What do I need to qualify for Topamax?

Understanding Your Medication Access Options in 2026

Binge eating disorder (BED) affects millions of Americans, but accessing treatment can be challenging. For many patients, telehealth has emerged as a convenient option to connect with providers and receive appropriate medication. But questions remain: Is it legal to get BED medications like Topamax (topiramate) or Wellbutrin (bupropion) via telehealth? Do you need an in-person visit first? What rules apply in your state?

This comprehensive guide answers these questions, giving you clarity on your treatment options based on the latest 2025-2026 regulations.

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The Current State of Telehealth Prescribing for BED

The good news is that both Topamax and Wellbutrin can legally be prescribed via telehealth nationwide. Unlike controlled substances (such as Vyvanse, which is FDA-approved for BED but more strictly regulated), these medications are classified as ‘non-controlled’ or ‘legend’ drugs, giving them a significant advantage for telehealth accessibility.

‘Non-controlled medications are not subject to the DEA’s Ryan Haight Act restrictions,’ explains Dr. Sarah Jenkins, a psychiatrist at Klarity Health who specializes in eating disorders. ‘This means patients can access these medications through a completely virtual process in all 50 states, as long as the provider is licensed in the patient’s state and follows standard care guidelines.’

Key Facts About Telehealth for BED Medications

• No federal in-person requirement exists for non-controlled medications like Topamax and Wellbutrin
• Most states allow fully remote prescribing for these medications
• Providers must be licensed in your state and conduct a proper evaluation
• These medications are used ‘off-label’ for BED (approved for other conditions but clinically supported for BED)
• Unlike stimulants, they face fewer regulatory barriers to telehealth access

State-by-State Policies: What to Know

While federal law permits telehealth prescribing of non-controlled medications, some state regulations add nuance. Here’s what to know about key states:

States with No In-Person Requirement

Most states, including California, New York, Delaware, Florida, Michigan, Texas, and Wisconsin, have no requirement for an in-person visit before or during treatment with non-controlled medications via telehealth. California’s telehealth laws specifically state that a good-faith examination can be conducted entirely via telehealth, including asynchronous methods in some cases.

States with Periodic In-Person Requirements

A few states maintain requirements for periodic in-person follow-ups when treatment continues long-term:

• Alabama: Requires an in-person visit if you have more than 4 telehealth visits for the same condition within 12 months
• Georgia: Requires an annual in-person evaluation for ongoing telehealth treatment
• New Hampshire: While telehealth is permitted for initial prescription, an in-person exam is required at least once every 12 months for continued care

Even in these states, the initial evaluation and prescription can typically be done completely via telehealth, and the follow-up requirement can often be satisfied by any collaborating provider in the practice.

Who Can Prescribe BED Medications via Telehealth?

The authority to prescribe these medications varies by provider type and state:

Medical Doctors (MDs) and Doctors of Osteopathic Medicine (DOs)

These providers can prescribe Topamax and Wellbutrin in all 50 states via telehealth.

Nurse Practitioners (NPs) and Physician Assistants (PAs)

• In approximately 34 states plus DC, NPs have full practice authority, meaning they can independently prescribe these medications without physician oversight
• Recent additions to full-practice states include Michigan and Wisconsin (2025), Louisiana and Kansas (2024)
• In collaborative states like Florida, Georgia, and Texas, NPs/PAs can still prescribe these medications under a formal agreement with a physician

‘The expansion of nurse practitioner prescribing authority has been transformative for telehealth access,’ notes Dr. Jenkins. ‘At Klarity Health, we’ve seen how this allows patients in underserved areas to connect with qualified providers who can prescribe appropriate medications for BED, often eliminating months-long wait times for specialist appointments.’

What to Expect During a Telehealth Evaluation for BED

A legitimate telehealth evaluation for BED medication should be thorough and similar to an in-person visit. Here’s what to expect:

1. Identity and Location Verification

The provider will verify your identity and confirm you’re physically located in a state where they’re licensed to practice.

2. Detailed Clinical Assessment

• Discussion of your eating behaviors, including frequency and characteristics of binge episodes
• Review of DSM-5 diagnostic criteria for BED (eating large amounts in a short time, feeling out of control, etc.)
• Evaluation of your medical history, current medications, and potential contraindications
• Assessment for co-occurring conditions like depression or anxiety

3. Discussion of Treatment Options

The provider should discuss various treatment approaches, including:

• Medication options (risks, benefits, side effects)
• Psychotherapy (particularly CBT, which is first-line for BED)
• Lifestyle modifications and nutritional guidance
• Follow-up schedule and monitoring plan

4. Informed Consent and Documentation

You’ll provide consent for telehealth treatment and medication use, acknowledging that these medications are used off-label for BED.

Medication-Specific Considerations

Topamax (Topiramate)

• Original approval: Seizures, migraine prevention
• BED mechanism: May reduce impulsivity and appetite
• Dosing: Usually started at a low dose (25mg) and gradually increased
• Monitoring: Regular assessment of weight, cognitive side effects, and metabolic parameters
• Special considerations: Not recommended during pregnancy due to risk of birth defects

Wellbutrin (Bupropion)

• Original approval: Depression, smoking cessation
• BED mechanism: May reduce food cravings and improve mood regulation
• Contraindications: History of seizures, eating disorders with purging behaviors (anorexia/bulimia)
• Warning: Carries black box warning about increased suicidal thoughts in young adults
• Monitoring: Mood changes, blood pressure, and potential interactions with other medications

Who Might Not Be Eligible for Telehealth BED Treatment?

While telehealth offers convenient access, not everyone is an appropriate candidate. Telehealth providers should screen for conditions that might require in-person care:

• History of anorexia or bulimia (contraindication for Wellbutrin)
• Uncontrolled epilepsy or seizure disorders
• Pregnancy or planning pregnancy (especially for Topamax)
• Severe medical instability related to obesity complications
• Need for controlled medications (might require in-person visits)
• Complex psychiatric comorbidities requiring more intensive monitoring

Ensuring Quality and Safety in Telehealth

With the telehealth industry growth, ensuring quality care has become a priority. Reputable telehealth providers implement strict protocols:

• Thorough medical history collection
• Verification of identity and location
• Comprehensive diagnostic assessment
• Clear explanation of risks and benefits
• Regular follow-up appointments
• Electronic prescribing to licensed pharmacies
• Secure, HIPAA-compliant platforms

‘At Klarity Health, we follow the same standard of care for telehealth patients as we would for in-office visits,’ explains Dr. Jenkins. ‘Our providers conduct thorough evaluations, create personalized treatment plans, and schedule regular follow-ups to monitor progress and adjust treatment as needed.’

Red Flags to Watch For

Be wary of telehealth services that:

• Promise prescriptions before proper evaluation
• Skip discussing non-medication treatment options
• Conduct extremely brief appointments (under 10 minutes)
• Ship medications directly rather than sending prescriptions to pharmacies
• Don’t verify your identity or ask about your medical history
• Don’t discuss potential risks or side effects

Recent Regulatory Developments (2025-2026)

The telehealth landscape continues to evolve:

• In late 2025, the DEA extended pandemic-era flexibilities for telehealth controlled-substance prescribing through December 2026
• Several states expanded nurse practitioner autonomy, increasing access to care
• New York implemented rules requiring in-person visits for controlled substances (but not affecting non-controlled medications like Topamax or Wellbutrin)
• New Hampshire removed telehealth barriers for certain medications while maintaining annual in-person follow-up requirements

These developments generally maintain or expand telehealth access for non-controlled medications used in BED treatment.

The Future

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