On December 31, 2025, the federal Drug Enforcement Administration (DEA) extended current regulatory flexibilities related to tele-prescribing of controlled substances for another year. The DEA issued a fourth temporary extension (2026 Extension) of its pandemic-era telehealth flexibilities, which are now scheduled to end on December 31, 2026. The DEA explained that another extension was necessary “to prevent disruption of care and other problems” likely to arise if it ended the flexibilities before finalizing new tele-prescribing rules intended to appropriately “balance access to care with the necessary safeguards against diversion.”
A third temporary extension of the telehealth flexibilities related to tele-prescribing of controlled substances had been scheduled to expire on December 31, 2025 (see our analysis of that extension, and the previous rulemaking on this issue, here, here, and here). The DEA acknowledged the need to “prevent what has commonly been referred to as the “telemedicine cliff” that could jeopardize access to care, the “potential harms” of which have been emphasized by stakeholders to DEA.
Interestingly, the DEA also cited the recent “abrupt cessation of Medicare’s telemedicine flexibilities” as having a “negative impact” on patient access to care, in support of its decision to extend the tele-prescribing flexibilities once more.
The 2026 Extension temporary rule does not make any substantive changes to the tele-prescribing flexibilities, other than to extend their expiration date until December 31, 2026. As a reminder, the COVID-era tele-prescribing flexibilities, among other things, allow practitioners and patients to form new relationships involving the prescription of controlled substances via telemedicine (i.e., without an in-person medical evaluation), but continue to require that all such prescriptions be issued for a legitimate medical purpose by a DEA-registered practitioner acting in the usual course of professional practice, and be issued pursuant to an interactive audio-video telecommunications system (or audio-only for certain mental health and buprenorphine prescribing if the patient does not consent to video).
We will continue to monitor DEA rulemaking and guidance on tele-prescribing, and health care organizations would be well-advised to review their current telehealth and tele-prescribing practices in light of the extension to ensure continued compliant activities.