Third Circuit upholds New Jersey's rule that telehealth doctors must hold a New Jersey license
In a precedential opinion filed August 31, 2026, the court rejected First Amendment, Commerce Clause and Privileges and Immunities challenges by two out of state physicians and New Jersey patients. State licensure of telemedicine is content based, the court said, but a long regulatory tradition means strict scrutiny does not apply.
New Jersey requires any physician who treats a patient located in the state by telemedicine to hold a New Jersey license. In MacDonald v. President of the New Jersey State Board of Medical Examiners, No. 25-2090, two physicians licensed elsewhere and three New Jersey residents argued that the requirement burdened their speech and interstate commerce. The district court dismissed; on August 31, 2026 a Third Circuit panel led by Judge Hardiman affirmed, with one modification, in an opinion designated precedential.
The court held that the licensing law is content based, since its application turns on what the speaker says, but concluded that strict scrutiny is inappropriate because professional licensing sits within a long and robust regulatory tradition, and that the law passes muster. The remaining constitutional claims were found insubstantial.
- Telehealth platforms whose prescribers treat patients across state lines under licenses from other states.
- Pharmacies that fill those prescriptions, whose validity depends on the prescriber being licensed where the patient is.
The law upheld is New Jersey's. The opinion is precedential in the Third Circuit, which covers New Jersey, Pennsylvania, Delaware and the U.S. Virgin Islands, and persuasive elsewhere.
| Source published | August 31, 2026 | Opinion filed. |
|---|---|---|
| Decided | August 31, 2026 |
The pandemic era argument that telemedicine escapes state by state physician licensure has now lost in a precedential appellate opinion. For a pharmacy the consequence is one step removed but concrete: a prescription written by a physician not licensed in the patient's state is not a valid prescription there, and a dispensing pharmacy is expected to know it. Prescriber licensure in the patient's state is a fact a pharmacy, a board or a certifier can check.
- For each telehealth platform you fill for, ask how it verifies that the prescriber holds a license in the patient's state at the time of the visit.
- Spot check a sample of recent telehealth prescriptions against the prescriber's licensure in the patient's state.
- Read the opinion if you operate in New Jersey, Pennsylvania or Delaware; it is binding law there.
Licensure and Registration. The Licensure and Registration domain verifies licensure against the issuing authority. Prescriber licensure in the patient's state is part of what makes a dispensed prescription valid.
- MacDonald v. President of the New Jersey State Board of Medical Examiners, No. 25-2090, precedential opinion PrimaryU.S. Court of Appeals for the Third CircuitNo. 25-2090; D.N.J. No. 1:23-cv-23044Retrieved Sep 22, 2026
Filed August 31, 2026; the introduction and Part II on content based laws, tradition and the conclusion that strict scrutiny is inappropriate.
Know where your pharmacy stands before the rules change again.
Certified pharmacies are re-verified nightly against state boards, federal enforcement records and their own websites.