In response to the COVID-19 public health emergency, on January 31, 2020, the Drug Enforcement Administration (“DEA”) issued temporary exceptions to the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 (the “Ryan Haight Act”) and the DEA’s implementing regulations, including 21 U.S.C. § 802(54)(D). These exceptions were intended to ensure continuity of care while minimizing in-person contact and reducing strain on the healthcare system.
Under the Ryan Haight Act, practitioners are generally prohibited from prescribing controlled substances without first conducting an in-person medical evaluation of the patient. The DEA’s temporary policies waived this in-person requirement when certain conditions were met, allowing practitioners to prescribe controlled medications through telemedicine encounters.
Although the federal COVID-19 public health emergency officially ended in May 2023, the DEA has continued to extend these telemedicine flexibilities through a series of temporary annual rules to avoid disruption to patient care while they promulgate a final set of regulations. On December 31, 2025, the DEA issued its fifth temporary extension of these exceptions.
As a result of this extension, practitioners may continue to prescribe controlled substances without a prior in-person medical evaluation under the following framework:
- Schedule II–V controlled substances may be prescribed following a real-time, two-way audio-visual telemedicine encounter; and
- Schedule III–V controlled substances may be prescribed following an audio-only telemedicine encounter, provided all other applicable federal and state prescribing requirements are satisfied.
In both circumstances, an in-person medical evaluation is not required before issuing the prescription, so long as the practitioner is otherwise authorized to prescribe the controlled substance and the prescription is issued for a legitimate medical purpose in the usual course of professional practice.
The current temporary extension remains in effect through December 31, 2026. During this period, providers, telehealth platforms, and digital health companies may continue relying on these flexibilities while the DEA evaluates and works toward a permanent regulatory framework for telemedicine prescribing of controlled substances.
Providers should be aware that these exceptions are limited to federal law. State licensure requirements, state telemedicine laws, and state-specific controlled substance prescribing rules continue to apply. Additionally, the DEA has signaled that future permanent rules may impose new conditions, such as registration requirements or documentation obligations, making it critical for providers to stay informed as the regulatory landscape evolves.
Key Takeaways for Providers and Telehealth Companies
- Telemedicine prescribing flexibilities remain in place through December 31, 2026. Providers may continue relying on the COVID-era exceptions to the Ryan Haight Act without interruption.
- No in-person exam is required under federal law to prescribe controlled substances when the applicable telemedicine requirements are met.
- Audio-video visits may be used to prescribe Schedule II–V controlled substances.
- Audio-only visits may be used to prescribe Schedule III–V controlled substances.
- State law still governs. Providers must remain compliant with state licensure requirements, state telemedicine rules, and any state-specific restrictions on controlled substance prescribing.
- The extension is temporary. The extension is temporary, and the DEA is actively advancing regulatory proposals. Future regulations may impose additional requirements, such as special telemedicine registrations, recordkeeping obligations, or limitations on certain drug classes. Providers should prepare now for imminent regulatory change.
Providers should prepare for change. Telehealth platforms and prescribing practitioners should monitor DEA rulemaking closely and be ready to adjust workflows before the expiration of the extension at the end of 2026.