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Internet Prescribing Summary

Iowa, Minnesota, Nebraska, North Dakota, South Dakota and Wisconsin(July 2011)

Advancements in medicine and technology have transformed the way health care is delivered to patients. However, laws governing these interactions have not evolved at thesame pace, leaving many legal and regulatory questions unanswered in the area of Internetprescribing and telemedicine. To best analyze this issue, we must examine the laws thatgovern physicians’ prescriptive authority.

Pre-existing Physician-Patient RelationshipMany states require that a patient have a pre-existing relationship with their doctor beforethe physician is able to prescribe medication to a patient. This same requirement applies toprescribing through telemedicine. In most states, if the patient does not have a pre-existingphysician-patient relationship with the physician, the physician providing the telemedicinetreatment is required to examine the patient in-person. For the most part, this law onlyapplies to those states that do not allow for the examination to take place electronically.

Physical ExaminationIn order to prescribe medication to a patient, a physician is required to conduct a medicalexamination of that patient. This is a standard of care that is accepted by the medicalcommunity. Traditionally, before the onset of telemedicine, examinations took place inpersonwhere the practitioner physically examined the patient face-to-face. As medicine andtechnology advanced, physicians were presented with new tools, such as telemedicine, thatwould allow a practitioner to conduct that examination electronically.

Electronic ExaminationHowever, there are a handful of states that specifically allow telehealth practitioners toconduct medical examinations using telemedicine technologies. These states require that thepractitioner keep with the standard of care when conducting the electronic examination.According to those state medical boards that allow for electronic examinations, practitionersshould not prescribe medication to a patient unless they believe the electronic examinationmeets the standard of care within the medical community.

Electronic Medical QuestionnaireNo state allows for the prescribing of medication to be based solely on an online medicalquestionnaire. State medical boards adhere to the belief that prescribing based solely on anonline medical questionnaire does not keep with the accepted medical standard of care.

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Executive Summaries: Iowa, Minnesota, Nebraska, North Dakota, South Dakota and Wisconsin

The following information is a review of each state’s internet prescribing laws as they relateto the practice of telemedicine. This report provides “executive summaries” for each state’sprofile within the jurisdiction of the Great Plans Telehealth Resource and Assistance Center(GPTRAC) – Iowa, Minnesota, Nebraska, North Dakota, South Dakota and Wisconsin.

This report only contains the executive summaries for each state within the jurisdiction of theGPTRAC – for a full legal and regulatory profile of each state’s prescribing laws, includingsupporting statutory laws and administrative regulations, please visit CTeL’s Website(www.ctel.org) for more information on how to obtain a copy of the report Internet andTelemedicine Prescribing: Survey of Individual Policies and Regulations in the 50 States.

IowaThe Iowa Board of Medicine has not addressed the issue of internet prescribing. However,with the advent of telemedicine, the members are considering issuing a new policy statementon the issue. Iowa law does not allow medication to be prescribed based solely on an internetquestionnaire, internet consultation, or telephonic consultation when there is no priorphysician-patient relationship.

MinnesotaMinnesota Law states that a prescription for certain drugs is not valid if it is based solely onan online questionnaire unless it can be established that the prescription or order was basedon a documented patient evaluation to establish diagnosis and identify underlyingconditions and contraindications to treatment. Prescriptions are invalidated if theprescription is for certain categories of drugs, not including birth control.

NebraskaNebraska regulations do not allow physicians to prescribe medication to a patient without a physician-patient relationship, which must include an examination. Nebraska also does not allow physicians to prescribe medication solely based on patient-supplied answers to an online questionnaire.

North DakotaNorth Dakota law does not have specific provisions addressing prescriptions withoutphysical examinations. There are, however, some North Dakota Board of Examiner casesthat have disciplined physicians for providing inappropriate care to patients by prescribingdrugs for them over the Internet without adequate safeguards or information, or a physicalexamination. These cases focused on the volume of Internet prescribing.

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South DakotaSouth Dakota’s statute prohibits a physician from prescribing in a manner or in amountscalculated in the opinion of the board to endanger the well being of an individual patient orthe public in general. No further information was available from the South Dakota Board ofMedical and Osteopathic Examiners clarifying the meaning of §36-4-30(9). However,according to the South Dakota Board of Pharmacy, a physician is permitted to conduct anexamination electronically (remotely) and prescribe as a result of that examination as long(this process/procedure has been approved by the SD Board of Medical and OsteopathicExaminers) as the physician is keeping with the standard of care.

WisconsinWisconsin law is silent on the matter of internet prescribing. The Medical Examining Boarddoes not have a policy on the matter, but does consider questions of telehealth on anindividual basis, and applies the same standards applicable to the traditional face-to-facepractice of medicine.

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50 State Internet Prescribing Overview

34 states/territory require that you have either pre-existing physician-patient relationshipor received an in-person “touch” physical examination before the prescribing ofmedication. These states include:

AlabamaAlaskaArizonaArkansasColoradoDelawareFloridaGeorgiaIndianaIowaKentuckyMaine

MassachusettsMichiganMinnesotaMississippiMissouriNebraskaNew HampshireNew JerseyNew YorkNorth DakotaOhioOklahoma

OregonPennsylvaniaRhode IslandSouth CarolinaTennesseeUtahWashingtonWest VirginiaWyomingPuerto Rico

12 states allow for physical examinations to take place electronically, as long as theexamination upholds the medical standard of care within the community. These statesinclude:

CaliforniaHawaiiKansasLouisiana

MarylandNevadaNew MexicoNorth Carolina

South DakotaTexasVermontVirginia

5 states and the District of Columbia are silent on the issue of prescribing. These statesinclude:

ConnecticutIdaho

IllinoisMontana

WisconsinWashington, D.C

30 states forbid prescribing based solely on a medical electronic questionnaire. Thesestates include:

AlabamaAlaskaArizonaArkansasColoradoDelawareFloridaHawaiiIdahoIndiana

IowaKentuckyLouisianaMaineMarylandMichiganMississippiNebraskaNew MexicoNew York

North CarolinaNorth DakotaOklahomaOregonSouth CarolinaTennesseeTexasUtahVermontWashington

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Contact Information

The Center for Telehealth & e-Health LawP.O. Box 15850 Washington DC 20003202.499.6970www.ctel.org | info@ctel.org

DisclaimerInformation contained in this summary report is current up to the date listed on the report. Note that the information is subject to change following action taken by a state’s legislature, state agencies, state medical boards, or other applicable state government agency or body. CTeL will make every effort to provide the most current information.

CTeL cautions the reader that the verbal information supplied within the Executive Summaries and table have not been codified in state statues, administrative regulations, or state medical board official policies. Practitioners should verify all such information with their respective state medical boards.