DEA, HHS Extend Telemedicine Flexibilities for Remote Prescribing of Controlled Substances

The Fourth Temporary Extension, effective through December 31, 2026, aims to prevent a disruptive "telemedicine cliff," which could abruptly limit patient access to care.

The U.S. Drug Enforcement Administration (DEA) and the Department of Health and Human Services (HHS) have extended telemedicine flexibilities, allowing healthcare providers to continue remotely prescribing Schedule II–V controlled substances after at least one initial in-person evaluation.

The Fourth Temporary Extension, effective through December 31, 2026, aims to prevent a disruptive "telemedicine cliff," which could abruptly limit patient access to care.

Under the extension, practitioners may prescribe controlled substances indefinitely via telemedicine, as long as prescriptions are issued for legitimate medical purposes and in compliance with federal and state regulations. The extension specifically covers Schedule II–V medications, ranging from high-abuse drugs like opioids and stimulants to lower-risk medications, including cough medicines containing small amounts of codeine.

The COVID-19 Telemedicine Flexibilities were first introduced in March 2020, during the public health emergency, allowing providers to prescribe controlled substances remotely without a prior in-person visit. At that time, telemedicine encounters could be conducted via video or audio-only.

The current extension maintains these flexibilities but notes that certain Schedule II medications may still require an initial in-person evaluation. Additionally, audio-only telemedicine visits remain permissible for prescribing Schedule III–V narcotic controlled substances approved by the FDA for opioid use disorder maintenance or withdrawal management, without a prior in-person visit, according to the DEA.

"Due to the impending expiration of the flexibilities provided in the Third Temporary Rule, DEA, jointly with HHS, has elected to again extend those flexibilities to maintain access to care during a limited window of time," the agencies said in a joint statement.

The extension comes amid concerns about the potential "telemedicine cliff," where the sudden end of remote prescribing flexibilities could disrupt patient care. The DEA noted receiving communications from patients, providers, and other stakeholders warning that ending the current rules without a permanent framework could abruptly restrict access to controlled medications.

"The abrupt end to the ability to prescribe controlled substances to patients who have not had an in-person medical evaluation is often referred to as the 'telemedicine cliff.' The potential harms are widespread," the agencies said.

The fourth extension ensures continuity of care while the federal government evaluates potential long-term telehealth regulations for controlled substance prescribing.

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