Prescription, Pharmacy, and Refill Policy

Prescriptions are issued only if the clinician determines that the medication is clinically appropriate, legally permitted, and safe based on the available information. Telehealth does not guarantee a prescription or refill.

Sky e-Clinic does not prescribe controlled substances under any circumstances. This includes opioids, benzodiazepines, stimulants, sleep medications such as zolpidem, tramadol, pregabalin, codeine-containing cough medicines, and all Schedule II–V drugs. Sky does not rely on any DEA telemedicine prescribing flexibility for this policy.

Prescriptions are sent only to pharmacies physically located in the state where the patient is located at the time of the visit. Sky e-Clinic currently provides care to patients located in 47 states and the District of Columbia. Patients located in New York, Kansas, or Wisconsin, or outside the United States, cannot be served at this time. If you are traveling, you must be physically located in one of Sky e-Clinic's served states/jurisdictions at the time of the visit or refill review, and your pharmacy must be physically located in that same state unless Sky e-Clinic expressly approves a different workflow under its current policy.

If a prescription already has remaining pharmacy-authorized refills, the patient normally contacts the pharmacy directly. Sky contact is not required merely to use a remaining refill. When a new Sky refill review, medication question, expired prescription, refill exhausted, pharmacy problem, side effect, symptom change, or follow-up decision is needed, the patient must use Elation Patient Passport secure messaging.

Refill requests must be associated with the patient's Sky chart and reviewed by the physician. Patients should use Patient Passport for refill questions or follow-up requests. If a pharmacy sends an electronic refill request through an available e-prescribing workflow, Sky may review it, but approval is not automatic and may require Patient Passport follow-up, a visit, or referral depending on the medication and clinical facts.

• Default-expedited approval is available for these medication classes when you are within the applicable follow-up window — typically 180 days for stable chronic maintenance medications and 90 days for medications requiring tighter follow-up such as contraceptives — your pharmacy is in your established state, and there are no outstanding labs or red-flag follow-up items: • Stable chronic maintenance medications (e.g., hypertension, hyperlipidemia, type 2 diabetes oral agents, hypothyroidism, GERD, allergic rhinitis controllers). • Continued contraceptives (oral contraceptive pill, patch, ring) for adult patients only at launch, when blood pressure / pregnancy-status assessment is current and the applicable Care Module is active. Sky e-Clinic does not provide confidential adolescent contraception services at launch (see Manual §22 and Pediatric Telehealth Operations Policy). • Topical dermatology medications under an established Care Module (eczema, acne topical, antifungal topical, topical steroid continuation), with no adverse-event report. • HSV suppression continuation (acyclovir, valacyclovir). • Erectile dysfunction medications (PDE5 inhibitor) and androgenic alopecia medications (finasteride, topical minoxidil) when no adverse effects are reported.

• The following classes are NOT eligible for default-expedited refill approval. A new evaluation, follow-up message, or visit is required: • Antibiotics for acute infection (a refill request usually signals treatment failure, resistance, or an adverse reaction — these need a fresh evaluation, not a refill). • Antivirals for acute infection (Tamiflu, Paxlovid, valacyclovir for an acute outbreak). • Systemic steroids (prednisone, methylprednisolone) — taper and continuation require clinical review. • Oral antifungals (terbinafine, fluconazole) — duration and hepatic-monitoring concerns. • Pediatric medications (any class) — the corresponding pediatric Care Module governs. • Acute pain medications (also see §2 controlled substance prohibition). • Mental health new starts (continuation of established medications may be eligible per Care Module; new diagnoses require referral).

Patients receiving ongoing refills for chronic conditions (such as hypertension, hyperlipidemia, type 2 diabetes, hypothyroidism) require an annual review visit to confirm continued safety, current labs, and your state of physical presence / location at the time of the review. Default-expedited refill approval bridges between annual reviews; the annual review re-validates the prescriber-patient relationship and ensures continued appropriateness.

• If your symptoms worsen, fail to improve, or you develop new symptoms (fever, severe pain, breathing difficulty, allergic reaction, neurological changes, etc.), do not wait for a refill response. Seek in-person care, urgent care, or emergency care (call 911) as appropriate. See the Emergency / Not-for-Emergency Notice for the full list of red-flag symptoms.
• Sky e-Clinic LLC | Formalized v3.0 | Nixon legal review done | 2026-06-20