DEA Extends Telemedicine Flexibilities for Prescribing Controlled Substances: What Clinics Must Know for 2026
The DEA is extending COVID-era telemedicine flexibilities for prescribing controlled substances into 2026. Learn what this means for aesthetics, telehealth, and wellness clinics.
Summary
The DEA has announced a Fourth Temporary Extension of the COVID-19 telemedicine flexibilities allowing Schedule II–V controlled substances to be prescribed via telehealth without an initial in-person visit. The extension is expected to last through 2026. Clinics must maintain compliant telehealth workflows, documentation, PDMP checks, and prepare for future DEA rule changes.
Introduction & Background
The Drug Enforcement Administration (DEA) has signaled another major regulatory update that will impact telehealth, aesthetics, hormone clinics, weight-loss programs, wellness practices, IV clinics, and any provider prescribing controlled substances.
On November 10, 2025, the DEA submitted a new rule titled:
“Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications.”
This means the DEA will again extend the pandemic-era rules that allow clinicians to prescribe controlled substances via telehealth without an in-person exam, continuing the flexibility that millions of patients and thousands of clinics now rely on. Prior to this Covid-era change, the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 (an amendment to the Controlled Substances Act) required that telemedicine providers perform an initial in-person assessment prior to prescribing controlled substances. In early 2020, the Secretary of the Department of Health and Human Services issued a public health emergency, which triggered an exception to the in-person evaluation requirement for controlled substances prescribing. From a practical standpoint, this was a relief to providers who were already comfortable with telehealth services and wanted to continue treating patients when the pandemic restricted in-office visits. However, this also triggered a boom in telehealth only start ups, some of which have been criticized for unsafe prescribing practices and have been accused of taking advantage of the lifted requirements. Now, almost six years later, millions of US patients rely on telehealth services and the DEA has yet to make an official ruling on the future of telehealth prescribing.
For practices that prescribe controlled medications – such as testosterone, stimulants, certain weight-loss drugs, or anxiety medications – this update is critical.
Below is the most comprehensive guide available to what this extension means, why it matters, and how clinics should prepare.
What Exactly Did the DEA Announce?
The Short Answer
The DEA will extend telemedicine flexibilities for prescribing controlled substances for another year, likely through the end of 2026.
The Longer Answer
The extension allows clinicians to continue prescribing Schedule II–V controlled medications through telemedicine without a prior in-person exam as long as:
- The prescription is for a legitimate medical purpose.
- The prescribing is done via live audio-video telehealth.
- The prescriber complies with state law and state telemedicine rules.
- The clinician holds the appropriate DEA registration(s).
- The prescriber checks the state PDMP.
- Documentation is complete and defensible.
The extension is temporary, but historically each temporary extension has been followed by another, while the DEA finalizes long-term telemedicine prescribing rules
Why the DEA Is Extending the Rule (The Real Reason)
The DEA received more than 38,000 public comments when it attempted to roll back telemedicine prescribing freedoms in 2023–2024. The overwhelming majority of comments warned that:
- Millions of patients would lose access to necessary medications;
- Mental health care would become inaccessible;
- Rural and mobility-limited patients would be left without care;
- Provider capacity would drop; and
- Overdose risk could increase due to disruption in continuity of care.
The DEA’s decision to extend telemedicine prescribing flexibilities suggests the agency sees the value in maintaining them. In its third extension of the rule in 2024, the DEA explained that one reason for temporary rule extensions was to avoid spurring investment in new telemedicine companies that could enable problematic prescribing. In other words, the agency remains concerned about financially motivated, unsafe prescribing practices. At the same time, the DEA acknowledged the significant public health benefits of these flexibilities and warned that patients already receiving telehealth prescriptions would face major backlogs and delays if required to obtain in-person evaluations. Unfortunately, these competing priorities leave providers in limbo while the DEA works to reconcile them.
Nonetheless, it seems telemedicine prescribing is here to stay – in some form.
Who Benefits From the Extension?
Telehealth and Hybrid Practices
Especially those prescribing controlled medications like:
- Testosterone injections
- Stimulants (e.g., ADHD medications)
- Certain weight-loss medications
- Sleep or anxiety medications
Aesthetic and Wellness Clinics Expanding into HRT or Weight Loss:
Many aesthetic clinics prescribe:
- Testosterone (C-III)
- Phentermine (C-IV)
- Certain compounded medications containing controlled components
For now, prescribers at aesthetics clinics can continue telehealth prescriptions.
IV Therapy, Functional Medicine & Longevity Clinics:
Many non-traditional healthcare providers prescribe benzodiazepines, testosterone, or other controlled medications as part of their programs.
Medical Groups with Multi-State Telemedicine Operations:
This extension temporarily preserves business continuity, but isn’t a long term solution. Medical groups operating in multiple states via telehealth should closely monitor state and federal regulatory changes to ensure they are in compliance in each state they service.
What This Extension Does Not Change
It does not allow:
- Prescribing controlled substances via asynchronous telemedicine
- Prescribing without a valid clinician–patient relationship
- Prescribing without PDMP checks
- Prescribing off-label controlled substances for aesthetic reasons without medical justification
And it does not remove malpractice or board-disciplinary risks for improper prescribing, or state-level regulations for telehealth prescribing.
What Clinics Must Do Now: Your 2026 Readiness Guide
Tighten Telehealth Documentation (This is where most clinics fail)
Your chart note should show:
- Reason for visit
- Medical history
- PDMP check
- Assessment
- Why telemedicine was appropriate
- Why the controlled substance was medically necessary
- Risks & alternatives discussed
- Follow-up plan
- Monitoring requirements
Thorough charting can protect you in the event of an audit. If you manage or employ other providers, mitigate risk by implementing practice-wide policies and procedures about compliant charting.
Audit Your Telehealth Platforms
The platform must be:
- HIPAA-compliant
- Secure
- Able to store or document identity verification
- Capable of real-time audio-video
If not, you’re out of compliance under both federal and state rules, which could lead to audits, fines, or other enforcement actions.
Review DEA & State Registration Requirements
Many states require:
- Separate state-controlled substance registration
- Physical address in the state
- And adherence to state-specific telemedicine prescribing regulations, which providers often overlook
Some states (e.g., Texas, Florida) have their own restrictions even during the federal extension.
Review Pharmacy Relationships & Supply Chain Compliance
This is especially important for clinics prescribing:
- Testosterone
- Stimulants
- Compounding pharmacies selling peptides that contain controlled ingredients
The DEA has increased enforcement against “suspicious prescribing + suspicious dispensing.” A common “suspicious prescribing” practice known to trigger DEA enforcement are large quantities of identical prescriptions, because this may indicate that prescriptions are not being individually adapted to meet patient needs.
Prepare for the End of Flexibility
The DEA’s latest extension will likely last through 2026, but waiting for an official ruling (especially if your business model relies on flexible telehealth prescribing) could leave your practice exposed to regulatory and operational risks. Your clinic should have a contingency plan that addresses:
- In-person visits for renewal
- Hybrid telehealth + clinic model
- Agreements with partner providers in high-volume states
- Emergency workflows if the rule changes suddenly
If your business model relies on telehealth prescribing, You do not want to scramble when the DEA issues the final rule.
How This Impacts Aesthetic Clinics Offering HRT, Weight Loss, or Wellness Programs
Most aesthetic clinics now offer:
- Testosterone therapy
- Peptide protocols
- Weight-loss medications
- Sleep or anxiety aides for post-procedure management
If any are controlled, this extension applies.
But:
The aesthetic industry is under unprecedented scrutiny—RF microneedling, counterfeit toxins, peptide crackdowns, compounding pharmacy investigations—so telemedicine prescribing is not a “safe zone” for sloppy compliance.
This is the time to:
- Revise your consents
- Tighten delegations
- Upgrade intake and follow-up standards
- Train injectors and NPs on prescribing documentation
- Review your GLP-1 workflows
- Verify every controlled medication is properly sourced
Frequently Asked Questions
Can you prescribe testosterone via telemedicine under the DEA extension?
Yes, as long as you meet all federal and state requirements for telehealth and controlled-substance prescribing. Importantly, this includes state-level requirements for good faith exams, documentation, and patient-monitoring and follow-up mandates.
Do you need an in-person visit to start a stimulant?
Not during the extension, but this may change when the DEA issues a permanent rule.
Does this extension apply to telehealth-only companies?
Yes – as long as the company is legally structured and providers hold required DEA and state registrations. Telehealth-only companies should plan for the possibility of in-person assessment requirements in the near future.
Does this extension apply to GLP-1s?
GLP-1s are not controlled substances, so this rule will not directly affect GLP-1 prescribing practices. Nonetheless, providers prescribing GLP-1s via telehealth will need to comply with state and federal telehealth requirements for non-controlled substances.
Conclusion: Telemedicine Prescribing Is Safe for Now
The DEA’s extension is a relief for thousands of clinics and millions of patients, but it’s temporary, and enforcement pressure is growing in aesthetics, wellness, weight loss, HRT, and telemedicine.
This is the moment to:
- Get your policies in order
- Update provider training
- Audit charting templates
- Audit your MSO or corporate structure for any potential CPOM violations
- Review pharmacy partnerships
- Future-proof your practice
Stay Ahead of the 2026 DEA Telemedicine Rules
Get a clear, practical plan for updating your clinic’s prescribing, documentation, and telehealth workflows before the new rules take effect. The guidance outlines the steps needed to stay compliant and audit-ready.