Article arranged by: Taylor A. Stonerock & Miranda A. Preston
The U.S. Drug Enforcement Administration (DEA) and the Department of Health and Human Services (HHS) have issued a fourth temporary extension[1] (the “Fourth Temporary Extension”) of rules that allow providers to prescribe controlled substances via telemedicine without an initial in-person exam through December 31, 2026.
These rules, first introduced during the COVID-19 public health emergency, were set to expire on December 31, 2025. According to DEA and HHS (collectively, the “Agencies”), in addition to preventing the “telemedicine cliff,[2]” the extension will prevent disruption of care, including a backlog of patients needing in-person appointments, allow the DEA additional time to finalize and implement appropriate regulations, and provide adequate time for patients and health care providers to come into compliance with any new requirements adopted in the final rule. The Agencies have not finalized the DEA’s proposed rule for a special telemedicine registration (the “Proposed Rule”).
Background
The Ryan Haight Act of 2008 (“Ryan Haight Act”) requires providers to conduct an initial in-person medical evaluation before prescribing a controlled substance via telemedicine, subject to very limited exceptions.[3] In response to the COVID-19 public health emergency, the DEA temporarily suspended the in-person evaluation requirement under the Ryan Haight Act.[4] This allowed providers to prescribe Schedule II-V controlled substances via telemedicine without having first conducted an in-person exam of the patient. These flexibilities made it easier to prescribe Schedule II-V controlled substances through telehealth, but also led to concerns about possible misuse and excessive prescribing. Since 2020, the DEA has continued to extend these flexibilities, but only for short periods of time.
The Push Toward Permanent Rules
On January 17, 2025, the Agencies published two final rules regarding telemedicine prescribing: the Expansion of Buprenorphine Treatment via Telemedicine (the “Buprenorphine Rule”) and Continuity of Care via Telemedicine for Veterans Affairs Patients[5] (collectively, the “Two Final Rules”). The Buprenorphine Rule expanded the circumstances under which DEA-registered practitioners can prescribe schedule III-V controlled substances for the treatment of opioid use disorders via telemedicine, including an audio-only encounter.[6] The effective date of the Two Final Rules was delayed by the Agencies. Pursuant to the Fourth Temporary Extension, the Two Final Rules went into effect on December 31, 2025. In the Fourth Temporary Extension, the DEA clarified that “…even [DEA]…registrants covered by one or both of the Two Final Rules may continue to utilize the telemedicine flexibilities under the fourth temporary rule, which imposes fewer requirements than the Two Final Rules.”
Currently, the pandemic-era telemedicine prescribing flexibilities will remain in place until December 31, 2026. It remains unclear when and if a final rule will be adopted, and to what extent any final rule will differ from the Proposed Rule. Healthcare providers should continue to stay up to date on the current regulatory landscape regarding controlled substance prescribing via telemedicine.
If you would like more information, please contact Miranda Preston or Taylor Stonerock.
[1] Fourth Temporary Extension of COVID‑19 Telemedicine Flexibilities for Prescription of Controlled Medications, 90 Fed. Reg. 61301 (Dec. 31, 2025).
[2] The abrupt end to the ability to prescribe controlled substances to patients who have not had an in-person medical evaluation is often referred to as the “telemedicine cliff.” See 90 Fed. Reg. 61301, 61303.
[3] 21 U.S.C. § 829(e).
[4] Drug Enforcement Admin., DEA’s Response to COVID‑19 (Mar. 20, 2020), https://www.dea.gov/press-releases/2020/03/20/deas-response-covid-19.
[5] Expansion of Buprenorphine Treatment via Telemedicine Encounter, 90 Fed. Reg. 6504 (Jan. 17, 2025); Continuity of Care via Telemedicine for Veterans Affairs Patients, 90 Fed. Reg. 6523 (Jan. 17, 2025).
[6] Expansion of Induction of Buprenorphine via Telemedicine Encounter, 88 Fed. Reg. 12890 (Mar. 1, 2023).
