The Drug Enforcement Administration (DEA) is preparing to issue a fourth extension of the telemedicine prescribing flexibilities originally adopted during the COVID-19 public health emergency. The forthcoming rule will continue to permit DEA-registered practitioners to prescribe Schedule II–V controlled substances via telehealth without an initial in-person medical evaluation, thereby preserving the regulatory structure that has governed remote prescribing since 2020.

The rule, titled “Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications,” is expected in advance of the current extension’s expiration on December 31, 2025. In lieu of allowing these flexibilities to terminate at year-end, the DEA is anticipated to extend them for approximately one additional year, with the new period projected to run through December 31, 2026. The additional time is intended to allow the DEA and the Department of Health and Human Services to complete work on a permanent telemedicine prescribing framework.

The anticipated extension reflects the agency’s ongoing efforts to balance continued access to telehealth-based prescribing with its responsibilities to prevent diversion and safeguard controlled substances. The DEA has indicated for nearly two years that it is developing a comprehensive, long-term rule that will govern remote prescribing practices nationwide. That final rule is expected to address issues such as special telemedicine registration, identity-verification mechanisms, documentation requirements, and the potential differentiation of standards for certain controlled substances. The scope and complexity of such considerations, particularly as they affect behavioral health, addiction treatment, primary care, and long-term-care providers, have contributed to the extended timeline.

During the upcoming extension period, practitioners may continue to prescribe controlled substances to new patients via telemedicine, provided they comply with all other applicable federal and state requirements. The extension also preserves the current ability to initiate treatment for conditions such as ADHD and opioid use disorder through telehealth without an initial in-person examination. The DEA is expected to clarify that prescriptions issued under the continued flexibilities will remain valid throughout the duration of the new extension, thereby ensuring continuity of care for patients whose treatment was initiated remotely.

Once published in the Federal Register, the extension will formally authorize the continued use of the existing telemedicine prescribing flexibilities through 2026 while the DEA completes its development of a permanent regulatory regime.

While the expected extension provides welcome certainty, it is important to remember that these flexibilities remain temporary. The DEA has made clear that a permanent telemedicine framework is forthcoming, and providers should expect new requirements, documentation standards, and verification protocols once that rule is finalized.

As the regulatory landscape continues to shift, we can help organizations assess their current practices, prepare for future compliance obligations, and position their telemedicine operations to transition smoothly once the permanent rule is issued.

If your organization needs support in navigating DEA requirements or updating its policies, contact our healthcare attorneys at (212) 668-0200 or info@mdrxlaw.com.