DEA Proposes New Telemedicine Prescribing Regulations

Two steps forward, one step back...

Photo by Towfiqu barbhuiya on Unsplash

On January 16^th, The U.S. Drug Enforcement Administration (DEA) proposed new rules for telemedicine prescribing of controlled substances, set to potentially take effect in January 2026. Since the 58-page document is not exactly an edge-of-your seat page turner, here is a summary of their recommendations:

Basically, for providers and organizations who wish to continue virtual controlled substance prescribing past December of this year, the newest DEA proposal offers three distinct registration pathways. These registration pathways aim to increase patient access to care while preventing medication misuse. The three potential registration pathways are as follows:

1. General Telemedicine Prescribing Registration

This registration permits Advanced Practice Nurse Practitioners (APRN), Physician Assistants, and Physicians to prescribe Schedule III-V controlled substances via telemedicine without an initial in-person examination. To be eligible, practitioners must demonstrate a legitimate need, such as treating patients for whom in-person visits are burdensome due to factors like severe weather, remote locations, or communicable diseases. Of note, this general registration pathways excludes virtual only prescribing of stimulants, which are Schedule II controlled substances.

2. Advanced Telemedicine Prescribing Registration

Designed only for certain physician and APRN subspecialities, this registration allows the prescribing of Schedule II-V controlled substances via telemedicine. Eligible professionals include psychiatrists, hospice and palliative care physicians, practitioners in long-term care facilities, pediatricians, neurologists, and board-certified mid-level practitioners in related specialties like psychiatry. Applicants must justify their need and provide evidence of specialized training with board certifications. In this pathway, Schedule II virtual prescriptions need to encompass less than 50 percent of all medications prescribed, and the provider still needs to be physically located in the same state as the patient.

3. Organizational Telemedicine Platform Registration

This registration is intended for online telemedicine platforms, enabling them to dispense Schedule II-V controlled substances through affiliated practitioners who hold either a Telemedicine Prescribing Registration or an Advanced Telemedicine Prescribing Registration. Eligible platforms must demonstrate a legitimate need, comply with federal and state regulations, and oversee their practitioners’ prescribing practices. This registration also requires the organization to submit annual prescription reports to the DEA, detailing quantity, frequency, and dosing of controlled substance prescriptions.

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On the one hand, these proposed pathways enhance clarity and legal certainty for clinicians by finally providing permanent, defined routes for telemedicine prescribing after several years of confusing and evolving guidance. This is a step in the right direction.

However, the new registrations also come with heightened prescription, recordkeeping, and reporting obligations: all time-consuming administrative tasks that add more paperwork time and less patient facing time to very long provider days. Additionally, they add more costs to licensure maintenance and renewals. Finally, by restricting virtual stimulant prescribing to practitioners physically co-located in the same state as the patient, these new laws restrict access to rural and low-income Americans living in states with less specialists. Turns out, not too many Psychiatrists live in rural Alaska.

The DEA’s proposed changes finally offer clear, structured pathways for continued telemedicine prescribing beyond 2025. But they also introduce significant administrative responsibilities to a thinly stretched, resource poor healthcare system, with new state-based stimulant prescribing restrictions. With these propositions, American healthcare moves two steps forward and one step back. BUT, we are indeed at least inching forward in the right direction.

Want to let the DEA know your thoughts on these new proposals? You can submit your comments directly to them here. The active comment period is open through March 18^th. Over 900 comments have already been submitted in the first two weeks. Large public comment volume was the main reason the DEA extended telemedicine flexibilities in both 2023 and 2024, so your feedback can make a real difference!

-Lauren