The U.S. Drug Enforcement Administration (DEA), in partnership with the Department of Health and Human Services (HHS), has issued a Fourth Temporary Extension of the COVID-19 Telemedicine Flexibilities for the Prescription of Controlled Medications, extending the current telemedicine flexibilities through December 31, 2026.
Telemedicine flexibilities regarding prescription of controlled medications include:
- A DEA-registered practitioner can prescribe a Schedule II-V controlled substance to a patient using telemedicine without having conducted an in-person medical evaluation if required conditions are met.
Earlier efforts, including the proposed rule on Special Registrations for Telemedicine and two related final rules, sought to establish permanent pathways for telemedicine prescribing of controlled substances. These include:
- Proposed Rule: Special Registrations for Telemedicine and Limited State Telemedicine Registrations (still awaiting finalization).
- Final Rule: Expansion of Buprenorphine Treatment via Telemedicine Encounters.
- Final Rule: Continuity of Care via Telemedicine for Veterans Affairs Patients.
Together, these rules aim to create permanent exceptions to the in-person evaluation requirement historically mandated under the Ryan Haight Act of 2008, which normally requires a physical visit before a controlled substance prescription can be issued.
However, because the special registration infrastructure and broader permanent rules are not yet fully finalized, the DEA has continued to rely on temporary extensions of the telemedicine flexibilities first introduced during the COVID-19 public health emergency.
Key Features of the 2026 Extension
Under the new extension:
- Telemedicine prescribing without prior in-person visits continues to be allowed for Schedule II-V controlled medications through December 31, 2026, provided the encounter complies with DEA guidance, federal and state law, and security requirements.
- Audio-only telemedicine still may be used for certain opioid use disorder medications (e.g., FDA-approved Schedule III-V drugs for maintenance and withdrawal management).
- Practitioners covered by related final rules (e.g., buprenorphine and VA continuity of care pathways) can continue using those authorities, which may carry additional or specialized requirements.
Why the Extension Matters
The DEA’s extension emphasized the critical role telemedicine plays in ensuring access to care and medications, particularly for those in rural and underserved areas, the elderly, and patients with mobility limitations.
The extension is intended to avoid a sudden “telemedicine cliff” where patients could abruptly lose access to essential medications if pandemic-era flexibilities expire before permanent regulations are in place.
Looking Ahead
The DEA and HHS are expected to finalize long-term rules that establish clear standards for telemedicine prescribing of controlled substances, including requirements related to registration, recordkeeping, and technology use.
To learn more about this extension, visit the Federal Registrar.