DEA Extends Telemedicine Flexibilities for Prescribing Controlled Medications Through 2026
Summary of the Fourth Temporary Rule and What Stakeholders Should Know
The Drug Enforcement Administration (DEA), jointly with the Department of Health and Human Services (HHS), has issued a Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for the Prescription of Controlled Medications. The temporary rule extends certain telemedicine prescribing flexibilities through December 31, 2026.
Effective dates: January 1, 2026 through December 31, 2026.
Quick Summary
- Action: Fourth temporary extension of telemedicine flexibilities
- Agencies: DEA (Department of Justice) and HHS (with SAMHSA acting on behalf of HHS in prior extensions)
- What is extended: Authorization for DEA-registered practitioners to prescribe Schedule II–V controlled substances via telemedicine without an in-person medical evaluation, if conditions are met
- Extension period: Through December 31, 2026
Background: The Ryan Haight Act and Telemedicine Prescribing
Under the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, a practitioner—subject to certain exceptions—may prescribe controlled substances remotely only after conducting at least one in-person medical evaluation within the practitioner-patient relationship.
During the COVID-19 public health emergency, DEA granted temporary exceptions to these remote prescribing requirements under statutory authority cited in the rule, enabling telemedicine prescribing under defined conditions.
These exceptions are commonly referred to as telemedicine flexibilities.
What the Fourth Temporary Rule Does
This Fourth Temporary Rule amends portions of 21 CFR 1307.41 and 42 CFR 12.1 to extend existing flexibilities through December 31, 2026.
Authorization (High-Level)
During the period May 12, 2023 through December 31, 2026, a DEA-registered practitioner is authorized to prescribe Schedule II–V controlled substances via telemedicine to a patient without having conducted an in-person medical evaluation, provided the conditions below are met.
Conditions Required (from the rule)
A practitioner is authorized to issue prescriptions under the temporary rule only if:
- The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice;
- The prescription is issued pursuant to communication using an interactive telecommunications system (as referenced in the rule);
- The practitioner is authorized under applicable DEA registration rules (or is exempt under applicable law); and
- The prescription is consistent with all other requirements of 21 CFR part 1306.
Why DEA and HHS Issued the Extension
The rule states that the extension is intended to prevent disruption that could occur if flexibilities expired before permanent regulations are finalized and implemented. The rule also describes stakeholder concerns about an abrupt shift back to pre-pandemic limitations, often described in the rule as the “telemedicine cliff.”
The agencies also state that the extension provides additional time for:
- Finalizing permanent regulations
- Allowing stakeholders time to prepare for compliance with any new registration, recordkeeping, reporting, or security requirements adopted in final rules
Interaction With DEA/HHS Final Rules Published January 17, 2025
The rule explains that two final rules were published on January 17, 2025:
- Expansion of Buprenorphine Treatment via Telemedicine Encounter (adding 21 CFR 1306.51)
- Continuity of Care via Telemedicine for Veterans Affairs Patients (adding 21 CFR 1306.52)
The rule notes these final rules were delayed and are scheduled to go into effect on December 31, 2025.
The temporary rule further explains that these authorities are separate and distinct, and that a prescription issued under the temporary rule follows the temporary rule’s requirements. Requirements of the final rules apply only when prescribing is done pursuant to those final rules.
What Stakeholders Can Track Operationally
While this temporary rule does not add new requirements, it clarifies the time window and conditions under which telemedicine prescribing flexibilities remain available through 2026. Stakeholders may want to track:
- Telemedicine prescribing workflows for controlled substances
- Compliance with DEA registration and 21 CFR part 1306 requirements
- Implementation timelines for any future final regulations that may add registration or operational requirements
Key Dates
- Published: Scheduled for publication in the Federal Register on December 31, 2025
- Effective: January 1, 2026
- Expires: December 31, 2026
Reference
Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications. DOJ. 21 CFR Part 1307. https://public-inspection.federalregister.gov/2025-24123.pdf
