Telehealth prescribing flexibility extended through 2026

The U.S. DEA and HHS have extended the telehealth prescribing flexibility for controlled substances through Dec. 31, 2026. This marks the fourth temporary extension of this flexibility.

The flexibility allows healthcare practitioners to virtually prescribe Schedule II-V controlled medications via audio and video telehealth, including Schedule III-V controlled medications like Adderall and Vicodin, without having previously conducted an in-person medical evaluation. The flexibility, established during the COVID-19 public health emergency, waives a requirement of the Ryan Haight Online Pharmacy Consumer Protection Act of 2008.

The flexibility is immensely popular among healthcare stakeholders. In 2024, more than 7 million virtual prescriptions for controlled medications were issued without a prior in-person visit, according to data reviewed by federal agencies and published in the Federal Register. The recent lapse of overarching Medicare telehealth flexibilities during the government shutdown further demonstrates the challenges of temporary telehealth policies.

Though appreciative of the extension, telehealth advocates noted that the last-minute nature of the decision -- taken on Dec. 31, 2025 -- caused stress among those who depended on the telehealth prescribing flexibility.

"This extension came within hours of expiration, placing patients, providers, and health systems on the brink of unnecessary disruption. ATA Action is deeply grateful for the extension and recognizes that it was offered in good faith, as allowing these flexibilities to lapse for any extended period would have constituted a predictable and preventable public health crisis," said Alexis Apple, vice president of federal affairs at the American Telemedicine Association (ATA) and deputy executive director of ATA Action, in an emailed statement. "However, allowing the waiver to approach a hard deadline created avoidable uncertainty."

The HHS further noted that the extension gives the agencies time to finalize permanent regulations for telehealth prescribing, including the proposed special registration framework that would establish designated pathways for telehealth prescribing of controlled substances. 

Though telehealth stakeholders oppose the framework in its current form, the ATA's Apple noted that the organization supports "a permanent Special Registration framework that enables responsible patient care and equips the DEA with appropriate tools to prevent misuse."

But it also "encourage[s] the DEA to seek provider feedback when developing safeguards to reduce diversion, improve access to essential prescriptions for mental health, substance use disorder, and other chronic conditions, and prioritize patient safety."

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.