Online Prescribing

Signing a blank prescription form; or dispensing, prescribing, administering or otherwise distributing any drug, controlled substance or other treatment without sufficient examination including failing to establish a valid physician-patient relationship pursuant to section 334.108, or for other than medically accepted therapeutic or experimental or investigative purposes duly authorized by a state or federal agency, or not in the course of professional practice, or not in good faith to relieve pain and suffering, or not to cure an ailment, physical infirmity or disease, except as authorized in section 334.104.

SOURCE: MO Revised Statutes § 334.100(4)(h). (Accessed Apr. 2025).

A telemedicine encounter, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.

• In order to establish a physician-patient relationship through telemedicine:
  • The technology utilized shall be sufficient to establish an informed diagnosis as though the medical interview and physical examination has been performed in person; and
  • Prior to providing treatment, including issuing prescriptions or physician certifications under Article XIV of the Missouri Constitution, a physician who uses telemedicine shall interview the patient, collect or review relevant medical history, and perform an examination sufficient for the diagnosis and treatment of the patient.  A questionnaire completed by the patient, whether via the internet or telephone, does not constitute an acceptable medical interview and examination for the provision of treatment by telehealth.

SOURCE: MO Revised Statute Ch. 191 Sec. 191.1146. (Accessed Apr. 2025).

Prior to prescribing any drug, controlled substance, or other treatment through telemedicine, as defined in section 191.1145, or the internet, a physician shall establish a valid physician-patient relationship as described in section 191.1146.  This relationship shall include:

• Obtaining a reliable medical history and performing a physical examination of the patient, adequate to establish the diagnosis for which the drug is being prescribed and to identify underlying conditions or contraindications to the treatment recommended or provided;
• Having sufficient dialogue with the patient regarding treatment options and the risks and benefits of treatment or treatments;
• If appropriate, following up with the patient to assess the therapeutic outcome;
• Maintaining a contemporaneous medical record that is readily available to the patient and, subject to the patient’s consent, to the patient’s other health care professionals; and
• Maintaining the electronic prescription information as part of the patient’s medical record.

The requirements of subsection 1 (see above) may be satisfied by the prescribing physician’s designee when treatment is provided in:

• A hospital;
• A hospice program;
• Home health services provided by a home health agency;
• Accordance with a collaborative practice agreement;
• Conjunction with a physician assistant licensed;
• Conjunction with an assistant physician;
• Consultation with another physician who has an ongoing physician-patient relationship with the patient, and who has agreed to supervise the patient’s treatment, including use of any prescribed medications; or
• On-call or cross-coverage situations.

No health care provider, as defined in section 376.1350, shall prescribe any drug, controlled substance, or other treatment to a patient based solely on an evaluation over the telephone; except that, a physician or such physician’s on-call designee, or an advanced practice registered nurse, a physician assistant, or an assistant physician in a collaborative practice arrangement with such physician, may prescribe any drug, controlled substance, or other treatment that is within his or her scope of practice to a patient based solely on a telephone evaluation if a previously established and ongoing physician-patient relationship exists between such physician and the patient being treated.

No health care provider shall prescribe any drug, controlled substance, or other treatment to a patient based solely on an internet request or an internet questionnaire.

SOURCE: MO Revised Statute Sec. 334.108. (Accessed Apr. 2025).

 “Remote dispensing site pharmacy”, any location in this state where the practice of pharmacy occurs and that is licensed as a pharmacy to dispense prescription drugs and is staffed by one or more qualified pharmacy technicians, as defined by the board, or intern pharmacists, whose activities are supervised by a pharmacist at a supervising pharmacy through a continuous real-time audio and video link.  “Remote dispensing site pharmacy” does not include the office of a dispensing prescriber or an automated device.

A remote dispensing site pharmacy shall be located at least ten miles from an existing retail pharmacy unless:

• The remote dispensing site pharmacy is part of a community mental health center, federally qualified health center, rural health clinic, or outpatient clinic setting; or
• An applicant of a proposed remote dispensing site pharmacy demonstrates to the board how the proposed remote dispensing site pharmacy will promote public health.

SOURCE: MO Revised Statutes Sec. 338.215, (Accessed Apr. 2025).

HealthNet Medicaid Program

SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330, (Accessed Apr. 2025).

Mental Health – Division of Behavioral Health Community Treatment Program

For purposes of the provision of all services via telemedicine and audio-only, the provider-patient relationship may be established by the following:

• An in-person encounter through a medical interview and physical examination; or
• Consultation with another health care professional, or that health care professional’s delegate, who has an established relationship with the patient and an agreement with the health care professional to participate in the individual’s care; or
• A telemedicine encounter, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.

In order to establish a provider-patient relationship via telemedicine and/or audio-only for all services:

• The technology utilized shall be sufficient to establish an informed diagnosis as though the medical interview and physical examination had been performed in person; and
• Prior to providing treatment, including issuing prescriptions and physician certifications under Article XIV of the Missouri Constitution, a physician who uses telemedicine shall interview the patient, collect or review relevant medical history, and perform an examination sufficient for diagnosis and treatment of the patient. A questionnaire completed by the patient, whether via the telephone or internet, does not constitute a medical interview and examination for provision of treatment via telemedicine.

In-Person Requirements Post Federal Declaration of Public Health Emergency (PHE)

• Individuals who have only received telemedicine and/or audio-only services must receive an in person service within 6 months of their last service. After the initial 6-month in-person visit, all individuals must be seen in person, at minimum, once every 12 months.
• All new individuals being served via telemedicine and/or audio-only require an in-person service within 6 months of beginning services and then every 12 months following.

SOURCE:  MO Division of Behavioral Health, Community Treatment Program, July 8, 2022, (Accessed Apr. 2025).

An abortion facility may request a waiver to the requirement that an OB/GYN or OB/GYN group be on call to treat complications. If an abortion facility cannot contract with an OB/GYN or OB/GYN group to provide treatment for abortion-pill complications, the abortion facility must request to contract with another qualified physician or physician group to fulfill the requirements in subsection (3) of this rule. The waiver request shall include: …

• Complication plans for all facilities for drug-induced abortions for patients outside the local area.   Every complication plan shall include provisions for patients who will complete the abortion outside of the abortion facility’s local area. When a physician determines that a patient will complete the abortion outside the local area, the complication plan shall require that the physician shall do the following: …
  • The physician who prescribed the abortion-inducing drugs must take all reasonable measures to follow up with any patient who has suffered complications from an abortion- inducing drug within twenty-four (24) hours of learning of the complication. If the physician is unable to contact the patient within twenty-four (24) hours, he or she must continue to attempt to contact the patient once a day for an additional seventy-two (72) hours. If the physician is unable to contact the patient after ninety-six (96) hours, the physician must document the attempts to contact the patient and the reason for the inability to schedule the follow-up appointment. The follow-up appointment may be in person or via a telehealth visit.

SOURCE:  Emergency Rule (Effective Mar. 27, 2025 to Sept. 22, 2025) 19 CSR 30-30.062, (Accessed Apr. 2025).