On August 25, 2026, the Drug Enforcement Administration (DEA) sent its final rule establishing special registrations for the telemedicine prescribing of controlled substances to the Office of Management and Budget’s Office of Information and Regulatory Affairs (OIRA). OIRA review is typically the last step before a rule is published. Although the text of the rule has not been made public, OIRA held stakeholder meetings on it in September and October 2026 and has scheduled additional meetings for November.
When do the telemedicine flexibilities for controlled substances expire?
The timing is significant. During the COVID-19 public health emergency, the DEA and the U.S. Department of Health and Human Services (HHS) temporarily waived the in-person evaluation requirement for prescribing. Practitioners could prescribe controlled substances via telemedicine without first seeing the patient in person. Those flexibilities have since been extended several times to prevent a “telemedicine cliff” for patients and providers who rely on telehealth.
Most recently, in December 2025, the DEA and HHS issued the Fourth Temporary Rule, extending the flexibilities through December 31, 2026. The extension gives the DEA time to finalize permanent rules and gives providers time to prepare for any new registration, recordkeeping, or security requirements.
Submitting the final rule to OIRA signals that the DEA is working to put a permanent framework in place before the flexibilities lapse. The form of that framework may significantly change how telehealth providers and platforms prescribe controlled substances.
What is the DEA telemedicine special registration?
Under the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 (the “Ryan Haight Act”), except in limited circumstances, a practitioner must perform an in-person medical evaluation before prescribing a controlled substance via telemedicine. Holding a “special registration” is one of the limited exceptions to this in-person requirement. In 2018, the DEA was directed to issue final regulations establishing when a special registration may be granted and how to obtain one. Due in part to the COVID-era flexibilities allowing providers to prescribe controlled substances via telehealth, these regulations had been postponed repeatedly. Nearly eight years later, it appears that a final rule is imminent.
In January 2025, the DEA released a proposed rule entitled “Special Registrations for Telemedicine and Limited State Telemedicine Registrations” (the “Proposed Rule”). The Proposed Rule would have established three special registrations:
1. Telemedicine Prescribing Registration.
Authorizes qualified clinical health care practitioners to prescribe Schedule III–V controlled substances via telemedicine.
2. Advanced Telemedicine Prescribing Registration.
Authorizes qualified and specialized clinical health care practitioners (e.g., psychiatrists, hospice care physicians) to prescribe Schedule II–V controlled substances via telemedicine.
3. Telemedicine Platform Registration.
Authorizes covered online telemedicine platforms, in their capacity as platform practitioners, to dispense Schedule II–V controlled substances.
The DEA received more than 6,400 comments on the Proposed Rule. Because the final text has not been released, it is unclear how closely the final rule will track the Proposed Rule. Given the volume of comments and the change in administration since the Proposed Rule was issued, however, health care providers should not assume the two will match.
What does the final rule mean for telehealth providers and platforms?
For now, the rules have not changed. Through December 31, 2026, DEA-registered practitioners may continue to prescribe controlled substances via telemedicine without a prior in-person evaluation, as long as they meet the conditions of the Fourth Temporary Rule.
The main risk lies in the transition, because the window between publication of the final rule and expiration of the Fourth Temporary Rule may be short. If the final rule resembles the Proposed Rule, providers and platforms should expect a heavy administrative burden to obtain and maintain the required registrations. That burden would likely fall hardest on organizations operating in multiple states, because the Proposed Rule would require a separate telemedicine registration in each state where a patient is treated, unless an exemption applies. The Proposed Rule also would require direct-to-consumer telehealth platforms to register with the DEA for the first time.
Even if the final rule is approved in the next several weeks, it may not take effect immediately. The DEA and HHS could instead issue an interim extension of the current flexibilities to give providers and platforms time to come into compliance with the new rule. Providers should prepare now by identifying patients who may need an in-person evaluation or a transition of care if the final rule limits their current business practices, and by planning how those patients will be notified and transitioned.
Frequently Asked Questions
Can providers still prescribe controlled substances via telemedicine without an in-person visit?
Yes, through December 31, 2026, if they meet the conditions of the Fourth Temporary Rule.
Has the DEA published the final special registration rule?
No. The DEA sent the final rule to OIRA on August 25, 2026, but the text has not been made public.
Will telehealth platforms need to register with the DEA?
Under the Proposed Rule, covered direct-to-consumer platforms would need a Telemedicine Platform Registration. Whether the final rule keeps that requirement is not yet known.
How Frier Levitt Can Help
The final rule may differ substantially from the Proposed Rule, and the transition to a permanent framework may leave little time to adjust. Frier Levitt’s attorneys can help telehealth providers and platforms that prescribe, or facilitate the prescribing of, controlled substances evaluate their current prescribing models, update their compliance policies, and navigate the state law requirements that apply alongside the federal rules. Contact Frier Levitt today to discuss how your organization can prepare for potential changes to DEA telemedicine prescribing requirements.
