DEA Telemedicine Prescribing Extension: What Happens After December 2026

Short version: if DEA doesn’t finalize a permanent rule before December 31, 2026, the old in-person requirement snaps back for telemedicine prescribing of controlled substances, except for two permanent rules that don’t depend on the extension at all. Here’s what that actually means for your practice.

What Happens If DEA Doesn’t Finalize a Permanent Rule by December 31, 2026?

Right now, telemedicine prescribing of Schedule II-V controlled substances without a prior in-person visit is allowed under the Fourth Temporary Extension, effective January 1, 2026 through December 31, 2026. This is the fourth time DEA has pushed this deadline since COVID-era flexibilities were first introduced.

If nothing replaces it before the deadline, the default rule under the Ryan Haight Act takes over: an in-person medical evaluation becomes required again before prescribing controlled substances via telemedicine, for any new patient relationship that isn’t already covered by one of the two permanent rules below.

What’s Actually Permanent Right Now, Even If the Extension Lapses?

Two rules don’t depend on the temporary extension at all, and would survive a lapse without changing.

The buprenorphine telemedicine rule, effective December 31, 2025, lets practitioners prescribe buprenorphine for opioid use disorder via telemedicine without an in-person visit, for up to six months with a new patient, audio-only included under certain conditions.

The VA continuity-of-care rule lets VA practitioners continue Schedule II-V telemedicine prescribing without an in-person visit, as long as another VA practitioner already conducted one.

Where Does the Special Registration Proposal Actually Stand?

DEA proposed the Special Registration framework in January 2025, in the final days of the Biden administration. It would create three registration pathways: a Special Registration for individual practitioners, a cheaper limited State Telemedicine Registration, and a separate registration for telehealth platforms that dispense controlled substances as intermediaries.

As of today, the Trump administration hasn’t finalized it. DEA has pointed to ongoing Tribal consultations and continued review of public comments as reasons it’s taking time. The entire point of this year’s extension was to buy room for exactly this, but there’s no confirmed date for when, or whether, it lands before December.

What Should Telehealth Providers Do to Prepare for December 2026?

1. Map out which of your patient relationships would fall back under the Ryan Haight in-person requirement if the extension isn’t renewed, separate from anything already covered by the buprenorphine or VA rules.
2. Don’t assume a fifth extension is guaranteed. The fourth one was finalized one day before the prior deadline, which industry groups called “avoidable uncertainty” at the time.
3. If you treat opioid use disorder, check whether your practice already qualifies under the permanent buprenorphine telemedicine rule. It doesn’t depend on whatever happens with the broader extension.
4. Track the Special Registration proposal’s progress through the rest of the year. If it gets finalized, even partially, it could replace the temporary extension entirely and bring new registration, recordkeeping, and fee requirements with it.
5. Consult your compliance counsel.

Source

Federal Register, December 31, 2025: Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications

This post is for educational purposes only and does not constitute legal or compliance advice. Consult a qualified attorney or compliance professional before acting on this information.