Telehealth regulation has emerged as a key focus for experts advocating reforms to enhance virtual care accessibility. Amid the COVID-19 pandemic’s peak, the proportion of U.S. office-based physicians adopting telemedicine—defined as patient consultations via audio or video—surged from 15.4 percent in 2019 to 86.5 percent in 2021. In 2020, digital health firms secured unprecedented investment, while healthcare networks nationwide introduced remote appointment options for patients. Post-pandemic, sustained consumer demand for virtual doctor visits spurred a rapid increase in the volume and diversity of online services offered.
Pandemic Flexibilities Face Regulatory Uncertainty
Despite its growth and popularity, the telehealth industry remains regulated by pandemic-era measures. In 2008, Congress passed a law mandating that patients receive an in-person evaluation before being prescribed controlled substances. In 2020, federal agencies waived this requirement for certain telemedicine prescriptions. During the same period, the Centers for Medicare and Medicaid Services loosened telehealth restrictions, allowing physicians to serve individuals regardless of geographic location and paying clinicians for virtual services at the same rate as in-person visits.
In the years following the pandemic, Congress repeatedly extended telehealth flexibilities rather than enact permanent legislation. In 2026, Congress again extended many of these policies through the end of 2027. With no unified federal framework in place, state legislators took on regulating virtual care, creating a patchwork system where costs and services vary from state to state. This regime has generated confusion among patients and has made it difficult for medical professionals to discern which restrictions apply to them and whether they can treat out-of-state patients.
Scholars Propose Divergent Reforms
Stacey A. Tovino of the University of Oklahoma College of Law highlights the instability of federal and state laws governing telemedicine prescriptions of buprenorphine, a drug used to treat opioid use disorder. A temporary federal rule allowed clinicians to prescribe buprenorphine without an in-person evaluation, but some states reversed their positions on in-person evaluations multiple times, giving prescribers less than one month to comply. Tovino argues that this instability harms patients, who must scramble to find in-person providers when agency positions change. She urges legislators to adopt laws that permanently extend pandemic-era telemedicine flexibilities.
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Prescription Rules Limit Addiction Treatment Access
Benjamin A. Barsky of the University of California College of the Law, San Francisco, points to the Ryan Haight Online Pharmacy Consumer Protection Act as limiting addiction treatment access for over 6 million people. Although temporarily exempted during the pandemic, the law requires in-person evaluations before prescribing controlled substances via telemedicine. Barsky finds that patients in states with additional in-person evaluation requirements were 22 percent less likely to start opioid addiction treatment via telemedicine than those in states without such requirements. He proposes allowing states to opt out of federal tele-prescription rules and creating a special registration pathway to shield clinicians from law enforcement actions.
Fazal Khan of Meharry Medical College argues that fragmented state medical licensing laws hinder telehealth’s ability to expand access to care. He advocates for federal legislation offering states additional Medicaid funding in exchange for recognizing out-of-state licenses, enabling providers to treat patients across state lines without extra credentials. He also urges states to expand the virtual services offered by nonphysician providers, such as nurse practitioners, based on their training, credentials, and ability to use emerging technologies. He believes these reforms could improve health care access while preserving state authority over in-person practices.
Ethan Blevins of the Pacific Legal Foundation takes a constitutional approach, arguing that state restrictions on telehealth violate patients’ First Amendment right to receive information from physicians. He contends that courts have overlooked these rights when upholding laws requiring out-of-state physicians to obtain additional licenses. Blevins proposes that states justify such restrictions under stricter constitutional standards and suggests less restrictive measures like disclosure requirements instead of outright prohibitions.
Fragmented Licensing Hinders Cross-State Care
Julie Ivanova and coauthors from the Journal of Medical Internet Research note that loosening restrictions during the pandemic allowed telehealth to grow in popularity. However, they argue the current fragmented regulatory approach makes it difficult for providers to deliver virtual care, as they must deal with both state and federal regulations and comply with the rules of the state where the patient is located. With Public Health Emergency rules expired, these compliance difficulties have grown more complex. The Ivanova team encourages legislators to create a generally applicable policy framework that protects patient privacy on video calls and simplifies compliance.
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Meighan Parker of the University of Georgia School of Law addresses the uneven distribution of physician shortages, noting that rural areas are more severely affected. She sees telehealth as a potential solution for bringing care to underserved regions but points out that licensing laws currently prevent physicians from serving out-of-state patients. Parker evaluated licensing waivers and cross-state endorsements, finding them insufficient to create meaningful change. Instead, she proposes federal legislation under the Full Faith and Credit Clause to require states to recognize out-of-state medical licenses.
Industry Expansion and Compliance Challenges
Following the pandemic, major pharmacies including Walgreens expanded their telehealth offerings, while many health care companies began providing expedited in-person services such as prescription filling to telehealth users. Patients have continued to seek faster ways to reach medical professionals, driving rapid expansion in the number and variety of services offered online.
Proposed Constitutional and Legislative Solutions
Blevins argues that courts should apply stricter constitutional scrutiny to state restrictions that prevent patients from receiving verbal medical advice tailored to their specific needs. He maintains that states could protect patients through less restrictive measures like disclosure requirements rather than outright prohibitions on consulting out-of-state physicians.