CURES before first Schedule II-IV prescription, then every 4 months
• Texas: Check PDMP before each controlled substance prescription
• New York: Check I-STOP before every controlled substance prescription
• Florida: Mandatory check in E-FORCSE before prescribing
• Pennsylvania, Illinois: Check before prescribing; ongoing monitoring required

Failing to check the PDMP can result in state board discipline even if the DEA allows telehealth prescribing.

Top 5 Citations

1. HHS Press Release (January 2, 2026) – ‘HHS & DEA Announce Fourth Extension of Telemedicine Flexibilities for Controlled Medications Through December 31, 2026’ – Official announcement of current federal telehealth policy allowing controlled substance prescribing via telemedicine without in-person exam. www.hhs.gov

2. 21 U.S.C. §829(e) – Ryan Haight Online Pharmacy Consumer Protection Act (via Cornell Legal Information Institute) – Federal law defining in-person medical evaluation requirement for controlled substance prescribing via internet/telemedicine, with listed exceptions. www.law.cornell.edu

3. Florida Statutes §456.47 (2025) – Use of Telehealth to Provide Services – State law restricting Schedule II and III controlled substance prescribing via telehealth except for psychiatric disorders, inpatient care, hospice, or nursing home residents (excludes narcolepsy from telehealth stimulant prescribing). www.leg.state.fl.us

4. New York State Department of Health Final Rule (May 2025) – Controlled Substance Prescribing via Telemedicine – State regulations requiring in-person exam before controlled substance teleprescribing unless federal law exception applies; effectively aligns NY state law with DEA telemedicine policy. www.nixonpeabody.com

5. Texas Medical Board – APRN/PA Prescriptive Delegation FAQs – Official guidance clarifying that APRNs and PAs in Texas cannot prescribe Schedule II controlled substances outside hospital/hospice facility-based settings; outpatient Schedule II prescriptions must be written by physician. www.tmb.state.tx.us

Source:

• https://www.law.cornell.edu/definitions/uscode.php?defid=21-USC-1796173870-113781527&height=800&iframe=true&termoccur=999&term_src=title%3A21%3Achapter%3A13%3Asubchapter%3AI%3Apart%3AC%3Asection%3A831&width=840#:~:text=,that%20a%20prescription%20has%20been
• https://www.hhs.gov/press-room/dea-telemedicine-extension-2026.html#:~:text=announced%20a%20fourth%20temporary%20extension,while%20permanent%20rules%20are%20finalized
• https://www.dea.gov/documents/2024/2024-11/2024-11-15/dea-and-hhs-extend-telemedicine-flexibilities-through-2025#:~:text=promulgate%20a%20final%20set%20of,Medications%2C%E2%80%9D%20was%20submitted%20to%20the
• https://www.dea.gov/press-releases/2025/12/31/dea-extends-telemedicine-flexibilities-ensure-continued-access-care#:~:text=On%20January%2017%2C%202025%2C%20DEA,to%20as%20the%20%E2%80%9CTwo%20Final
• https://www.leg.state.fl.us/statutes/index.cfm?Appmode=DisplayStatute&URL=0400-0499%2F0456%2FSections%2F0456.47.html#:~:text=telehealth%20to%20provide%20health%20care,in%20Schedule%20II%20of%20s
• https://www.tmb.state.tx.us/page/facility-based-prescriptive-delegation#:~:text=at%20the%20hospital%E2%80%99s%20facility,from%20a%20qualified%20hospice%20provider
• https://www.cchpca.org/resources/state-telehealth-laws-and-reimbursement-policies-report-fall-2025/#:~:text=Texas%20regulations%20emphasize%20continuity%20of,Note
• https://www.nixonpeabody.com/insights/alerts/2025/06/18/new-york-state-finalizes-telemedicine-rule-for-controlled-substances#:~:text=match%20at%20L114%20The%20rule,and%20the%20US%20Department%20of
• https://www.nixonpeabody.com/insights/alerts/2025/06/18/new-york-state-finalizes-telemedicine-rule-for-controlled-substances#:~:text=In%20short%2C%20the%20exception%20permits,as%20a%20condition%20of%20state
• https://rxagent.co/blog/np-prescribing-authority#:~:text=Conversely%2C%20in%20Restricted%20Practice%20states,expand%20this%20scope%20%206