Key points
- Federal law sorts some medicines into controlled substance schedules, and those medicines carry extra rules for prescribing by telehealth.
- For any medicine, the prescriber must be licensed where you are and must judge that the medicine is appropriate for you.
- As of October 2026, a temporary federal rule allows Schedule II to V prescribing by audio-video telemedicine without a prior in-person evaluation, through December 31, 2026, if conditions are met.
- State law, insurance coverage and each prescriber's own judgment still apply, and the federal rules may change after that date.
- No rule entitles anyone to a particular prescription: a video visit may or may not end with one.
Two groups of medicines, two sets of rules
When people ask what an online psychiatrist can prescribe, the honest answer starts with a split. Some medicines are controlled substances under federal law. Many others are not. The two groups follow different rules when the visit happens by video.
Federal regulations list controlled substances in five schedules, numbered I to V. Each schedule names the substances that belong to it. Schedule II, for example, includes several stimulants. The National Institute of Mental Health (NIMH) says health care providers may prescribe stimulant medications to treat ADHD.
Not every mental health medicine appears on those lists. If you are not sure which group a medicine you take belongs to, a prescriber or pharmacist can tell you.
Medicines that are not controlled
NIMH notes that, depending on your insurance and the type of provider you see, care you can receive virtually includes a mental health assessment, a diagnosis, a treatment plan and a prescription for medication.
State licensing rules still matter. Pennsylvania's Department of State says licensed health professionals can provide services within their existing scope of practice by telemedicine when appropriate, according to accepted standards of care. It also says a practitioner must be licensed in Pennsylvania to provide services to people in Pennsylvania, whether in person or by telehealth.
So for a non-controlled medicine, the main questions are practical: is the prescriber licensed where you are, and do they believe the medicine is right for you after a full conversation about your health?
Controlled substances and the in-person rule
Controlled substances start from a stricter baseline, set by the Ryan Haight Online Pharmacy Consumer Protection Act of 2008. Its default is that remote prescribing of these medicines requires the prescriber to have evaluated the patient in person at least once, apart from a short list of exceptions.
In 2020, the Drug Enforcement Administration (DEA) relaxed that requirement for the pandemic. These temporary exceptions became known as the telemedicine flexibilities, and DEA and the Department of Health and Human Services have renewed them together more than once.
Even under the flexibilities, conditions apply. According to the current rule, the prescription must be for a legitimate medical purpose, issued in the usual course of professional practice, through a live interactive connection with the patient, by a practitioner registered with the DEA for that class of medicine.
Where the federal rule stands, as of October 2026
The current version is the Fourth Temporary Extension, published in the Federal Register on December 31, 2025. It is effective from January 1, 2026 through December 31, 2026. During that period, a DEA-registered practitioner may prescribe Schedule II to V controlled substances by telemedicine without having conducted an in-person medical evaluation, if all of the rule's conditions are met.
The rule describes these visits as audio-video telemedicine encounters. It also explains that DEA published a proposal in January 2025 for a special registration for telemedicine, and that the extension gives DEA more time to finalize permanent rules.
Before you rely on this
- What you read here is the federal picture as of October 2026, and it may look different after December 31, 2026.
- A state, or an individual prescriber, may ask for more than the federal minimum, such as an in-person visit.
- This is general information, not legal or medical advice.
Three layers that all apply
It can help to picture any video prescription passing through three layers at once. A medicine has to clear all of them.
- Federal rules: whether a medicine is controlled, and if so, the telemedicine rule in effect at the time.
- State rules: the prescriber must be licensed in the state where you are during the visit, and state law can add its own requirements.
- Clinical judgment: the prescriber decides whether a medicine fits your history, your other medicines and your goals. NIMH notes that medicines affect people in different ways and that it may take several tries to find the one that works best with the fewest side effects.
How we can help
For people physically located in Pennsylvania during each visit, a licensed psychiatrist on our team, a Doctor of Osteopathic Medicine (DO), offers psychiatric care and medication management by secure video. He is open to new patients and referrals. Our page on online psychiatry in Pennsylvania explains how it works, and you can also read about a psychiatric evaluation.
We cannot say in advance whether any medicine will be prescribed, or which one. That is decided with you after an evaluation. If you already see a prescriber elsewhere and are thinking about a change, read about switching psychiatrists first.
Our therapists do not prescribe. Therapy is online for clients physically located in Pennsylvania, West Virginia, Arizona, Colorado or Florida during sessions. Outside Pennsylvania, medication questions go to your own prescriber. To ask about coverage, see insurance and fees, or book a time on our booking page.
If you are in crisis, call or text 988, or call 911. Locascio Wellness does not provide emergency services.
Common questions
Can a psychiatrist prescribe medication after a video visit?
Often, yes. NIMH notes that care you can receive virtually can include a prescription, depending on your insurance and the provider. The prescriber must be licensed in the state where you are, and controlled substances carry extra federal rules. Whether any medicine is prescribed is always the prescriber's decision after evaluating you.
Do I need an in-person visit for a controlled medicine in 2026?
Not under federal rules, as of October 2026. A temporary rule lets DEA-registered practitioners prescribe Schedule II to V medicines by audio-video telemedicine without a prior in-person evaluation, if conditions are met, through December 31, 2026. State law and a prescriber's own policies can still require one, so ask the prescriber.
What happens to the telehealth rule after December 31, 2026?
No one can say for certain yet. The current extension ends on that date, and DEA has proposed a special registration for telemedicine that had not been finalized as of October 2026. If you take a controlled medicine prescribed by video, ask your prescriber ahead of time how they plan to handle visits next year.
Can your psychiatrist see me if I live outside Pennsylvania?
No. Our psychiatric care is only for people who are physically located in Pennsylvania during each visit. If you are in West Virginia, Arizona, Colorado or Florida, our therapists may still be able to help, and medication questions go to your own prescriber.
Sources
- Federal Register: Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications
- eCFR: 21 CFR Part 1308, Schedules of Controlled Substances
- National Institute of Mental Health: Getting Mental Health Support Virtually
- Pennsylvania Department of State: Telemedicine FAQs
- National Institute of Mental Health: Mental Health Medications
Published by Locascio Wellness. Published October 27, 2026. This page is general information, not medical advice or a diagnosis.