The DEA telemedicine flexibilities end on December 31

The DEA rule that lets providers prescribe controlled substances by telemedicine, without first seeing the patient in person, runs out on December 31, 2026. A permanent replacement went to the White House for review on August 25. Its text is not public, so nobody outside government knows yet what it will ask of your providers.

What ends on December 31

Since the pandemic, DEA-registered practitioners have been allowed to prescribe Schedule II to V controlled substances by telemedicine with no in-person exam first. The DEA has extended that four times. The fourth extension runs from January 1 to December 31, 2026.

When it ends, the default under the Ryan Haight Act comes back: an in-person medical evaluation before a controlled substance is prescribed, with narrow exceptions.

What is meant to replace it

The DEA sent its final “special registration” rule to the Office of Management and Budget on August 25, 2026. Review usually takes up to 90 days, with one 30-day extension allowed, which puts the end of review somewhere between late November and late December. It may publish before the deadline. It may not, and the DEA has extended the old rules four times before rather than let them lapse.

What the 2025 proposal looked like

The final rule can differ from the proposal, but the January 2025 proposal is the best public guide to its shape:

• Three new registration types. Telemedicine Prescribing (Schedule III to V), Advanced Telemedicine Prescribing (Schedule II to V, for certain specialists), and a Telemedicine Platform registration for online platforms.
• A registration for every state a patient is treated in, issued by the DEA, proposed at $50 per state for clinicians.
• $888 for the special registration itself.
• A standard DEA registration still required underneath it.
• A nationwide prescription monitoring (PDMP) check before prescribing, with a three-year delay before that part takes effect.

If that survives, a telehealth prescriber picks up a new registration and possibly one per patient state, each with its own date, on top of the DEA registrations you already track per state of practice.

What to do this month

• List which providers prescribe controlled substances by telemedicine, across every client practice. Behavioral health and addiction medicine are the obvious place to start, but ask every practice.
• Note the states their patients are in, not only where the provider sits. Under the proposal, that is what decides how many registrations they need.
• Check their current DEA registrations and expiry dates, state by state.
• Ask each affected practice what its plan is for January 1. Whether to stop, switch to in-person visits or apply for a new registration is the practice’s decision. Knowing who is affected is yours.

We will write up the final rule when it publishes.

Not the same as Medicare telehealth

Whether Medicare pays for a telehealth visit is a separate question, set by Congress and CMS on its own timetable. This note is only about DEA prescribing rules.

RosterSafe tracks every DEA registration, license and payer enrollment across your client practices, and warns you before any of them lapse. Try it on one provider, free.