DEA and HHS Announce Fourth Extension of Telemedicine Flexibilities for Controlled Medications Through 2026

Telemedicine Flexibilities Extended to Prevent 'Telemedicine Cliff'

The U.S. Department of Health and Human Services (HHS) and the Drug Enforcement Administration (DEA) have jointly announced a fourth temporary extension of telemedicine flexibilities, permitting the remote prescribing of controlled medications through December 31, 2026. This critical measure is designed to prevent a 'telemedicine cliff' that would otherwise disrupt access to care for millions of Americans. The rule is effective from January 1, 2026, to December 31, 2026.

Background of Telehealth Waivers

These flexibilities originated in March 2020, at the onset of the COVID-19 Public Health Emergency (PHE), to ensure patients could continue receiving necessary medical care remotely when in-person visits were restricted or unsafe. The initial waivers allowed practitioners to prescribe controlled substances via telehealth without a prior in-person consultation. This latest extension follows three previous temporary rules, with the third having been set to expire on December 31, 2025.

Scope of the Extension and Patient Impact

Under this fourth temporary rule, DEA-registered practitioners are authorized to continue prescribing Schedule II-V controlled substances via telemedicine, even in cases where an initial in-person medical evaluation has not occurred, provided all conditions of the temporary rule are met. This includes allowing audio-only telemedicine encounters for prescribing Schedule III-V narcotic controlled medications approved by the Food and Drug Administration (FDA) for maintenance and withdrawal management treatment of opioid use disorder. The extension is particularly beneficial for:

• Patients in rural and underserved areas
• The elderly and individuals with mobility limitations
• Patients receiving treatment for mental health conditions or substance use disorder

The agencies believe this extension will result in significant cost savings for both patients and prescribers.

Rationale and Future Regulatory Landscape

The primary motivations behind this extension are to ensure continuity of care and to provide the DEA and HHS with additional time to finalize and implement permanent regulations. The DEA has acknowledged that the expiration of current flexibilities without a permanent framework could lead to an abrupt restriction of access to controlled medications. The agencies are actively working on a 'Special Registration' proposal for telemedicine, which aims to establish clear standards for prescribing controlled substances via telemedicine while balancing patient safety and preventing drug diversion. This ongoing effort reflects a commitment to adapting healthcare delivery to modern needs while maintaining necessary safeguards.