DEA Extends Telemedicine Flexibilities (Again)
How long will DEA take to implement a final rule? (Answer: More than 17 years.)
In an eleventh hour move, DEA published its fourth temporary extension of telemedicine flexibilities for prescribing controlled pharmaceutical drugs (CPDs), which were due to expire at midnight tonight. These flexibilities were first authorized by the agency in March 2020 in response to the COVID-19 Public Health Emergency (PHE) and permit a prescriber to operate in two specific ways that would otherwise be prohibited. The first flexibility allows a prescriber to prescribe CPDs via telemedicine without first having an in-person evaluation with a patient; however, telemedicine must be conducted via two-way, real-time, interactive audio and video communications between the provider and the patient (with a few exceptions)- CPD prescriptions via asynchronous-only evaluations and visits are prohibited. The second flexibility allows a prescriber to prescribe CPDs to patients in other states without having a DEA registration in each state where a patient resides, so long as this prescribing also comports with state laws.
In this fourth extension, DEA acknowledges its need in order to prevent the disruption of care for patients who rely on telemedicine, to prevent a backlog of patients who would need to schedule in-person evaluations had the flexibilities expired, and to give the agency more time to finalize and implement permanent telemedicine rules.
Interestingly, as I had mentioned in my prior article almost a year ago, The Ryan Haight Act of 2008 provided for a special registration for telemedicine, but in the intervening 17 years, DEA has failed to finalize one. In the most recent iteration from January 2025 (see here), DEA proposed a series of telemedicine registrations with related prescription, recordkeeping, and reporting requirements; however, these have also not yet been finalized, hence the need for this fourth extension. Consequently, two questions linger: first, will DEA publish a final telemedicine rule(s) prior to the expiration of this extension in December 2026? Second, how will a final telemedicine rule balance patients’ access to care with the need to prevent diversion?