Since the COVID-19 pandemic, the U.S. healthcare system has undergone a permanent transformation in how care is delivered, and telehealth has become a pillar of access. What began as an emergency measure has grown into a multi-billion-dollar segment of outpatient care. In 2025, over 35% of ED consultations now occur via telemedicine platforms, including virtual consultations dedicated solely to men’s sexual health.
But as telehealth matures, telehealth regulation is catching up. And while erectile dysfunction (ED) medications like tadalafil and sildenafil are not controlled substances, the rules governing how they’re prescribed remotely are evolving. Licensing standards, prescribing authority, state-level requirements, and payer rules have become more nuanced, fragmented, and compliance-heavy.
Both patients and telemedicine providers must now navigate a shifting landscape: federal flexibilities extended (but not permanent), state-based prescribing limits, Medicare’s looming “policy cliff” in late 2025, and questions around who can prescribe, where, and under what documentation conditions.
This article offers a clear, updated breakdown of how U.S. telemedicine regulation affects ED prescribing specifically, and what patients, clinicians, and platforms need to know to stay compliant and continue to access care through the end of 2025 and beyond.
Federal Telemedicine Prescribing Flexibility & Its Limits
In response to the COVID-19 emergency, U.S. federal agencies relaxed many long-standing restrictions on telemedicine. Under the Public Health Emergency (PHE) provisions, providers could prescribe medications via telehealth without requiring an initial in-person visit, a rule change that supported explosive growth in virtual prescribing for both controlled and non-controlled drugs.
While erectile dysfunction (ED) medications like tadalafil (Cialis) and sildenafil (Viagra) are not classified as controlled substances, these prescribing flexibilities still indirectly affect their prescribing. Many telehealth platforms operate under unified protocols for all prescriptions, and changes to federal law shape billing, platform access, and multi-state operations. In November 2024, the DEA and HHS jointly extended certain prescribing flexibilities through December 31, 2025, especially for controlled medications under the Ryan Haight Act framework (DEA, 2024). However, this extension does not make these changes permanent. If Congress fails to act before October 2025, Medicare coverage of many non-behavioral telehealth services, including those for ED, could revert to pre-pandemic rules.
This would mean stricter geographic requirements (e.g., patients must be in rural areas or approved facilities), limiting access to virtual consultations for urban patients seeking routine ED care. Additionally, telehealth providers may face greater compliance burdens when operating across state lines or billing Medicare for ED-related visits.
While current flexibilities remain in place, the clock is ticking. Patients and platforms alike must plan for potential disruption unless broader telehealth reform legislation is passed in time.
State-by-State Differences in Telehealth Prescribing
While federal extensions have kept many pandemic-era telehealth flexibilities in place, state laws now dictate the finer details, and those details vary widely across the U.S. For ED prescribing, this means patients in different states may face very different experiences even if the medication (e.g., tadalafil) isn’t federally restricted. For example, in Arizona, clinicians can prescribe via telehealth without an in-person exam, but only for a maximum of four virtual sessions, after which an in-person visit is required within 12 months. Meanwhile, Texas allows broad telemedicine prescribing for non-controlled medications but mandates clear documentation of clinical necessity and informed consent. Some states also restrict cross-state licensure, requiring providers to be fully licensed in the patient’s state. This affects national men’s health platforms, which often need to maintain multi-state licensure or hire regionally credentialed physicians to stay compliant.
Even subtle differences, like whether a state requires a synchronous video visit versus allowing asynchronous questionnaires, can shape how quickly and affordably a patient receives a prescription for ED. Platforms that rely on intake forms only may be noncompliant in states with stricter definitions of medical evaluation.
The Center for Connected Health Policy (CCHP) maintains a current tracker of state-by-state online prescribing rules, showing just how fragmented the policy map remains (CCHP, 2025).
For patients and providers alike, navigating this patchwork requires constant attention to location-specific rules and a willingness to adapt as state boards revise guidance in response to federal policy changes.
Medicare & Private Payer Policies Affecting ED Telehealth
Although Medicare doesn’t typically cover erectile dysfunction treatments like tadalafil or sildenafil, the policies that govern telehealth visit eligibility still influence how patients access care for ED, especially older adults managing comorbidities.
As of 2025, Medicare coverage’s broad telehealth flexibilities, including removal of geographic restrictions and allowance of home as the originating site, remain in effect through September 30, 2025. This extension covers most non-behavioral services, enabling virtual ED consultations for eligible beneficiaries, even if the resulting prescription isn’t reimbursed (HHS, 2025).
Private payers, on the other hand, vary considerably. Some insurers continue to reimburse telehealth visits at parity with in-person care, especially for established patients. Others have adopted stricter coding and documentation requirements, reflecting growing scrutiny over virtual-first platforms offering one-click prescriptions. In 2025, new CPT coding guidance also affects how telehealth visits are billed for non-complex issues like ED. This inconsistency means patients may need to verify both medical and administrative coverage before booking a virtual ED visit, particularly if they expect the encounter itself (not the medication) to be reimbursed.
Implications for Patients & Telehealth Platforms
The shifting regulatory environment of 2025 doesn’t just affect policymakers, but directly impacts how patients access care and how telehealth companies operate. For patients seeking ED treatment, the changes can influence everything from appointment availability to prescription timelines. Patients may assume that since PDE5 inhibitors like tadalafil are not controlled substances, access via telehealth is guaranteed. In many cases, that’s still true. However, state laws may restrict virtual-only prescribing or require specific types of encounters. These policies can delay treatment or force patients into hybrid care models, particularly in regions with tighter oversight.
For telehealth platforms, staying compliant is a growing operational burden. National services must ensure that every prescriber is appropriately licensed in the patient’s state and that prescribing practices conform to local statutes, even for seemingly routine medications like ED pills. Many companies are investing in automated compliance engines, but smaller startups may struggle to keep pace.
Meanwhile, pending DEA rulemaking around special telemedicine registrations, which may simplify cross-state prescribing, is still in development (Federal Register, 2025). Until those rules are finalized, both patients and providers must tread carefully.
Practical Recommendations for Stakeholders
In the face of regulatory complexity, clarity and preparation become essential for both patients and providers.
Patients should start by verifying that their telehealth provider is licensed to prescribe in their state. They should also ask whether a video visit is required, whether their insurer covers virtual ED consultations, and whether a follow-up in-person appointment may eventually be necessary. Especially for those on Medicare, it’s worth checking if the platform is Medicare-participating and if the visit itself (not just the drug) qualifies for coverage.
Clinicians and telehealth platforms shall stay vigilant. Maintaining a current matrix of state prescribing rules, licensure requirements, and payer billing guidance is no longer optional—it’s operationally vital. Providers should ensure documentation supports clinical necessity and aligns with state-specific expectations, particularly as some regions revisit or tighten telemedicine rules in anticipation of federal sunset clauses.
Finally, policymakers should recognize the risk of “telehealth whiplash”—where sudden reversals in access disproportionately affect rural, aging, or underserved populations. Making 2025’s provisional rules permanent, with guardrails, could protect access to safe, routine virtual care, ED prescribing included.
For all parties, the key to sustainable access is shared responsibility and constant adaptation to a regulatory landscape still in flux.
References
- Center for Connected Health Policy. (2025). Online prescribing. https://www.cchpca.org/topic/online-prescribing/
- Drug Enforcement Administration & U.S. Department of Health and Human Services. (2024, November 15). DEA and HHS extend telemedicine flexibilities through 2025. https://www.dea.gov/documents/2024/2024-11/2024-11-15/dea-and-hhs-extend-telemedicine-flexibilities-through-2025
- Federal Register. (2025, January 17). Special registrations for telemedicine and limited state telemedicine registrations; proposed rule. https://www.federalregister.gov/documents/2025/01/17/2025-01099/special-registrations-for-telemedicine-and-limited-state-telemedicine-registrations
- Telehealth Resource Center. (2025). The telehealth policy cliff: Preparing for October 1, 2025. https://telehealthresourcecenter.org/resources/the-telehealth-policy-cliff-preparing-for-october-1-2025/
- U.S. Department of Health and Human Services. (2025, March 20). Telehealth policy updates. https://telehealth.hhs.gov/providers/telehealth-policy/telehealth-policy-updates/
