After more than 16 years of waiting, the Drug Enforcement Administration’s telemedicine special registration rule has reached the last stop before publication. The DEA sent its final rule to the White House Office of Management and Budget’s Office of Information and Regulatory Affairs on August 25.
That matters because the temporary rules that let clinicians prescribe controlled substances over telehealth, without first seeing the patient in person, run out on December 31, 2026.
How we got here
The Ryan Haight Act of 2008 generally requires an in-person exam before a controlled substance is prescribed online. It also told the DEA to create a special registration so qualified telehealth prescribers could skip that step. The 2018 SUPPORT Act set an October 2019 deadline for those regulations. The deadline passed.
During the pandemic the DEA waived the in-person requirement, then extended that waiver several times. The most recent extension, published December 30, 2025, carries the flexibilities through the end of 2026.
In January 2025 the agency proposed a special registration framework with three tiers:
- A Telemedicine Prescribing Registration for Schedule III through V medications.
- An Advanced Telemedicine Prescribing Registration for Schedule II through V, aimed at specialists such as psychiatrists.
- A Telemedicine Platform Registration for online platforms involved in dispensing controlled substances.
The proposal also included prescription drug monitoring program checks, audio-video visit requirements, limits on Schedule II prescribing, identity verification and record keeping. An earlier 2023 proposal drew a record 38,000 public comments.
What we do not know yet
The text of the final rule is not public. Law firm McDermott Will & Schulte notes it is unknown how closely the final version tracks the January 2025 proposal. OIRA review typically takes up to 90 days, with a possible 30-day extension, which puts a decision close to the year-end deadline.
Separately, the DEA and HHS have already finalized narrower telemedicine rules for buprenorphine treatment of opioid use disorder and for Veterans Affairs patients.
Who this affects
The rule matters most to patients who get ADHD medication, certain mental health medications, testosterone and other controlled substances through virtual care. If no final rule or new extension arrives in time, those patients could face a sudden requirement to see someone in person.
GLP-1 weight loss medications such as semaglutide and tirzepatide are not controlled substances, so this rule does not change how they are prescribed by telehealth.
If you take a controlled medication through a telehealth provider, it is worth asking now whether your prescriber has a plan for January. We will report on the final rule when it is published.
Photo: A clinician conducts a telemedicine consultation by video. Intel Free Press via Wikimedia Commons, CC BY-SA 2.0.
Sources
- McDermott Will & Schulte: DEA appears close to finalizing telemedicine special registration
- McDermott+: DEA extends telemedicine flexibilities for controlled substance prescribing for 2026
- Federal Register: Special Registrations for Telemedicine and Limited State Telemedicine Registrations (proposed rule, Jan. 2025)
- Alliance for Connected Care: DEA Prescribing of Controlled Substances
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