Telemedicine in Panama: what a physician may prescribe remotely

What Law 203 of 2021 says about telemedicine in Panama

Telemedicine in Panama is not a legal vacuum. Law 203 of March 18, 2021, published in Gaceta Oficial 29244-A, "establishes the guidelines for the development of telehealth in Panama" and supports the Ministry of Health (MINSA) and the Social Security Fund (CSS); its article 1 also lets "any private entity that wishes to" implement telehealth if it meets the guidelines¹. President Laurentino Cortizo signed it on March 18, 2021⁵. The law defines telemedicine as the provision of health services at a distance by "qualified health professionals" (art. 2, no. 19) and requires every provider, public or private, to comply with the licensing rules¹.

The law distinguishes four categories: interactive telemedicine (real-time video call), non-interactive (asynchronous communication), tele-expertise and telemonitoring (art. 10)¹. In the first two, "the health professional will assume responsibility for the diagnosis, opinion, treatment and interventions ordered"¹. Article 9 adds that the professional, "within the context of their autonomy", decides whether the user needs in-person care¹. In the public sector, MINSA and the CSS are in charge of implementing the Telemedicine System (art. 21)¹, and in August 2025 MINSA Resolution 1142 created a national telehealth program for public facilities, coordinated with the CSS and framed within Law 203⁴.

Remote prescriptions: what the law does and does not regulate

Article 14 is the one that most affects the prescribing physician. It establishes a "Digital Medical Prescription System", a platform "through which all medical prescriptions issued within care under the telemedicine modality will be issued", along with systems for disability certificates and medical attendance statements; the electronic signature has full validity when it meets the requirements of the applicable rules¹. Press coverage at the time summarized that, through telehealth, physicians would be able to issue prescriptions and sick leave⁶.

What Law 203 does not do is create a special product category. It contains no rules of its own for controlled substances or for products without sanitary registration¹; those matters stay under their own rules. Law 419 of 2024 defines the medical prescription as "the prescription issued by a qualified physician" (art. 3, no. 71)⁸. This is a reading of the cited texts, not a MINSA ruling: prescribing by video does not change what can be prescribed, only the channel. On sanitary registration and import, see the physician's legal map in Panama, and on enforcement against unregistered products, the stem cell case in Panama. In August 2026 MINSA inspected two stem cell therapy establishments and opened administrative files over possible violations, including "the presence of products without sanitary registration"¹¹.

Foreign physicians and third-party platforms

Article 16 provides that for medical services delivered through telehealth or telemedicine, "the same limitations established for the practice of in-person medicine in the country will apply" to foreign institutions and physicians¹. In other words, treating a patient in Panama from another country does not exempt a physician from Panamanian licensing. If the platform belongs to a third party, article 11 makes the provider responsible for verifying its security, privacy and confidentiality conditions¹, and article 17 requires platforms to meet the HL7 standard and interoperate with public-sector institutions' systems¹. A study published in the University of Panama's Anuario de Derecho traces telemedicine in the country back to 1999 and raises the open ethical and legal questions, including how to guarantee consent at a distance⁹.

Informed consent at a distance

Article 6 obliges whoever is responsible for the activity to obtain the patient's informed consent and explain "how care works through the use of information and communication technologies", the scope, risks, benefits, responsibilities, privacy handling, handling of personal data, "the conditions for prescribing health technologies", and procedures for emergencies and technology failures¹. Consent is recorded in the patient's clinical history, with a digital, electronic or handwritten signature¹. In addition, every telemedicine activity must be recorded in the clinical history (art. 13) and, if the video call is recorded, authorization from the user and the professional is required (art. 10)¹. If artificial intelligence is used in tele-orientation, article 8 requires telling the user and naming the party responsible for the platform¹.

Health data: Law 81 of 2019 and the Penal Code

Law 81 of March 26, 2019, published in Gaceta Oficial 28743-A, defines as sensitive the personal data that may reveal, among other aspects, "data relating to health" (art. 4, no. 11)². For consent over sensitive health data, article 8 requires it to be "prior, irrefutable and express"². Cross-border transfer of confidential or sensitive data is allowed if the controller meets standards equal to or higher than the law's, or if the data subject consents (art. 5)², which matters when a video-consultation platform stores data abroad. Executive Decree 285 of May 28, 2021 regulated the law, and the National Authority for Transparency and Access to Information (ANTAI) created a personal data protection directorate³. In January 2025 ANTAI reminded the public that it supervises compliance and that sensitive data requires greater security guarantees¹⁰.

The sanctions are real. Failing to observe the rules on sensitive data is a very serious infraction (art. 41, no. 2); fines run from B/.1,000 to B/.10,000 (art. 36) and, for very serious offenses, registries may be shut down or storage and processing suspended (art. 43)². The controller must also compensate property or moral damage (art. 37)². Law 203 itself toughened the Penal Code: its article 22 amended article 291 to increase the penalty by one third to one sixth for unlawful access to databases of "hospitals or any type of entity that handles information relating to medical data"¹.

What the evidence says about prescribing by telemedicine

The law does not settle whether remote prescribing is safe; studies do, and almost all are from the United States and so cannot simply be extrapolated to Panama. In pediatric respiratory infections, a matched cohort with 4,604 direct-to-consumer telemedicine visits found antibiotics in 52% of visits, versus 42% in urgent care and 31% in primary care, and guideline-concordant management in 59% versus 67% and 78%¹². In another study of 12,842 respiratory-infection visits, antibiotics were prescribed in 55%, and 93.4% of parents gave five stars when an antibiotic was prescribed versus 80.8% when it was not: satisfaction can push toward over-prescribing¹³.

The picture is not uniformly negative. In a retrospective cohort of US veterans with opioid use disorder treated with buprenorphine, using telehealth was associated with a lower risk of discontinuing treatment than in-person care (adjusted hazard ratio 0.69; 95% CI 0.60 to 0.78 for substance use disorders)¹⁴. The practical lesson for the physician is that the channel matters less than the protocol: documented indication, follow-up and judgment about when to refer to an in-person visit, which article 9 of Law 203 expressly leaves to the physician's judgment¹¹²¹⁴.