LICENSING
Medicine is licensed one state at a time, and the law that applies is the law of the state the patient is in. Tessic Health holds that coverage for every brand on the platform: licensed providers in all 50 states, checked at the source before a first visit and every month after, with every visit routed to a provider licensed where the patient is. This page shows how the network is built, the rules in every state, and how new coverage comes online.
50
States live today
0
Medical licenses the brand needs
Monthly
License and exclusion checks per provider
45
States that allow an async first visit
PROVIDER NETWORK
Four parts, each with one job. The brand runs the business. Licensed clinicians make every medical decision.
The brand · MSO
The operator's company
Owns the brand, the storefront, prices, marketing, and patient relationships, and runs the business side of the clinic as its management services organization (MSO). It never makes a medical decision, so no one at the company needs a medical license.
The practice · friendly PC
A physician-owned professional corporation
The medical practice. It employs or contracts the providers, holds the clinical policies, and is where medical decisions legally sit. The brand's management services agreement is signed with this corporation.
The clinicians
Licensed providers
Physicians (MD and DO), nurse practitioners, and physician assistants, each licensed in every state where they treat. A physician medical director writes the treatment protocols and oversees quality.
The patient
Treated under their own state's law
Where the patient is during the visit decides which state's license and rules apply. Intake records that state and sends the visit only to a provider licensed there.
01
Every state requires a provider to be licensed in the state where the patient is located at the time of the visit. Tessic holds licenses provider by provider, state by state, so a brand selling nationally is covered wherever its patients are.
02
Every state is covered by more than one licensed provider, so a vacation, a resignation, or a license renewal never takes a state offline.
03
Nurse practitioners practice on their own license in the 27 states that grant full practice authority, and with a collaborating or supervising physician everywhere else. Tessic's physicians hold those agreements, so the brand never has to arrange them.
04
Prices, marketing, and the storefront belong to the brand. Diagnosis, prescribing, and dosing belong to the provider. The management agreement writes that line down, which is what keeps the clinic within each state's corporate-practice-of-medicine rules.
COVERAGE BY STATE
One row per state: coverage, whether a first visit can be async, extra state rules on controlled substances, how nurse practitioners may practice, and whether physicians can license through the interstate compact. Search or filter the table; every row can be linked to directly.
Showing 50 of 50 states
| State | First visit | Physician compact | NP practice | Controlled substances | What to know |
|---|---|---|---|---|---|
| AlabamaALLive | Async allowed | IMLC member | Reduced | Live contact plus an in-person visit within the prior 12 months, with limited exceptions (Ala. Code 34-24-704). | More than four telehealth visits in 12 months for the same unresolved condition triggers an in-person visit or referral. Mental health is exempt. |
| AlaskaAKLive | Async, with conditions | Full application | Full | No telehealth-specific rule found | No prescribing to a new patient from a questionnaire or email alone; the patient must be offered a copy of the records for their primary care provider (AS 08.64.364). Compact licenses begin in 2027. |
| Arizona: full state rulesAZLive | Async allowed | IMLC member | Full | Schedule II only after an in-person or audio-video exam (A.R.S. 36-3602). Every DEA-registered prescriber registers with the CSPMP and checks it before opioids and benzodiazepines (A.R.S. 36-2606). | Out-of-state providers may use a board telehealth registration instead of a full license; registrants may prescribe controlled substances once registered with the CSPMP (A.R.S. 36-3606). |
| ArkansasARLive | Async, with conditions | Full application | Reduced | No telehealth-specific rule found | No relationship from a questionnaire, email, or text alone; a new patient needs a live audio-video exam unless the provider has a clinician-kept health record (Ark. Code 17-80-403). Compact enacted, not yet issuing. |
| California: full state rulesCALive | Async allowed | Full application | Restricted | A CURES check within 24 hours before a first Schedule II–IV prescription, repeated at least every six months (H&S 11165.4). | Telehealth consent must be documented before care (B&P 2290.5); a questionnaire-based exam is allowed when it meets the standard of care (B&P 2242); every prescription must be electronic (B&P 688). |
| ColoradoCOLive | Async, with conditions | IMLC member | Full | Out-of-state telehealth registrants may not prescribe controlled substances (C.R.S. 12-30-124). | Board policy: a prescription based only on an online questionnaire is not acceptable care. A telehealth-only registration for out-of-state clinicians opened in 2026. |
| ConnecticutCTLive | Async allowed | IMLC member | Full | No Schedule I–III by telehealth, except non-opioid Schedule II–III for psychiatric or substance-use care (CGS 19a-906). | Before telehealth care the provider needs the patient's history and record, and must give the patient their license number and contact details. |
| DelawareDELive | Async, with conditions | IMLC member | Full | Controlled prescriptions generally rest on at least one in-person evaluation (16 Del. C. 4701), with a telehealth path for opioid-use disorder. | Identity and location checks, consent, and a written visit summary are required; no prescribing from a questionnaire alone (24 Del. C. 6003). |
| Florida: full state rulesFLLive | Async allowed | IMLC member | Restricted | No Schedule II by telehealth except for psychiatric, inpatient, hospice, or nursing-home patients (F.S. 456.47). | Out-of-state providers may treat Floridians through a telehealth registration with the Florida board. |
| Georgia: full state rulesGALive | Live visit first | IMLC member | Restricted | No controlled prescriptions from an electronic consult alone, and no chronic-pain controlled prescribing by telemedicine (Rule 360-3). | The Board has stated async telehealth does not meet its standard. Providers must also make diligent efforts to get the patient an in-person exam each year. |
| HawaiiHILive | Async, with conditions | IMLC member | Full | Opiates need an in-person consultation to establish the relationship, except a short supply within the same medical group (HRS 453-1.3). | Only a Hawaii-licensed physician may establish a relationship by telehealth, and a prescription from an online questionnaire alone is not acceptable care (HRS 453-1.3). |
| IdahoIDLive | Async, with conditions | IMLC member | Full | No telehealth-specific rule found | Virtual care may establish the relationship if Idaho's standard of care is met, but not from a static online questionnaire alone (Idaho Code 54-5705). |
| Illinois: full state rulesILLive | Async allowed | IMLC member | Reduced | A state controlled substance license (720 ILCS 570/302), a PMP check before a first Schedule II narcotic (widening to stimulants and benzodiazepines on Jan. 1, 2027), and e-prescribing for Schedules II–V (720 ILCS 570/311.6). | An Illinois license is required to treat Illinois patients by telehealth (225 ILCS 150/10). |
| IndianaINLive | Async, with conditions | IMLC member | Reduced | Any controlled substance needs a real-time audio-video visit and an INSPECT check; opioids only for opioid-use disorder (IC 25-1-9.5-8). | No care from an internet questionnaire alone. With consent, the prescriber notifies the patient's primary care provider of each prescription (IC 25-1-9.5-7). |
| IowaIALive | Async, with conditions | IMLC member | Full | No telehealth-specific rule found | A static questionnaire is not an acceptable exam (an adaptive, interactive interview is), and audio-only calls are not telemedicine (481 IAC 655.9). |
| KansasKSLive | Async, with conditions | IMLC member | Full | No telehealth-specific rule found | With consent, a treatment report goes to the patient's primary care physician within three business days (K.S.A. 40-2,212). Out-of-state physicians may use a telemedicine waiver. |
| KentuckyKYLive | Async, with conditions | IMLC member | Reduced | No telehealth-specific rule found | A questionnaire is inadequate for the first evaluation or any follow-up, so refills need more than a form (KRS 311.597). Consent is required before telehealth. |
| LouisianaLALive | Async, with conditions | IMLC member | Reduced | An in-person history or exam before any controlled prescription by telehealth, and an in-person visit within the past year (R.S. 40:1223.4; LAC 46:XLV §7513). | Board rules still restrict telemedicine treatment of obesity and chronic pain; a newer state statute says board rules may be no stricter than in-person care. |
| MaineMELive | Async, with conditions | IMLC member | Full | No telehealth-specific rule found | A static internet questionnaire is not an acceptable clinical interview, and prescribing from one alone is prohibited (Joint Rule Ch. 11). |
| MarylandMDLive | Async allowed | IMLC member | Full | No Schedule II opiates for pain by telehealth without a prior in-person assessment or other listed exception (Health Occ. 1-1003). | The pre-prescribing evaluation may be synchronous or asynchronous, but audio-only calls do not count as telehealth. |
| MassachusettsMALive | Async allowed | Full application | Full | No telehealth-specific rule found | Every prescriber needs a Massachusetts Controlled Substances Registration, even for non-controlled drugs, because the state schedules all prescription drugs. |
| MichiganMILive | Async allowed | IMLC member | Restricted | Schedule 2–5 requires a bona fide relationship: a records review plus an evaluation in person or by telehealth (MCL 333.7303a). | Consent is required before telehealth, and the provider must offer or arrange follow-up care. |
| MinnesotaMNLive | Async allowed | IMLC member | Full | Schedule II–IV drugs, muscle relaxants, and butalbital need an in-person exam; telehealth exams are allowed only for ED drugs and opioid-use disorder (Minn. Stat. 151.37). | Testosterone falls in the in-person group. Erectile dysfunction medication needs a documented exam, which may be done by telehealth. |
| MississippiMSLive | Live visit first | IMLC member | Reduced | No telehealth-specific rule found | Store-and-forward may support but never replace a real-time visit (video, or audio where appropriate); a questionnaire without an exam violates Board rules. |
| MissouriMOLive | Async, with conditions | IMLC member | Restricted | No telehealth-specific rule found | Since Aug. 28, 2026, questionnaire-based care is allowed through a Missouri-licensed entity, with a report to the patient's primary care provider within 14 days (RSMo 191.1146). |
| MontanaMTLive | Async allowed | IMLC member | Full | No telehealth-specific rule found | — |
| NebraskaNELive | Async allowed | IMLC member | Full | No telehealth-specific rule found | — |
| NevadaNVLive | Async allowed | IMLC member | Full | Schedule II–IV for pain needs an evaluation and risk assessment, with reevaluation before repeated dose increases (NRS 639.23911). | Out-of-state physicians may use a telehealth special purpose license instead of full licensure. |
| New HampshireNHLive | Async allowed | IMLC member | Full | Schedule II–IV by telemedicine needs a follow-up evaluation at least once a year (RSA 329:1-d). | — |
| New JerseyNJLive | Async, with conditions | IMLC member | Reduced | Schedule II requires an initial in-person exam and an in-person visit every three months (N.J.S.A. 45:1-62). | Async is allowed only after the provider reviews the patient's history and records; no prescribing from a static questionnaire alone. |
| New MexicoNMLive | Async, with conditions | Full application | Full | No telehealth-specific rule found | Board rules treat questionnaire-only prescribing as unprofessional. Out-of-state physicians may hold a limited telemedicine license. Compact enacted, not yet issuing. |
| New York: full state rulesNYLive | Async allowed | Full application | Full | Testosterone is Schedule II in New York (PHL 3306): no refills and a 30-day supply unless a listed condition applies. A PMP check within 24 hours before every Schedule II–IV prescription (PHL 3343-a). | Every prescription, controlled or not, must be sent electronically (PHL 281). Physician ads may not use patient testimonials (Educ. Law 6530(27)). |
| North Carolina: full state rulesNCLive | Async, with conditions | IMLC member | Restricted | No statute bars controlled prescribing by telemedicine, but the STOP Act requires e-prescribing and a CSRS check before a first targeted controlled substance and every three months after (G.S. 90-106, 90-113.74C). | Board position: prescribing from a static online questionnaire alone is not acceptable. Informed consent should be documented. |
| North DakotaNDLive | Async, with conditions | IMLC member | Full | Opioids by telemedicine only for opioid-use disorder treatment or hospital and long-term-care patients (NDCC 43-17-45). | A first exam by questionnaire or audio call alone does not meet the standard; video, or store-and-forward with diagnostics, does (NDCC 43-17-44). |
| Ohio: full state rulesOHLive | Async allowed | IMLC member | Reduced | Schedule II for a new patient needs an in-person visit first, with listed exceptions (OAC 4731-11-09). | Patient identity and location must be verified and telehealth consent documented before treatment. |
| OklahomaOKLive | Live visit first | IMLC member | Restricted | Telemedicine cannot establish care for opiates, benzodiazepines, or carisoprodol, with narrow addiction-treatment exceptions (59 O.S. 478.1). | A first exam must use real-time audio and video (OAC 435:10-7-13). |
| OregonORLive | Async allowed | Full application | Full | Telemedicine-status licensees may not prescribe controlled substances for chronic pain (OAR 847-025-0030). | Out-of-state physicians may practice under a Telemedicine status license, which carries added limits. |
| Pennsylvania: full state rulesPALive | Async allowed | IMLC member | Reduced | An initial history and physical exam before any controlled prescription (49 Pa. Code 16.92); an ABC-MAP query on a patient's first controlled prescription and before every opioid or benzodiazepine (35 P.S. 872.8). | Nurse practitioners prescribe under a collaborative agreement, with Schedule II capped at a 30-day supply and Schedule III–IV at 90 days (49 Pa. Code 21.284). |
| Rhode IslandRILive | Live visit first | Full application | Full | Controlled substances only within an established in-person relationship (Board guidelines). | Async evaluation without a real-time exchange is not appropriate, and questionnaire-only prescribing is unprofessional (216-RICR-40-05-1). Compact enacted, not yet issuing. |
| South CarolinaSCLive | Async, with conditions | Full application | Restricted | No Schedule II–III narcotics by telemedicine outside listed exceptions; a state controlled-substance registration is required (S.C. Code 40-47-37). | Prescribing from a questionnaire alone is unprofessional. Where applicable, the provider must discuss a primary care home with the patient. |
| South DakotaSDLive | Async, with conditions | IMLC member | Full | No controlled prescriptions from an internet questionnaire or consult alone (SDCL 34-52-6). | A real-time audio-video exam is required wherever the same service in person would need a face-to-face exam (SDCL 34-52-5). |
| TennesseeTNLive | Async, with conditions | IMLC member | Restricted | Buprenorphine by telehealth only through listed licensed treatment entities (TCA 63-1-155). | Prescribing from a questionnaire alone, or without an appropriate history or exam, is grounds for discipline. |
| Texas: full state rulesTXLive | Async, with conditions | IMLC member | Restricted | Chronic-pain prescribing by telemedicine needs two-way audio-video, with a narrow exception (22 TAC 175.3). | Async must use clinically relevant photos or records. With consent, a treatment record goes to the patient's primary care provider within 72 hours (Occ. Code 111.005). |
| UtahUTLive | Async, with conditions | IMLC member | Full | No telehealth-specific rule found | No care based only on an online questionnaire, email, or patient-written history. A report goes to the patient's designated provider within two weeks (Utah Code 26B-4-704). |
| VermontVTLive | Async, with conditions | IMLC member | Full | No telehealth-specific rule found | A questionnaire-only first evaluation is inadequate. Out-of-state clinicians need a Vermont license, or a capped telehealth license or registration. |
| VirginiaVALive | Async, with conditions | Full application | Restricted | Schedule II–V requires a Virginia practice location or the ability to refer for an in-person exam (Va. Code 54.1-3303). | Store-and-forward needs an available history and an exam or tests where the standard of care requires. Audio-only is for follow-ups only. |
| WashingtonWALive | Async allowed | IMLC member | Full | No telehealth-specific rule found | A relationship may be set up by telehealth, but not by email, text, instant message, or fax alone (RCW 18.134.030). |
| West VirginiaWVLive | Live visit first | IMLC member | Reduced | No Schedule II for patients treated only by telemedicine, with narrow exceptions (W. Va. Code 30-3-13a). | No relationship by questionnaire or text: a real-time visit (video or phone) is required, then an in-person visit within 12 months of starting telemedicine. |
| WisconsinWILive | Async, with conditions | IMLC member | Reduced | No telehealth-specific rule found | A prescription based only on a static questionnaire does not meet the standard of care (Wis. Admin. Code Med 24.07). |
| WyomingWYLive | Async allowed | IMLC member | Full | Initial controlled prescribing online without a documented relationship is grounds for discipline (W.S. 33-26-402). | — |
State rules are summarized from the Center for Connected Health Policy, state statutes and medical board rules, the AANP State Practice Environment map (May 2026), and interstate compact participation lists, reviewed September 2026. The first-visit and controlled-substance columns summarize the rules for physicians; nurse practitioner and physician assistant boards can add their own. The controlled-substance column lists telehealth-specific rules and, where research found them, general prescribing rules that change how a telehealth visit runs; every state also runs its own prescription-monitoring program. Summaries are simplified for comparison. Rules change, and Tessic applies the rule in force in the patient's state at the time of every visit.
STATES WITH EXTRA RULES
Most states ask for the same things: a license where the patient is, a visit that meets the standard of care, and good records. These states ask for something more.
The rule
A physician or practice that treats the same patient by telehealth more than four times in 12 months for the same unresolved condition must see the patient in person, or refer them, within 12 months. Mental health care is exempt (Ala. Code 34-24-700 et seq.).
What Tessic Health does
Visits are counted per patient and condition. Before a fifth visit for the same unresolved condition, the patient is booked for an in-person visit or referred to a local physician.
The rule
A patient relationship cannot be created by an internet questionnaire, email, patient-written history, text, or fax. It needs an in-person exam, a real-time audio-video exam, or access to a health record kept by a clinician (Ark. Code 17-80-403).
What Tessic Health does
New Arkansas patients see a provider by live video for their first visit. Follow-ups move to async once the relationship exists.
The rule
No Schedule I, II, or III controlled substance may be prescribed by telehealth. The only exception is a non-opioid Schedule II or III drug for a psychiatric disability or substance use disorder (CGS 19a-906).
What Tessic Health does
Testosterone and other Schedule II–III medications are not prescribed to Connecticut patients by telehealth outside that exception. Non-controlled treatments run normally, including async.
The rule
New patients must be examined with technology equal to an in-person exam, and the Board has stated that asynchronous telehealth does not meet that requirement. Providers must also make diligent efforts to get the patient an in-person exam each year (Rule 360-3-.07).
What Tessic Health does
Georgia patients see a provider by live video before a first prescription, and the care team prompts an annual in-person exam with a Georgia-licensed clinician.
The rule
It is unprofessional conduct to prescribe in response to electronic communications without verifying identity and documenting a diagnosis, and the law states a questionnaire is inadequate for the initial evaluation or for any follow-up evaluation (KRS 311.597).
What Tessic Health does
Kentucky patients never receive a prescription or a refill from a questionnaire alone. First visits and follow-ups include a back-and-forth history with the provider, plus photos or live video where the condition calls for them.
The rule
A controlled substance may be prescribed by telehealth only after an in-person history or exam, and board rules require an in-person visit within the past year. Board rules also restrict telemedicine treatment of obesity and chronic pain (R.S. 40:1223.4; LAC 46:XLV §7513).
What Tessic Health does
Controlled medications for Louisiana patients are prescribed only after a qualifying in-person visit, and controlled weight-loss drugs such as phentermine are never prescribed by telehealth.
The rule
Massachusetts classifies every prescription drug as a controlled substance (Schedule VI), so a prescriber needs a state Controlled Substances Registration to prescribe anything, even with no DEA registration (M.G.L. c. 94C).
What Tessic Health does
Every provider who treats Massachusetts patients holds a Massachusetts Controlled Substances Registration, not only those who prescribe federally controlled medications.
The rule
Schedule II–IV drugs, muscle relaxants, and butalbital require a documented exam that must be in person. A telehealth exam is allowed only for erectile dysfunction drugs and opioid-use disorder medication (Minn. Stat. 151.37).
What Tessic Health does
Before testosterone or another listed medication is prescribed, a documented in-person exam is required. Erectile dysfunction treatment runs by telehealth, as the law allows.
The rule
Store-and-forward may enhance but never replace a real-time provider-patient interaction, and a simple questionnaire without an appropriate exam violates Board policy (30 Miss. Admin. Code Pt. 2635, R. 5.5).
What Tessic Health does
Mississippi patients always have a real-time visit, by video or by phone where medically appropriate, before a first prescription. Intake answers and photos support the visit and never replace it.
The rule
Schedule II drugs may be prescribed by telemedicine only after an initial in-person exam, with an in-person visit every three months. Prescribing from an online static questionnaire alone is barred (N.J.S.A. 45:1-62).
What Tessic Health does
Before any first visit, the provider reviews the patient's history and available records. Schedule II medications are never started by telehealth for New Jersey patients.
The rule
New York lists anabolic steroids, testosterone included, in Schedule II rather than the federal Schedule III (PHL 3306). Schedule II prescriptions cannot be refilled and are capped at a 30-day supply unless a listed condition applies, and the state PMP must be checked within 24 hours before any Schedule II–IV prescription (PHL 3332, 3339, 3343-a).
What Tessic Health does
Testosterone for New York patients is written under New York's Schedule II rules: a new electronic prescription for every fill, a 30-day supply unless a listed condition allows more, and a PMP check within 24 hours before each one.
The rule
Telemedicine may not be used to start a relationship for prescribing opiates, benzodiazepines, or carisoprodol, and a telemedicine exam must use interactive, real-time audio and video (59 O.S. 478.1; OAC 435:10-7-13).
What Tessic Health does
Oklahoma patients see a provider by live audio-video before a first prescription. Opiates, benzodiazepines, and carisoprodol are never started by telehealth.
The rule
An initial medical history and physical examination are required before any controlled substance is prescribed (49 Pa. Code 16.92). The state PDMP, ABC-MAP, must be queried the first time a prescriber gives a patient a controlled substance and before every opioid or benzodiazepine (35 P.S. 872.8).
What Tessic Health does
Pennsylvania patients start testosterone or any other controlled medication only after the initial history and physical exam the rule requires, and every ABC-MAP query is documented in the patient's chart.
The rule
Asynchronous evaluation without a real-time, interactive exchange between physician and patient is not appropriate, and prescribing based only on an online questionnaire is unprofessional conduct (216-RICR-40-05-1).
What Tessic Health does
Rhode Island patients always have a real-time visit before a prescription, and controlled medications are prescribed only within an established in-person relationship.
The rule
A prescribing relationship can be formed by live audio-video or by store-and-forward that uses clinically relevant photos, video, or the patient's records. With consent, a treatment record must reach the patient's primary care provider within 72 hours (Tex. Occ. Code 111.005).
What Tessic Health does
Texas async visits always include relevant photos or records, never a questionnaire alone, and the record goes to the patient's primary care provider within 72 hours when the patient agrees.
The rule
Schedule II–V drugs may be prescribed by telemedicine only if the prescriber has a practice location in Virginia or can refer the patient to a Virginia practitioner for an in-person exam when the standard of care requires one (Va. Code 54.1-3303).
What Tessic Health does
Controlled medications for Virginia patients are prescribed only with a Virginia referral path for an in-person exam in place. Audio-only visits are used for follow-ups, never first visits.
The rule
A relationship cannot be formed by email, internet questionnaire, or text. It needs a real-time visit, and state law points to an in-person visit within 12 months of starting telemedicine. Schedule II is barred for patients treated only by telemedicine (W. Va. Code 30-1-26, 30-3-13a).
What Tessic Health does
West Virginia patients start with a real-time visit. The 12-month in-person window is tracked per patient, and an in-person visit is booked or referred before telehealth access would lapse.
CREDENTIALING AND OVERSIGHT
Credentials are verified at the source (the state board, the school, the national registries), never taken from a résumé. The checks follow the credentialing standard NCQA sets for health plans.
01
Every state license
Verified directly with each issuing board, for every state the provider will treat in.
02
Education and training
Confirmed with the school and the residency or training program, at the highest level completed.
03
Board certification
Confirmed with the certifying board wherever the provider holds one.
04
Malpractice and discipline history
Queried in the National Practitioner Data Bank, the federal record of malpractice payments and board actions.
05
Federal exclusion lists
Checked against the HHS Office of Inspector General exclusion list and SAM.gov.
06
DEA registration
Verified for each state where the provider prescribes controlled substances, with identity proofing completed for controlled-substance e-prescribing (EPCS).
07
Malpractice coverage
Confirmed active, covering telehealth in every state the provider treats in.
08
Identity and work history
Verified, with any gap in work history explained in writing.
Every month
Licenses, board actions, and exclusions
Every provider is re-screened against state boards and the OIG and SAM.gov exclusion lists, the monthly monitoring NCQA requires.
Before every expiry
Renewals
Each state license and DEA registration is renewed ahead of its own cycle, so nothing lapses between visits.
Every three years
Full re-credentialing
The complete source check above is repeated from scratch.
Every treatment
Written protocols
A physician medical director sets who qualifies, dosing, required labs, and when to escalate, for every treatment in the catalog.
On a set schedule
Chart review
Physicians review a sample of every provider's visits, plus every visit tied to a patient complaint or adverse event.
As laws change
State rule tracking
State telehealth rules are tracked continuously. When a rule changes, visit routing changes with it before the effective date.
ADDING STATES
For a brand, every state is already on. The timelines below are how Tessic adds licensed providers inside a state, so capacity grows before demand needs it.
For a brand
Day 1
A brand opens any state from its settings. There is no per-state application, fee, or wait, because the licenses already exist. Brands that launch in a few states first switch the rest on whenever they choose.
For the network: adding a licensed provider in a state
40 states issue physician licenses through the Interstate Medical Licensure Compact (IMLC). Compact figures show about 19 days on average from application to license, with nearly half issued within a week.
About 3 weeks
Alaska, Arkansas, California, Massachusetts, New Mexico, New York, Oregon, Rhode Island, South Carolina, and Virginia do not issue licenses through the compact yet, so each takes a full state application. Slow boards can take six months or more.
60 to 105 days
There is no working multistate nurse practitioner license. The APRN Compact takes effect only once seven states join, and five have, so every NP license is its own state application.
4 to 12 weeks
A provider needs a separate DEA registration in each state where they prescribe controlled substances, and the state license must be active first.
4 to 6 weeks
Where a state requires one for a nurse practitioner or physician assistant, a Tessic physician licensed in that state signs it as soon as the new license issues.
Days
Tessic watches visit volume and review times state by state and starts new licenses when a state's forecast calls for more providers. The weeks or months a license takes are spent before the demand arrives, so a brand's growth never waits on a state board.
ASYNC VS. LIVE VISITS
An async visit is a questionnaire, photos, and history that a provider reviews on their own time. A live visit is a real-time video or phone call. Both are real medical visits held to the same standard of care. The patient's state and the medication decide which one the law requires.
Asynchronous
Synchronous
20
States: async first visit allowed
25
States: async, with conditions
5
States: live visit first
0
States where controlled drugs are prescribed async
At intake, the patient's state and the medication set the visit type. A patient in a live-visit-first state, or asking for a controlled medication, is booked into a live visit; everyone else goes to async review. The provider can move any visit to live when their judgment calls for it.
| Treatment | Visit | Why |
|---|---|---|
| Weight care (GLP-1s) | Async where the state allows | GLP-1 medications are not controlled substances. |
| Hair, skin, and sexual health | Async where the state allows | Standard intake, with photos where the condition calls for them. |
| Longevity and peptides | Async where the state allows | Not controlled; the provider moves a visit to live when judgment calls for it. |
| Mental health (non-controlled) | Async or live, provider's choice | Many first evaluations go live by clinical preference even where async is allowed. |
| Testosterone and other controlled medications | Live video, or in person where the state requires it | Testosterone is Schedule III federally and Schedule II in New York. Federal rules require a real-time audio-video visit when there has been no in-person exam, and some states go further: Minnesota requires an in-person exam, Pennsylvania requires a physical exam first, and Connecticut bars Schedule III by telehealth. |
| Any treatment, in a live-visit-first state | Live visit first | State law requires it before the first prescription. Follow-ups move to async where the state allows. |
Federal rule for controlled substances
The DEA's fourth temporary extension, in effect through December 31, 2026, lets DEA-registered providers prescribe Schedule II–V controlled substances by audio-video telehealth without a prior in-person exam. The DEA's permanent special-registration rule went to White House review on August 25, 2026 and has not been published. Tessic will route controlled-substance visits under whichever rule is in force on January 1, 2027.
LICENSING FAQ
Yes. Licensed providers treat patients in all 50 states today. Licenses are held by the individual providers, state by state, through the professional corporation that employs or contracts them, and every visit is routed to a provider licensed in the patient's state.
No. The operator's company is the management services organization: it owns the brand and runs the business. The medical practice is a physician-owned professional corporation whose licensed providers make every clinical decision, so the brand needs no medical license of its own.
Georgia, Mississippi, Oklahoma, Rhode Island, and West Virginia require a live, real-time interaction before a first prescription. Tessic books patients in those states into a live visit automatically. 25 more states allow async visits only under specific conditions, listed in the table.
In most states, yes, by live video. Under the DEA's temporary extension, in effect through December 31, 2026, a DEA-registered provider can prescribe Schedule II–V medications by audio-video telehealth without a prior in-person exam. Several states add their own limits: Minnesota requires an in-person exam for testosterone, New York treats testosterone as Schedule II, and Connecticut bars Schedule III by telehealth outside psychiatric and substance-use care. Every state's rule is in the table, and controlled-substance visits are never async on Tessic.
Licenses are renewed ahead of each state's cycle and screened every month, so lapses are caught before they matter. Every state is covered by more than one licensed provider, so one provider leaving never takes a state offline.
Intake records the state the patient is in at the time of the visit and checks it against the shipping address. A patient who is traveling is treated under the rules of the state they are in, by a provider licensed there.
About three weeks for a physician in a compact state, 60 to 105 days by full application elsewhere, and 4 to 12 weeks for a nurse practitioner. New licenses are started from each state's demand forecast, so capacity is added before a brand needs it.
SOURCES
Reviewed September 2026. State and federal rules are summarized from the public sources above and simplified for comparison; they are general information, not legal advice. Telehealth rules change often, and every Tessic Health visit follows the rule in force in the patient's state at the time of the visit.
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