DEA and HHS Issue Fourth Extension of Telehealth Prescribing Flexibilities

Summary — The DEA and HHS are extending pandemic-era telemedicine rules through 2026, so providers can keep prescribing many controlled medications remotely without first seeing patients in person while permanent rules are finalized. However, providers still have to follow all standard rules and any state-specific requirements, including Virginia’s licensing and telehealth guidelines.

The U.S. Drug Enforcement Administration (DEA), in coordination with the Department of Health and Human Services (HHS), has issued a fourth temporary extension of COVID‑era telemedicine flexibilities for prescribing controlled substances. The extension is effective January 1, 2026, through December 31, 2026, avoiding an abrupt return to pre‑pandemic restrictions while permanent rules are finalized.

What the Extension Allows

• DEA‑registered practitioners may continue prescribing Schedule II–V controlled substances via audio‑video telemedicine without an initial in‑person visit.
• Audio‑only prescribing remains permitted for certain Schedule III–V medications approved for opioid use disorder treatment.
• Existing COVID‑era workflows may continue unchanged, subject to federal and state law.

What Has Not Changed

• Prescriptions must be issued for a legitimate medical purpose, by properly licensed and DEA‑registered practitioners, and in compliance with all DEA requirements.
• Prescriptions must still satisfy DEA recordkeeping, security, and diversion‑control rules.
• State law continues to apply and may impose additional limitations.

Virginia‑Specific Note 

• Providers treating patients located in Virginia must comply with Virginia licensure and telemedicine requirements, including:
  • Holding an active Virginia license.
  • Establishing a bona fide practitioner–patient relationship, typically through real‑time audio‑visual communication.
  • Meeting Virginia’s electronic prescribing requirements for opioids and applicable standard‑of‑care rules.
• Federal telehealth flexibilities do not override Virginia law.

Looking Ahead: DEA and HHS have indicated the extension is intended to provide time to finalize permanent telemedicine prescribing regulations, including potential special registration pathways. Providers and telehealth companies should use 2026 to prepare for more durable compliance frameworks.