In response to COVID–19 on January 31, 2020, the DEA granted temporary exceptions to the Ryan Haight Act and the DEA’s regulations under 21 U.S.C. 802(54)(D). For nearly six years, those flexibilities have remained in place through a series of temporary rules.
If you’ve been waiting for clarity on the future of telemedicine prescribing for controlled substances, the DEA just gave its clearest signal yet. The Office of Information and Regulatory Affairs (OIRA) has published a new entry titled: “Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications.”
This tells us one thing: The DEA is preparing to extend the current telemedicine flexibilities for another year.
Here is what we know so far and what it means for your practice:
1. The DEA Has Officially Submitted a New Final Rule for Review
The rule appeared on OIRA’s site on November 10, 2025, acting as a notice that it intends to extend telemedicine flexibilities. There is no information yet on the details of the rule, “Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications.”
While the rule’s text is not yet public, OIRA lists it as a “final rule.” Once a final rule reaches OIRA at this stage, it is typically published within weeks.
2. Telemedicine Flexibilities Will Likely Continue Beyond December 31, 2025
The DEA’s last extension runs through December 31, 2025. With this new rule pending, it is clear the DEA does not plan to let those flexibilities expire yet.
Under the existing framework, practitioners may:
Prescribe controlled medications (schedule II–V) via audio-video telemedicine
Prescribe schedule III–V controlled medications via audio-only telemedicine encounters
Do so without requiring an in-person medical evaluation
This was allowed so long as the prescribing of these medications otherwise complied with the requirements outlined in DEA guidance and regulations and applicable Federal and State law.
What Providers Should Do Now
Track state telemedicine and prescribing laws: Prescribing rules vary state-by-state.
Keep thorough documentation: Every telemedicine visit, patient location, and prescribing rationale must be documented.
Until the DEA publishes the new telemedicine final rule, nothing is guaranteed, but every indicator suggests remote prescribing of controlled substances will continue under the existing framework.
Clinics should continue operating under current rules, stay current with state law variations, and prepare for rapid updates once the final rule is released.