As of October 8, 2026
DEA-registered practitioners may prescribe Schedule II–V controlled substances by telemedicine without a prior in-person evaluation through Dec 31, 2026, under DEA’s fourth temporary extension (90 FR 61301). The buprenorphine and VA telemedicine rules have been in effect since Dec 31, 2025. The special registration that may replace the flexibilities was proposed in January 2025 and is not final.
What the law requires without the flexibilities
The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 bars dispensing a controlled substance by means of the internet without a valid prescription, and a valid prescription requires at least one in-person medical evaluation by the prescriber, 21 U.S.C. 829(e). The statute lists the exceptions under which the practice of telemedicine counts instead, at 21 U.S.C. 802(54). Those include treatment while the patient is in a DEA-registered hospital or clinic, treatment in the physical presence of a DEA-registered practitioner, certain Indian Health Service and VA circumstances, a public health emergency declared by the Secretary of Health and Human Services, and a practitioner holding a special registration for telemedicine.
The special registration exception has been in the statute since 2008. DEA never implemented it until its January 2025 proposal, which is why the COVID-era flexibilities have been extended four times.
The rules in force and pending
Fourth temporary extension
In force through Dec 31, 2026
Schedule II–V by telemedicine without a prior in-person evaluation, for DEA-registered practitioners, for a legitimate medical purpose, over an interactive audio-video system (audio-only where 42 CFR 410.78(a)(3) allows it). 90 FR 61301.
Buprenorphine rule
In force since Dec 31, 2025
An initial six-month supply of buprenorphine for opioid use disorder by telemedicine, including audio-only, after a check of the state PDMP. 90 FR 6504, effective date as amended by 90 FR 13410.
VA continuity-of-care rule
In force since Dec 31, 2025
VA practitioners may prescribe by telemedicine to a VA patient who has had an in-person evaluation by another VA practitioner within the prior 24 months. 90 FR 6523.
Special registration
Proposed Jan 17, 2025; not final
Proposed a special registration for telemedicine prescribing, an advanced registration for some Schedule II prescribing by specialists, a registration for online platforms, and state-by-state telemedicine registrations, with recordkeeping and PDMP duties. 90 FR 6541. The final rule may differ.
Timeline
May 10, 2023
First temporary extension of the COVID-19 telemedicine flexibilities
88 FR 30037
Oct 10, 2023
Second temporary extension, through Dec 31, 2024
88 FR 69879
Nov 19, 2024
Third temporary extension, through Dec 31, 2025
89 FR 91253
Jan 17, 2025
Buprenorphine and VA final rules published; special registration proposed
90 FR 6504; 90 FR 6523; 90 FR 6541
Mar 24, 2025
Buprenorphine and VA rules’ effective date delayed to Dec 31, 2025
90 FR 13410
Dec 31, 2025
Buprenorphine and VA rules take effect; fourth temporary extension published
90 FR 61301
Aug 25, 2026
Final special registration rule sent to the White House Office of Information and Regulatory Affairs for review
reginfo.gov
Dec 31, 2026
Fourth temporary extension ends
90 FR 61301
What to do before Jan 1, 2027
- List every patient receiving a controlled substance by telemedicine, by medication schedule and the state the patient is in.
- Mark the patients covered by the buprenorphine or VA rules, and those who have had an in-person evaluation by the prescriber.
- For everyone else, plan the in-person evaluation or the exception each prescription will rely on if the flexibilities end.
- Confirm each prescriber holds a DEA registration, and any state controlled-substance registration, in every state where patients are located.
- Check state law: several states limit controlled-substance prescribing by telehealth more tightly than DEA. See telehealth laws by state.
- Watch the Federal Register for the final special registration rule and its effective date.
Our DEA Telemedicine Readiness plan does this for your practice and is refreshed at no charge when the final rule publishes. Registration filings are handled by the White Glove licensing teams.
Questions
- Can I prescribe controlled substances by telemedicine without an in-person visit right now?
- Yes, through Dec 31, 2026, if you are DEA-registered, the prescription is for a legitimate medical purpose in the usual course of practice, and you use an interactive telecommunications system as defined at 42 CFR 410.78(a)(3). That is the fourth temporary extension, 90 FR 61301. State law can be stricter.
- What happens on Jan 1, 2027?
- Unless DEA extends the flexibilities again or a final special registration rule takes effect, the Ryan Haight Act’s in-person evaluation requirement applies again (21 U.S.C. 829(e)), with its statutory exceptions. The buprenorphine and VA rules, in effect since Dec 31, 2025, continue.
- Is the special registration rule final?
- Not as of October 8, 2026. DEA proposed it on Jan 17, 2025 (90 FR 6541), and a final rule went to the White House for review on Aug 25, 2026. Until it is published in the Federal Register, its terms are a proposal.
- Does the buprenorphine rule cover all addiction treatment?
- It covers Schedule III–V narcotic medications approved for opioid use disorder, which in practice means buprenorphine. It allows an initial six-month supply by telemedicine, including audio-only, after a check of the state prescription drug monitoring program. Further prescriptions need an in-person evaluation or another route the rules allow.
Sources
- Fourth temporary extension, 90 FR 61301 (Dec 31, 2025)
- Buprenorphine final rule, 90 FR 6504 (Jan 17, 2025)
- VA continuity-of-care rule, 90 FR 6523 (Jan 17, 2025)
- Special registration proposed rule, 90 FR 6541 (Jan 17, 2025)
- Effective date delay, 90 FR 13410 (Mar 24, 2025)
- 21 U.S.C. 829(e) and 802(54)
Research, not legal advice. Confirm with your counsel before relying on it.