The DEA Special Registration for Telemedicine, as Proposed

The special registration for telemedicine is a proposed rule, not a law you can comply with yet. DEA published it on January 17, 2025 as Special Registrations for Telemedicine and Limited State Telemedicine Registrations (90 FR 6541, RIN 1117-AB40). A final version went to the White House Office of Information and Regulatory Affairs for review on August 25, 2026, according to a McDermott client alert, and the Unified Agenda lists November 2026 for final action. Until the final rule is published, everything below describes what DEA proposed, and the final rule may differ in ways that matter.

Why does a special registration exist at all?

Congress wrote it into the Ryan Haight Act in 2008. One of the seven exceptions to the in-person evaluation requirement, 21 U.S.C. 802(54)(E), covers telemedicine "conducted by a practitioner who has obtained from the Attorney General a special registration under section 831(h)." Section 831(h) lets DEA issue one to a practitioner who demonstrates "a legitimate need" and is registered in the state where the patient will be located. The SUPPORT Act of 2018 told DEA to issue final regulations within one year of October 24, 2018. It did not, and the COVID-era flexibilities have been filling the gap ever since. The background is in our Ryan Haight Act post.

What three registrations did DEA propose?

• Telemedicine Prescribing Registration. For physicians and mid-level practitioners prescribing Schedule III through V controlled substances by telemedicine without a prior in-person evaluation.
• Advanced Telemedicine Prescribing Registration. Adds Schedule II, limited to specialties. The proposed list: psychiatrists, hospice care physicians, palliative care physicians, physicians treating patients in long-term care facilities, pediatricians, neurologists, and mid-level practitioners board certified in psychiatric or psychological disorders, hospice, palliative, pediatric or neurological care unrelated to pain treatment. Mid-level practitioners would have to be board certified; physicians could show specialization through certification, training or the share of their practice.
• Telemedicine Platform Registration. For "covered online telemedicine platforms" that act as intermediaries in the practitioner-patient relationship. The proposal excludes hospitals, clinics, insurers and "local in-person medical practices," defined as practices with all offices within 100 miles of each other where less than 50 percent of controlled substance prescriptions in a month are issued by telemedicine.

On top of the special registration, a clinician would need a State Telemedicine Registration for each state where patients are located, and a platform would need one per state too.

What would it cost?

As proposed, each of the three special registrations would cost $888 per three-year cycle, the same as the existing practitioner fee. A clinician's State Telemedicine Registration would cost $50 per state; a platform's would cost $888 per state. Applications would go on a new Form 224S. A clinician licensed in 15 states would pay $888 plus $750 every three years under those numbers, before any state controlled substance registration fees. Final fees could change.

What would a special registration prescription require?

• Electronic prescribing through an EPCS system.
• Identity verification of the patient, with a record of how it was done. The proposal allows documents other than a photo ID where a patient has none, such as a pay stub or a bill showing the home address.
• PDMP checks. For the first three years after the rule took effect, the clinician would check the PDMP of the state where the patient is, the state where the clinician is, and any state with a reciprocity agreement with either. After three years, a "nationwide PDMP check" of all 50 states and any territory with its own PDMP. See PDMP checks for telehealth prescribers.
• Registration numbers on the prescription, both the special registration and the state telemedicine registration numbers, and the platform's numbers if a platform was involved.
• Audio-video only. The proposal would not authorize audio-only encounters for special registration prescribing, with an exception for opioid use disorder treatment.
• Recordkeeping and reporting to DEA, including an annual report that DEA costed in the proposal's economic analysis.

What did DEA propose for Schedule II?

Two possible limits, and DEA said it might adopt one or both. Under proposed 21 CFR 1306.45(b), the clinician would have to be physically located in the same state as the patient when issuing a Schedule II special registration prescription. Under proposed 1306.45(c), special registration prescriptions for Schedule II drugs would have to stay under 50 percent of the clinician's total Schedule II prescriptions in a calendar month, counting in-person practice. For an all-virtual ADHD practice, either limit would change the model. See ADHD stimulants by telehealth.

What can a practice prepare for now?

Some work pays off under any final version, because it rests on statutes and existing DEA rules rather than on the proposal.

1. Map patients to states. Section 831(h) already ties the special registration to the state where the patient will be located. Know, for each clinician, which states their controlled-substance patients sit in today.
2. Close the DEA registration gaps. A practitioner needs a DEA registration in each state where they prescribe controlled substances. Holding one in your home state does not cover patients in another. Filings go through our sister sites: White Glove APRN for NPs, White Glove PA for PAs and White Glove IMLC for physicians.
3. Get PDMP access in every patient state. Some states only grant access to prescribers licensed there; find out now.
4. Write an identity verification procedure and start logging how identity was checked. The buprenorphine rule already asks pharmacists to verify ID, and every version of the special registration proposal asks the prescriber to.
5. Confirm your EPCS setup works for every prescriber in every state you serve.
6. Decide whether you are a "platform." If your company recruits patients and routes them to contracted clinicians, read the platform definition with counsel. Our Counsel-Ready Structure Packet ($950) assembles the facts counsel will ask for.

What to avoid: buying software or signing contracts that only make sense if one particular version of the Schedule II limits is adopted. Wait for the text. When the final rule is published, our DEA Telemedicine Readiness engagement ($1,450) maps it against your patient roster within days. Rule history is on the DEA telemedicine rules hub, and the near-term decision is in what changes on January 1, 2027.