Ryan Haight Act & In-Person Care Requirements
Last updated: October 2025
Applies to: All prescribing providers at Tulsa Family Psychiatry & Wellness
Overview
Federal and state law govern when an in-person visit is required before prescribing controlled substances (Schedules II–V).
Tulsa Family Psychiatry & Wellness (TFPW) continues to initiate care in person whenever possible. This remains the safest and most compliant approach under current DEA and Oklahoma Board of Medical Licensure standards.
Federal (DEA/HHS) Status
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The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 generally requires an in-person medical evaluation before prescribing any controlled substance via telemedicine.
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Temporary flexibilities created during the COVID-19 PHE have been extended through December 31, 2025.
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These allow Schedule II–V prescriptions to be issued via telemedicine without a prior in-person exam if certain conditions are met (real-time audio-video connection, legitimate medical purpose, within prescriber’s DEA registration, etc.).
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DEA and HHS are developing a permanent “special registration” rule, which will define long-term telemedicine prescribing authority after the current extension ends.
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No new federal in-person requirement takes effect before December 31, 2025.
Oklahoma State Requirements
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Oklahoma law allows telemedicine but prohibits establishing a physician–patient relationship solely via telehealth when the purpose is prescribing:
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Opiates, synthetic opiates, semisynthetic opiates, benzodiazepines, or carisoprodol, except when used for medication-assisted treatment (MAT) or detoxification.
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Once an initial in-person evaluation has occurred, refills or follow-ups may be managed via telehealth if clinically appropriate.
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Oklahoma does not set a fixed interval for repeat in-person visits; this is left to provider discretion, guided by standard of care and risk assessment.
Practice Application (TFPW)
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New patients: Continue the standard of initial in-person evaluation before prescribing any controlled medication.
- Follow-up interval: TFPW’s clinical standard is to conduct an in-person follow-up at least every 180 days (twice per year) for any patient prescribed a controlled substance, unless clinical circumstances require a shorter interval.
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Existing telehealth-only patients who established during the PHE should be scheduled for at least one in-person follow-up visit prior to long-term controlled medication continuation.
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Refills: May be handled via telehealth when clinically appropriate, with PDMP checks and documentation of ongoing therapeutic relationship.
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Documentation: Each controlled-substance visit must note the evaluation type (in-person vs telehealth), PDMP verification (when applicable), and clinical justification.
Prescription Drug Monitoring Program (PDMP) Check Frequency
| Authority / Source | Mandatory Frequency | What This Means for TFPW |
|---|---|---|
| Oklahoma State Law (63 O.S. § 2-309D; OBNDD Guidance) | PDMP must be checked before prescribing and at least every 180 days for opiates, benzodiazepines, or carisoprodol when continuing therapy. | For high-risk medications: verify PDMP data prior to initial prescription and at least every six months thereafter if therapy continues. |
| Federal / National (DEA / CDC / HHS) | No federally mandated interval. States set their own PDMP check requirements. | Compliance is determined by state law; Oklahoma’s 180-day standard is the controlling minimum. |
| Best Practice Standard (TFPW Policy) | Check PDMP at every new controlled-substance prescription and each renewal or refill, or at least every 90–180 days for ongoing therapy. Increase frequency if risk factors are present (multiple prescribers, early refills, dose escalation). | TFPW adopts a conservative standard—PDMP review at each prescribing encounter is strongly recommended to ensure patient safety and regulatory compliance |
TL;DR Summary Table
| Level | Rule / Authority | Key Requirement | Status (2025) | Effect for TFPW |
|---|---|---|---|---|
| Federal (DEA) | Ryan Haight Act (2008) | In-person exam required before online prescribing of CS | Temporarily waived through 12/31/25 under DEA/HHS extension | Continue in-person initiation; telehealth prescribing permitted under current flexibilities |
| Federal (Proposed) | DEA “Special Registration” Rule | Would allow long-term telemedicine prescribing with additional safeguards | Not yet final (as of Oct 2025) | Monitor for rulemaking updates; expect permanent standards in 2026 |
| State (Oklahoma) | 59 O.S. § 478.1 and Oklahoma Board Rule 510:5-7-1 | Cannot establish care via telehealth for prescribing opiates, benzos, carisoprodol (except MAT); renewals OK after in-person initiation | Active | Initial in-person required for C2–C4 opioids/benzos; telehealth renewals allowed |
| Practice (TFPW) | Internal Policy | All new controlled-substance patients must be seen in person before telehealth management | Active / recommended best practice | Fully aligned with federal and state requirements |
Staff FAQs – Ryan Haight & In-Person Care
Q1. What about patients who established care via telehealth during the COVID-19 emergency?
Some patients established care under the federal telehealth flexibilities that began in 2020. These patients may have been started on controlled medications without an in-person visit.
→ Action: Providers should ensure that any such patient has had at least one in-person visit before ongoing or indefinite continuation of controlled medications. This can occur at the next appropriate follow-up or renewal interval. Document that the in-person visit occurred and that it served to fulfill Ryan Haight compliance.
Q2. Can I prescribe controlled medications via telehealth for a new patient today?
Yes, temporarily—if all current DEA telemedicine conditions are met and the medication is clinically appropriate.
→ However, Tulsa Family Psychiatry & Wellness policy requires an initial in-person evaluation before initiating controlled medications (CII–CV). This ensures full compliance with both Oklahoma law and anticipated DEA rules.
Q3. How often must patients be seen in person once established?
There is no federal or state-defined interval (e.g., every 3 or 6 months). Frequency of in-person visits should be determined based on:
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Risk category of the medication (e.g., CII vs. CIV)
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Clinical stability of the patient
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Provider judgment and best practice
As a general standard, controlled-substance patients should be reassessed in person at least every 6 months or sooner if clinically indicated.
Q4. What happens after December 31, 2025?
The DEA and HHS are developing a permanent “special registration” rule to govern telemedicine prescribing. Until that is finalized, the current flexibilities remain active.
→ TFPW will review and update internal policy when the final rule is published to ensure seamless compliance and provider guidance.
Q5. Does this affect non-controlled prescriptions?
No. The Ryan Haight Act and related DEA rules apply only to controlled substances (Schedules II–V). Non-controlled medications are unaffected and can continue to be prescribed via telehealth as clinically appropriate.
References
Online Prescribing of Controlled Substances – Psychiatry.org
H.R.6353 – Ryan Haight Online Pharmacy Consumer Protection Act of 2008