The U.S. Department of Health and Human Services (HHS), working with the Drug Enforcement Administration (DEA), has issued a fourth temporary extension of telemedicine flexibilities, first introduced in response to the COVID-19 public health emergency.
Summary of Additional Extension
Effective January 1, 2026, through December 31, 2026, DEA-registered practitioners may continue prescribing controlled substances via telemedicine to patients who have not yet had an in-person evaluation. See 21 CFR 1307.41; 42 CFR 12.1. This includes Schedule II–V controlled medications through audio-video telemedicine encounters, as well as Schedule III–V narcotic medications approved by the Food and Drug Administration (FDA) for opioid use disorder treatment, specifically for maintenance and withdrawal management, via audio-only telemedicine encounters.
Importantly, this extension does not change existing requirements that prescriptions must still be issued for a legitimate medical purpose by licensed practitioners acting in the usual course of professional practice, pursuant to a real-time communication between practitioner and patient using an interactive telecommunications system, and in full compliance with applicable federal and state laws.
This extension preserves access to essential care without adding new requirements for patients or providers during the interim period, thereby averting a “telemedicine cliff,” the abrupt reduction of access to care, while permanent rules are finalized. Without this extension, the default rule under the Ryan Haight Act would apply, which generally requires at least one in-person medical evaluation before a practitioner may prescribe controlled substances remotely, subject to limited statutory exceptions. During the COVID-19 public health emergency, HHS and DEA temporarily waived that requirement, allowing audio-video encounters for Schedule II–V prescribing and, in certain circumstances, audio-only encounters for Schedule III–V narcotics used in opioid use disorder treatment. These flexibilities have been extended multiple times to prevent disruptions in care; this fourth extension continues them through 2026 while regulators work toward permanent solutions.
Special Registration Proposal for Permanent Standard
Looking ahead, HHS and DEA have signaled that permanent telemedicine prescribing standards are forthcoming. Although final regulations have not been decided, one proposal, the Special Registration for Telemedicine, offers insight into the possible direction of future rules. See Special Registrations for Telemedicine and Limited State Telemedicine Registrations, 90 FR 6541 (January 17, 2025).
Under this framework, practitioners with the Special Registration would be authorized to prescribe controlled substances via audio-video telemedicine and, in limited cases, audio-only, without ever conducting an in-person evaluation, provided they meet strict prescription, recordkkeeping, and reporting requirements. The proposal also includes registration for certain direct-to-consumer telemedicine platforms that dispense Schedules II through V controlled substances and act as intermediaries in the practitioner-patient relationship. In the meantime, providers should continue operating under the current extension through December 31, 2026.
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