Pandemic-Era Telemedicine Prescribing Flexibilities for Controlled Substances Extended Through 2026, by Abbye Alexander, Esq., Christopher Tellner, Esq., and Henry Norwood, Esq., 3-3-2026

The U.S. Drug Enforcement Administration (DEA), jointly with the U.S. Department of Health and Human Services (HHS), has issued a fourth temporary rule extending pandemic-era federal telemedicine flexibilities for prescribing controlled substances through December 31, 2026.

Effective since January 1, 2026, this move averts a year‑end 2025 “telemedicine cliff,” preserving uninterrupted authority for clinicians to prescribe controlled medications via telehealth and maintaining critical access to care for patients nationwide.

Background: How We Got to a Fourth Temporary Rule

At the outset of the COVID‑19 public health emergency, DEA and HHS rapidly relaxed in‑person evaluation requirements under the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 to allow controlled substances to be prescribed via telemedicine. These flexibilities were initially tied to the public health emergency, but as that declaration wound down, the agencies began issuing a series of temporary extensions to avoid abruptly cutting off tele‑prescribing.

Over time, a clear pattern emerged: strong utilization of telemedicine for behavioral health, pain management, and substance use disorder care; broad stakeholder support for maintaining access; and persistent concern that an abrupt return to pre‑pandemic rules would destabilize care for high‑risk populations. Each prior temporary rule bought additional time for the agencies to collect public input, evaluate data, and craft permanent regulations. The fourth temporary rule continues that trajectory by pushing the expiration date to the end of 2026 and ensuring that no gap occurs after December 31, 2025.

What the Fourth Temporary Rule Does

The fourth temporary rule keeps in place the same telemedicine prescribing flexibilities that providers and patients have relied on since the pandemic era. In practical terms, this means:

• Clinicians may continue to prescribe Schedule II–V controlled substances via telemedicine without an initial in‑person examination under the extended COVID‑19 flexibilities, subject to all applicable federal and state requirements and any other DEA telemedicine exceptions.
• Patients who initiated treatment under the COVID‑19 flexibilities can maintain their care plans through telemedicine without being forced into a rapid, potentially destabilizing transition to in‑person visits solely to preserve access to medication.
• Telemedicine platforms, digital health companies, and brick‑and‑mortar practices can continue to operate under the existing remote‑care model through December 31, 2026, rather than reconfiguring workflows for a tighter in‑person requirement at the end of 2025.

By extending the existing pandemic-era framework—rather than narrowing it midstream—the rule prioritizes continuity and operational stability across the healthcare system.

Why DEA and HHS Extended Telemedicine Flexibilities Again

The rationale for the extension is straightforward: without this fourth temporary rule, federal telemedicine prescribing authority for controlled substances would have lapsed at the end of 2025, creating significant disruption in care. Many patients now receive ongoing treatment for conditions such as depression, anxiety, ADHD, chronic pain, and opioid use disorder through telehealth modalities, and their treatment plans often involve controlled medications. A sudden requirement to obtain in‑person visits for continued prescribing would have:

• Overwhelmed some in‑person practices and specialty clinics, particularly in mental health and addiction medicine.
• Left patients in rural or underserved areas without realistic access to qualifying prescribers.
• Increased the risk of treatment interruption, non‑adherence, relapse, or unmanaged symptoms.

The agencies have also been signaling for some time that they intend to establish a permanent telemedicine framework that balances access with diversion control. However, building that structure is complex: it requires weighing public comments, analyzing prescribing data, aligning with evolving state law, and coordinating across multiple programs and payors. Extending the current flexibilities to December 31, 2026, gives regulators additional runway to finalize and implement long‑term rules without sacrificing continuity of care in the interim.

Strategic Considerations Through 2026

With the new December 31, 2026 horizon in view, providers and digital health organizations should use this period strategically rather than treating it as a simple reprieve. Key steps to consider include:

• Scenario‑planning for the eventual transition: Compliance, legal, and clinical leadership should develop playbooks for several potential futures—ranging from relatively broad permanent telemedicine authority to a more constrained, use‑case‑specific regime.
• Data collection and quality monitoring: Organizations can strengthen their position in future policy discussions by tracking outcomes, adherence, diversion indicators, and patient satisfaction for tele‑prescribed controlled substances.
• Patient communication planning: As the 2026 deadline approaches, practices will need clear, proactive communication strategies to explain any future rule changes, set expectations, and prevent anxiety about ongoing access to care.
• Contracting and technology investments: Knowing that the flexibilities will last through 2026, organizations may be more comfortable making medium‑term investments in telehealth infrastructure, vendor contracts, and care‑model innovations.

Authors: Abbye Alexander and Christopher Tellner, Co-Chairs of the Health Care/Managed Care Practice Group and Of Counsel Henry Norwood