The DEA telemedicine cliff: what ends December 31, 2026

Current as of October 21, 2026. Next review: on any Federal Register publication on these rules, and on January 1, 2027.

The short version

On December 31, 2026, the temporary rule that lets practitioners prescribe controlled substances by telemedicine without a prior in-person visit expires.
DEA’s permanent special-registration rule has been under White House review since August 25. The federal agenda lists November 2026.
If nothing issues, the Ryan Haight Act’s in-person requirement returns on January 1. The narrower permanent paths for buprenorphine and VA care remain.

Paul’s take

My view: a final rule or another extension lands before January 1. There is too much money and too much capital in this market for anything else, and I think the cliff is mostly noise. That still doesn’t mean you skip the planning. Build the January 1 version of your patient flow anyway. If relief comes, you’ve lost nothing.

— Paul Albarrán

What ends on December 31, 2026?

A temporary rule of the Drug Enforcement Administration (DEA) on telemedicine prescribing expires at the end of December 31, 2026. On stated conditions, it lets DEA-registered practitioners prescribe Schedule II through V controlled substances by telemedicine to patients never evaluated in person. Unless a new rule issues first, the Ryan Haight Act’s in-person evaluation requirement then returns for those patients, with exceptions. DEA’s special registration final rule has been under review at the Office of Information and Regulatory Affairs (OIRA) since August 25, 2026. It has not been published.

The reinstatement of the pre-pandemic restrictions under the Controlled Substances Act is commonly called the “telemedicine cliff”, as DEA’s fourth extension notes. The flexibilities began in March 2020, during the COVID-19 public health emergency. DEA and the Department of Health and Human Services (HHS) published the fourth extension on December 31, 2025. Three earlier extensions came in 2023 and 2024. The temporary rule’s conditions include a legitimate medical purpose, an interactive telecommunications system and a registration covering the drug class.

What happens on January 1, 2027, if nothing new is published?

Unless a new rule is published first, the federal in-person requirement applies again from January 1, 2027, with exceptions. The requirement comes from the Ryan Haight Online Pharmacy Consumer Protection Act of 2008. That law amended the Controlled Substances Act.

Under 21 U.S.C. 829(e)(1), no prescription-drug controlled substance may be “delivered, distributed, or dispensed by means of the Internet” without a “valid prescription”. A valid prescription must be issued for a legitimate medical purpose in the usual course of professional practice. It must come from a practitioner who has conducted at least one in-person medical evaluation, or from a covering practitioner. A covering practitioner acts at the request of another practitioner who is temporarily unavailable. The unavailable practitioner must have evaluated the patient within the previous 24 months.

The statute’s exceptions are in 829(e)(3), which says the rule does not apply in two cases. One is dispensing under practices the Attorney General sets by regulation. The other exception is for a practitioner engaged in the “practice of telemedicine”. That term is defined in 21 U.S.C. 802(54), which lists seven categories. The current flexibilities rely on one of them, 802(54)(G). It lets DEA and HHS jointly define other permitted circumstances by regulation.

After the fourth temporary rule lapses, prescribing to a patient never evaluated in person needs another basis in the statute. The options include the other telemedicine categories and a valid prescription from a covering practitioner.

DEA notes that once a practitioner has evaluated a patient in person, these remote prescribing limits no longer apply to that relationship. Other DEA rules and state law still apply to those prescriptions.

Which telemedicine prescribing rules do not expire on December 31?

Two final rules published on January 17, 2025, took effect on December 31, 2025, after two delays.

The buprenorphine rule, 21 CFR 1306.51, covers certain Schedule III through V medications for opioid use disorder. They must be approved by the Food and Drug Administration (FDA) for that use. It allows audio-only or audio-video prescribing for up to six calendar months, beginning with the first prescription. The prescriber must first review the patient’s state prescription drug monitoring program data, and the pharmacist must verify the patient’s identity. If that data is unavailable, each prescription is limited to a seven-day supply. After six months, further prescriptions need an in-person evaluation or another form of telemedicine the statute allows.

The Department of Veterans Affairs (VA) rule, 21 CFR 1306.52, applies only to VA employees and contractors treating VA patients. It allows telemedicine prescribing when a qualifying VA practitioner has evaluated the patient in person at any time. The prescriber must first check VA records and, where one exists, the state prescription drug monitoring program. It does not cover contracted practitioners outside a VA facility who provide community care.

The fourth extension states that a prescriber may still use the temporary rule even when one of these rules also applies. That option ends with the temporary rule on December 31, 2026.

Where does DEA’s special registration rule stand?

The Ryan Haight Act lists a special registration for telemedicine as one permitted category, in 21 U.S.C. 802(54)(E). DEA’s regulatory agenda lists a statutory deadline for the final rule of October 24, 2019. DEA proposed its special registration framework on January 17, 2025, and received over 6,475 comments.

On August 25, 2026, OIRA received DEA’s special registration final rule for review. OIRA’s list of rules under review still showed it on October 20, 2026. As of that date, a Federal Register search showed no published special registration final rule. The federal regulatory agenda lists the final rule’s action date as November 2026. In the proposal, DEA said it would revise the regulations as necessary and appropriate, so the final text may differ.

What did DEA propose in January 2025?

The proposal would create three special registrations:

a Telemedicine Prescribing Registration for Schedule III through V controlled substances;
an Advanced Telemedicine Prescribing Registration adding Schedule II, limited to listed practitioners such as psychiatrists, hospice and palliative care physicians, pediatricians and neurologists;
a Telemedicine Platform Registration for covered online telemedicine platforms.

Unless exempt, special registrants would also need a DEA-issued State Telemedicine Registration for each state where their telemedicine patients are located. Proposed safeguards include audio-video encounters, electronic prescribing, prescription drug monitoring program checks and patient identity records. Under a special registration, audio-only prescribing would be allowed only for opioid use disorder treatment begun by audio-video.

For Schedule II, DEA proposed two added limits and said it may adopt one or both. One requires the prescriber and patient to be in the same state. The other keeps special registration prescriptions below 50 percent of the prescriber’s monthly Schedule II prescriptions.

Under the proposed definition, a platform is covered if it meets any of four criteria. They include advertising controlled substance prescribing, financial ties to prescription volume, influence over prescribing, and custody of prescriptions or records. Hospitals, clinics, insurers and local in-person practices are excluded.

Does state law still apply?

Yes. Federal law defines the practice of telemedicine as practice “in accordance with applicable Federal and State laws”. In its January 2025 buprenorphine rule, DEA states that a prescriber generally needs a DEA registration in each state where patients are located. State licensing and prescribing rules differ, and they apply alongside the federal rules. Under the proposal, a special registrant would have to follow the laws of both the prescriber’s and the patient’s states. This article does not survey any state’s rules.

What questions follow for telehealth companies before January 1, 2027?

The rules above raise several questions for companies that prescribe controlled substances by telemedicine:

which patients have never had an in-person medical evaluation with their current prescriber;
which prescriptions are buprenorphine for opioid use disorder, and whether the 1306.51 conditions are met;
whether each prescriber is DEA-registered in every state where patients are located;
what each relevant state’s telehealth and prescribing rules require;
whether the platform’s role could meet the proposed definition of a covered online telemedicine platform.

The answers depend on each company’s facts and on any rule published before January 1, 2027.

The information on this site is general information, not legal advice.