The Drug Enforcement Administration has signaled that it will issue a fourth temporary extension of the telemedicine flexibilities for prescribing controlled substances, pushing the threshold date further into 2026. This extension will allow providers and APPs licensed with DEA registration to continue prescribing Schedule II-V medications via telehealth visits without the traditional in-person visit requirement, at least until a permanent regulatory framework is finalized.
For clinicians, pharmacists, and health system leaders, this announcement carries immediate importance. This flexibility means that patients who receive telemedicine visits, whether for chronic pain management, opioid use disorder treatment, ADHD, or other conditions requiring controlled medications, can continue care without interruption. It also means that healthcare teams must remain vigilant about compliance, documentation, and diversion prevention even as the tele-prescribing environment remains in flux. The extension also affords institutions time to plan for the transition to new rulemaking. Currently, the flexibilities are slated to expire on December 31, 2025. The forthcoming rule points toward December 31, 2026.
Background
During the COVID-19 public health emergency, the DEA and the Department of Health and Human Services implemented temporary waivers that allowed practitioners to issue controlled substance prescriptions via telehealth without an in-person consultation. This included initial visits. The immediate goal was to preserve access to care when in-person visits were unsafe or restricted. Over successive extensions, these waivers have kept the tele-prescribing pathway open while the agencies developed proposed rules and engaged stakeholders. The third such extension ran through December 31, 2025.
What’s Next
The DEA’s title for the upcoming rule is “Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications.” While the full text has yet to be published, provider advocacy groups anticipate the extension will run through December 31, 2026, which gives healthcare providers and organizations roughly another year to prepare for a longer-term regulatory change. At the same time, the DEA is working on its “Special Registration” proposal for telemedicine controlled-substance prescribing, which would create new categories of provider registration, state telemedicine registration requirements, and reporting obligations to guard against diversion.
How it Impacts You
For physicians, pharmacists, nurse practitioners, physician assistants, and other prescribing clinicians, the extension means current workflows for remote controlled substance prescribing remain valid for now, but new regulatory burdens may be on the horizon. Healthcare administrators will want to evaluate telehealth platforms, ensure appropriate electronic prescribing of controlled substances is in place, and review internal policies to support documentation, patient identity verification, state licensure, and prescription drug monitoring program checks. Pharmacists should stay alert to changes in prescribing patterns, be prepared for potential special registration verification, and collaborate with prescribers on safe dispensing practices. Across the continuum, system leaders should view this extension as a transitional zone, maintaining access and compliance now, while tracking the rule-making process and building operational readiness for the next regulatory phase.
The DEA’s signal of an extension into 2026 gives all stakeholders breathing room, but it is not a permanent fix. Health systems, prescribers, pharmacists, and administrators will need to stay ahead of the evolving regulations governing telemedicine-based prescribing of controlled substances, and align policy, workflow, and technology accordingly.