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VA · STATE RULES

Telehealth rules in Virginia

Virginia writes its telemedicine rules into the drug law rather than into a telehealth act, and that choice shapes everything downstream. A sixth schedule sweeps ordinary prescription medicines into the controlled-substance statute, so the conditions on remote prescribing apply to a skin or hair product as squarely as to a scheduled one. Physicians also stand outside the interstate licensing compact that every bordering state has joined.

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Rules checked September 2026 · 20 sources cited

ONLY IN VIRGINIA

What is different about Virginia

Each rule here is true of Virginia and of none of the states that border it. Beside each one: what the neighbours do instead.

  1. 01 · Prescribing

    A sixth schedule covers ordinary medicines

    The Drug Control Act adds a schedule the federal list does not have. Schedule VI takes in drugs and devices outside Schedules I through V that federal law requires to carry prescription-only labeling, together with those not recognized as safe except under a practitioner's supervision. Since the prescribing statute speaks to Schedule II through VI as one group, the remote prescribing conditions land on a non-scheduled medicine exactly as they land on a scheduled one.

    Source: Va. Code 54.1-3455

    Across the border

    • Maryland

      Its drug law stops at the fifth schedule, so the telehealth prescribing section splits the world into controlled dangerous substances and everything else.

      Source: Md. Health Occ. 1-1003

    • West Virginia

      Nothing beyond the federal five appears in its controlled substances act, and the distinctive pressure on a remote prescriber comes from how the relationship was opened.

      Source: W. Va. Code 30-3-13a

    • Kentucky

      Drug classification tracks the federal schedules there, leaving the quality of the evaluation, rather than the breadth of the schedule list, to do the regulating.

      Source: KRS 311.597

    • Tennessee

      Its narrowing is aimed at one molecule instead of at a whole schedule: buprenorphine may be prescribed by telehealth only through the treatment entities the statute names.

      Source: T.C.A. 63-1-155

    • North Carolina

      Reporting duties there fasten onto a defined set of targeted controlled substances rather than onto prescription drugs as a whole class.

      Source: N.C.G.S. 90-113.74C

  2. 02 · First visit

    A checklist stands in for a camera

    No provision here names a technology for a first visit. Instead the prescribing statute sets out the conditions a practitioner meets to form a bona fide relationship through telemedicine: a medical history the prescriber can review, an updated history taken at the time of prescribing, an appropriate examination, a diagnosis reached then, care matching the standard expected in person, an active license carrying prescriptive authority, timely release of the patient's records, and consistency with federal law.

    Source: Va. Code 54.1-3303

    Across the border

    • Maryland

      Its statute is far shorter at this point, naming identity verification, a disclosure of the practitioner's own credentials and consent as the three steps to a relationship.

      Source: Md. Health Occ. 1-1002

    • West Virginia

      Technology is precisely what its statute regulates, listing the live modes that may open a case and shutting out every written channel by name.

      Source: W. Va. Code 30-3-13a

    • Kentucky

      One item does the work there: a questionnaire is declared inadequate for an initial evaluation and for any follow-up, and professional judgment covers the rest.

      Source: KRS 311.597

    • Tennessee

      The limit arrives there as a sanction rather than as a set of preconditions, since prescribing without an appropriate history or examination is grounds for discipline.

      Source: Center for Connected Health Policy: Tennessee

    • North Carolina

      Guidance from its medical board carries the weight instead of a statute, and it warns that a fixed online questionnaire on its own will not support a prescription.

      Source: Center for Connected Health Policy: North Carolina

  3. 03 · Prescribing

    An address here or a referral here

    One further condition attaches to the scheduled drugs. Before a Schedule II through V medicine may be prescribed by telemedicine, the prescriber either keeps a practice at a physical location in the Commonwealth or is able to refer the patient to a practitioner licensed here for an in-person examination when the standard of care calls for one. The test is about reach into the state rather than about the drug itself.

    Source: Va. Code 54.1-3303(B)

    Across the border

    • Maryland

      Its closed lane is much narrower, covering a Schedule II opiate written for pain, and three listed situations reopen even that one.

      Source: Md. Health Occ. 1-1003

    • West Virginia

      The bar there is fixed to the patient's own history, closing Schedule II to anyone whose treatment has run entirely through telemedicine.

      Source: W. Va. Code 30-3-13a

    • Kentucky

      Geography plays no part in its rule, which turns instead on whether the evaluation behind a prescription was genuine or merely a form.

      Source: KRS 311.597

    • Tennessee

      Its statute picks out a treatment setting rather than a prescriber address, routing telehealth buprenorphine through licensed entities named in the law.

      Source: T.C.A. 63-1-155

    • North Carolina

      No statute there blocks a controlled prescription written over video, and the controls that do apply are an electronic transmission duty and a database query.

      Source: N.C.G.S. 90-113.74C

  4. 04 · Licenses

    Doctors have no compact to use

    Licensure compacts here run wide and stop short of physicians. Nurses, psychologists, physician assistants, counselors, occupational therapists, physical therapists, social workers, dentists and emergency medical personnel all have a multistate route, and doctors do not. A physician treating someone located here therefore applies to the Board of Medicine in the ordinary way, and the prescribing statute makes that active license one of the conditions for prescribing by telemedicine.

    Source: Center for Connected Health Policy: Virginia

    Across the border

PRACTICE RULES

How telehealth works in Virginia

There is no separate telehealth practice act to read. The operative provisions live in the Drug Control Act and in the Board of Medicine's unprofessional conduct statute, which is why so much of the compliance work here reads as prescribing law.

  1. 01

    The relationship comes before the prescription

    A prescription for a Schedule II through VI drug may be issued only to a person with whom the practitioner has a bona fide practitioner-patient relationship. Because the sixth schedule captures ordinary prescription medicines, that requirement covers a brand's entire catalog rather than its controlled products alone.

    Source: Va. Code 54.1-3303

  2. 02

    Licensed here and able to prescribe

    Among the statutory conditions is that the prescriber be actively licensed in the Commonwealth and authorized to prescribe. A license held next door does not travel, and there is no separate telehealth credential that would substitute for it.

    Source: Va. Code 54.1-3303

  3. 03

    Records go out on time

    The conditions include providing the patient's records in a timely manner in line with state and federal law, so a brand's records request path is part of the prescribing test rather than a separate service promise.

    Source: Va. Code 54.1-3303

  4. 04

    Plan credentialing where it applies

    Where a health plan is involved, the statute expects the practitioner to have met that plan's credentialing requirements before prescribing through telemedicine, which matters to a brand adding insurance billing on top of a cash-pay program.

    Source: Va. Code 54.1-3303

FIRST VISIT

Can a first visit happen without a live call in Virginia?

Yes, with conditions

Yes, within limits. No technology is mandated for a first encounter, so a store and forward review can work, but every condition in the prescribing statute has to be satisfied first. For a scheduled drug the prescriber also needs a practice location here or a usable referral to one.

The question is answered by a list rather than by a modality rule, which gives a brand room to design intake and at the same time gives a regulator eight or nine separate places to find a gap.

  1. 01

    Two histories, not one

    The conditions separate the history the prescriber can review from the updated history taken at the moment of prescribing. An intake form completed weeks earlier does not satisfy both, so a refresh step belongs in the flow before any prescription is issued.

    Source: Va. Code 54.1-3303

  2. 02

    An examination suited to the complaint

    An appropriate examination of the patient is required, and the statute does not say it must happen in a room. What makes it appropriate is the standard of care for that condition, which is where photographs, measurements and laboratory results earn their place in the record.

    Source: Va. Code 54.1-3303

  3. 03

    The diagnosis is made at the time

    A diagnosis has to be reached at the point of prescribing rather than inferred from the product a patient selected. A flow that lets a patient choose a medicine first and collects clinical detail afterwards inverts the order the statute expects.

    Source: Va. Code 54.1-3303

  4. 04

    Treat audio-only as a follow-up tool

    Voice-only contact is recognized in coverage policy and billed with its own modifier, but it is a thin foundation for an opening encounter where the standard of care expects to see the patient. Counsel should review any design that opens a case by telephone alone.

    Source: Center for Connected Health Policy: Virginia

PRESCRIBING

Prescriptions and controlled drugs in Virginia

Three layers stack here: the sixth schedule that widens what counts as a controlled substance, the in-state anchor for Schedules II through V, and the Board of Medicine's own rules on opioids and the monitoring program.

  1. 01

    The anchor for scheduled drugs

    A practice at a physical location in the Commonwealth, or the ability to refer the patient to a practitioner licensed here for an in-person examination, is the gate on remote prescribing of a Schedule II through V medicine. A named referral partner is the practical way a remote-only brand meets it.

    Source: Va. Code 54.1-3303(B)

  2. 02

    Non-scheduled does not mean unregulated

    Because the sixth schedule captures drugs that carry prescription-only labeling, the bona fide relationship test reaches a hair, skin or weight medicine that no federal schedule touches. A brand cannot treat its non-controlled catalog as lightly governed here.

    Source: Va. Code 54.1-3455

  3. 03

    Opioid quantity for short-term pain

    Board of Medicine rules hold a prescription for acute or subacute pain, including pain following a surgical procedure, to no more than fourteen days unless the record documents why a longer course was necessary.

    Source: 18VAC85-21-40

  4. 04

    The monitoring program and long courses

    A prescriber starting a new opioid course expected at the outset to run more than seven consecutive days requests the patient's monitoring program history first, with exemptions for hospice, inpatient care, sickle cell pain and a system outage.

    Source: Va. Code 54.1-2522.1

Federal rules apply on top of every state's. Prescribing controlled substances by telehealth without an in-person visit runs on DEA flexibilities currently extended through December 31, 2026, with a permanent rule still pending.

LICENSES

Who can treat patients in Virginia

Every clinician treating a patient located here holds a credential issued by the relevant board within the Department of Health Professions. For most professions a compact shortens that road. For doctors it does not.

  1. 01

    One application, one board

    A physician applies to the Board of Medicine and waits out an ordinary review, which is a material difference in launch timing for a brand that expects compact letters of qualification to cover a multistate rollout.

    Source: Center for Connected Health Policy: Virginia

  2. 02

    The compacts that do exist

    Nurses, psychologists, physician assistants, counselors, social workers, dentists, occupational therapists and physical therapists all have multistate routes here, so a brand staffing those roles moves faster than one staffing physicians.

    Source: Center for Connected Health Policy: Virginia

  3. 03

    Nurse practitioners join a care team

    A nurse practitioner maintains collaboration and consultation with at least one patient care team physician under a written or electronic practice agreement, which covers periodic health record review, ongoing communication and joint evaluation of the services delivered.

    Source: Va. Code 54.1-2957

  4. 04

    Autonomy after enough clinical time

    A nurse practitioner who has the equivalent of at least three years of full-time clinical experience may apply to practice without the agreement, supported by an attestation describing the qualifying practice relationship and its duration.

    Source: Va. Code 54.1-2957

How Tessic Health's providers are licensed in Virginia

ADVERTISING

Marketing to patients in Virginia

Marketing here is policed from three directions at once: the unprofessional conduct statute, the consumer protection act, and a consumer data act that gates the sensitive categories behind consent.

  1. 01

    Do not claim to be better

    Publishing an advertisement about a professional practice that contains a claim of superiority, or that breaches the board's advertising regulations, is listed as unprofessional conduct. Comparative language in growth copy is therefore a licensing exposure and not only a marketing choice.

    Source: Va. Code 54.1-2915

  2. 02

    Prescribing for the wrong reason

    Prescribing or dispensing a controlled substance with the intent or knowledge that it will be used other than medicinally is its own ground for discipline, which is the provision behind any scrutiny of volume-driven prescribing in a subscription program.

    Source: Va. Code 54.1-2915

  3. 03

    Damages under the consumer act

    A person injured by a prohibited practice may recover actual damages or a fixed statutory sum, and the award rises to three times actual damages only where the violation was willful, so intent governs the size of the exposure.

    Source: Va. Code 59.1-204

  4. 04

    Sensitive data needs permission

    The consumer data protection act requires a controller to obtain consent before processing sensitive data, which covers information revealing a physical or mental health diagnosis. Consent language therefore belongs in the intake flow rather than buried in a policy page.

    Source: Va. Code 59.1-578

TESSIC HEALTH IN VIRGINIA

How Tessic Health's providers cover Virginia

Because the sixth schedule pulls the whole catalog inside the prescribing statute, the product applies the same relationship checks to a non-scheduled medicine here that it applies to a scheduled one elsewhere.

  1. 01

    The checklist runs on every order

    Each encounter with a patient located here records the reviewed history, the updated history, the examination, the diagnosis and the prescriber's license status, because all of those are conditions rather than good practice.

  2. 02

    A referral partner before a scheduled drug

    No Schedule II through V medicine is written for a patient here until a route to an in-person examination with a locally licensed practitioner is in place and recorded against the patient's chart.

  3. 03

    Licenses are held, not borrowed

    Clinicians serving patients here hold the credential the relevant board issued, since no compact letter reaches physicians and no remote-only permission exists. Tessic Health's providers are licensed across all fifty states.

  4. 04

    A live look before a first prescription

    Telephone-only contact is kept for follow-up conversations, and a first encounter carries either live video or photographic and laboratory evidence sufficient for the examination the statute expects.

  5. 05

    Getting the medicine to the patient

    Dispensing for patients located here runs through pharmacies cleared to ship into the Commonwealth, the medication carries no markup, and refrigerated products travel under cold chain.

COMMON QUESTIONS

Questions about telehealth in Virginia

  • It can, because no statute names a required technology. What has to be satisfied is the full list of prescribing conditions, including an appropriate examination and a diagnosis made at the time. A design that skips either of those will not hold.

  • A sixth schedule sweeps in drugs and devices that federal law requires to carry prescription-only labeling. The prescribing statute addresses Schedule II through VI together, so the relationship test applies to a non-scheduled product as well.

  • Either a practice at a physical location in the state, or the ability to refer the patient to a locally licensed practitioner for an in-person examination when the standard of care requires one. A remote-only brand usually meets this with a named referral partner.

  • No. Compacts cover nurses, psychologists, physician assistants, counselors, therapists, social workers and others, but physicians are outside them. A doctor applies to the Board of Medicine and waits out the standard review.

  • Not at first. A nurse practitioner collaborates with at least one patient care team physician under a written or electronic practice agreement. After the equivalent of three years of full-time clinical experience, an application to practice without that agreement becomes possible.

  • A claim of superiority in an advertisement about a professional practice is expressly listed as unprofessional conduct, alongside advertising that breaches board regulations. Comparative and best-in-class phrasing is the most common problem in growth copy.

SOURCES

Rules checked September 2026 · 20 sources cited. A planning summary, not legal advice. Statutes, board rules and enforcement priorities change; a brand's own counsel should review its model and marketing before launch.

OTHER STATES

Rules in other states

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