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On December 31, 2025, the Drug Enforcement Administration ("DEA") and the Department of Health and Human Services ("HHS") jointly issued a Fourth Temporary Rule again extending the telemedicine flexibilities of the Ryan Haight Act (the "RHA"), now through December 31, 2026.
The RHA ordinarily requires a prescriber to have conducted at least one in-person medical evaluation prior to prescribing a controlled substance via telemedicine. During the COVID-19 Public Health Emergency, DEA promulgated a rule granting temporary exceptions to the RHA's remote prescribing requirements. The December ruling is the fourth extension of the telemedicine flexibilities allowing DEA-registered practitioners to prescribe Schedule II through V controlled substances via telemedicine without a prior in-person medical evaluation. For such a prescription to be permitted, it must be issued for a legitimate medical purpose, in the usual course of professional practice, and pursuant to a two-way, real-time interactive communication with the patient. The practitioner must also be authorized under their registration to prescribe the basic class of controlled substance specified on the prescription, or the practitioner must be exempt from obtaining a registration to dispense controlled substances. Furthermore, the prescription must be otherwise consistent with DEA requirements. The temporary rule interacts with two final rules published by DEA and HHS last January regarding the prescribing of buprenorphine via telemedicine and telemedicine for Veterans Affairs patients. These two rules went into effect on December 31, 2025, and both impose greater requirements than the temporary rule. According to the Fourth Temporary Rule, while there is overlap, the three rules constitute three separate sets of authority for telemedicine prescribing – prescribers covered by one or both of the final rules may still utilize the telemedicine flexibilities provided by the temporary rule.
This most recent extension comes just one day before the flexibilities were set to expire on January 1, 2026. As each expiration date approached, provider and patient groups have pushed for a permanent rule to reduce the uncertainty associated with the "telemedicine cliff": the sudden end of the ability to prescribe controlled substances to patients who have not had an in-person medical evaluation. Telemedicine lowers barriers to care, particularly for patients in rural areas or with mobility challenges, and these telemedicine flexibilities are widely used. In the Fourth Temporary Rule, DEA points to data showing that in 2024, seven million (or 16 percent) of all controlled substance prescriptions were issued without a prior in-person medical evaluation. Sudden interruption of the status quo will therefore have wide-ranging effects on patient care.
The recent government shutdown revealed the potential implications of the telemedicine cliff. Congressionally-granted Medicare telemedicine flexibilities expired on September 30, 2025, the day before the shutdown began. As the temporary rule notes, in the first 17 days of the shutdown, fee-for-service telemedicine visits dropped by 24 percent on average. In many states, telemedicine visits dropped by close to 40 percent or more. As the Fourth Temporary Rule states, removing the telemedicine prescribing flexibilities could similarly disrupt patient access to care, including critical services.
While this latest extension avoids disruption of care in the short term, patients and providers reliant upon telemedicine are still in a state of regulatory uncertainty as they await a permanent framework that balances safety and access. HHS has described the rule as extending the flexibilities "while permanent rules are finalized."1 Whether those rules will be finalized quickly enough to provide regulatory certainty, without the need for another short-term extension, remains unclear.
Footnote
1. HHS & DEA Extend Telemedicine Flexibilities for Prescribing Controlled Medications Through 2026, https://www.hhs.gov/press-room/dea-telemedicine-extension-2026.html (Jan. 2, 2026).
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