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Telemedicine Prescribing Flexibilities Extended Through 2026, Uncertainty Remains
The Drug Enforcement Administration (DEA) and the department of Health and Human Services (HHS) have jointly extended temporary rules allowing the prescribing of controlled substances via telemedicine through December 31, 2026, averting immediate disruption to patient care but leaving the long-term future of these practices uncertain.
The extension, issued on December 31, 2025, marks the fourth time these flexibilities have been prolonged. Originally implemented during the COVID-19 public health emergency, the rules provide exceptions to the Ryan Haight Act (RHA), which typically requires an in-person medical evaluation before a practitioner can prescribe controlled substances remotely.
under the RHA, a prescriber must ordinarily conduct at least one in-person medical evaluation prior to prescribing a controlled substance via telemedicine. However, the temporary rules allow DEA-registered practitioners to prescribe Schedule II through V controlled substances via telemedicine without this prior evaluation, provided the prescription is issued for a legitimate medical purpose, within the usual course of professional practice, and through a two-way, real-time interactive communication with the patient. Practitioners must also be appropriately registered to prescribe the specific controlled substance.
These temporary rules operate alongside two final rules, published in January 2025, concerning the prescribing of buprenorphine via telemedicine and telemedicine for Veterans Affairs patients. While these final rules have stricter requirements, the DEA clarifies that prescribers covered by either can still utilize the flexibilities offered by the temporary rule. “The three rules constitute three separate sets of authority for telemedicine prescribing,” according to the Fourth Temporary Rule.
The extension arrives just in time, as the existing flexibilities were set to expire on January 1, 2026. Provider and patient advocacy groups have consistently called for a permanent rule to eliminate the looming “telemedicine cliff” – the sudden loss of access to remote prescribing for patients who haven’t undergone an in-person evaluation. telemedicine is particularly crucial for individuals in rural areas or those with limited mobility, lowering barriers to essential care.
Data released by the DEA indicates the significant impact of these flexibilities. In 2024 alone, approximately seven million – or 16% – of all controlled substance prescriptions were issued without a prior in-person medical evaluation. A sudden end to these practices would undoubtedly have “wide-ranging effects on patient care,” a senior official stated.
the potential consequences of losing these flexibilities were recently underscored by a government shutdown. Congressionally-granted Medicare telemedicine flexibilities expired on September 30, 2025, coinciding with the start of the shutdown. During the first 17 days of the shutdown, fee-for-service telemedicine visits decreased by an average of 24%, with some states experiencing drops of 40% or more. The Fourth Temporary Rule suggests that removing the prescribing flexibilities could similarly disrupt access to critical services.
While this latest extension provides short-term relief, a state of regulatory uncertainty persists. HHS has characterized the rule as a temporary measure “while permanent rules are finalized.” Whether these permanent rules will be established swiftly enough to avoid the need for further extensions remains an open question. .
The future of telemedicine prescribing hangs in the balance, requiring a framework that effectively balances patient access with safety and responsible prescribing practices
