The DEA has not yet finalized a permanent rule governing telemedicine prescribing of controlled substances. In the meantime, temporary flexibilities — extended repeatedly since 2020 — remain the operative framework, which leaves telehealth prescribers working under rules that are, by design, provisional.
Where the rulemaking stands
The DEA published a proposed rule for a telemedicine special registration process, intended to give qualifying practitioners a defined pathway to prescribe certain controlled substances without a prior in-person evaluation. The proposal drew a large volume of public comment. As of this writing, no final rule has taken effect, and the temporary flexibilities that have been extended since the pandemic remain the governing framework in practice.
What "temporary" has meant in practice
The current flexibilities have been extended multiple times rather than allowed to lapse, but each extension has come with its own expiration date, which means the rules prescribers rely on today are not guaranteed to still apply at a future date without another extension or a finalized permanent rule.
Every extension so far has come with a new expiration date attached — "current flexibilities" is not the same as "permanent rules."
What a final rule would likely address
Based on the proposed rule and public commentary, a finalized version would likely address which drug schedules qualify for reduced in-person requirements, what registration or reporting obligations would apply, and whether any patient volume or duration limits would be attached. None of this is settled, and the shape of a final rule could differ from the proposal.
What to do while it remains unresolved
Physicians prescribing controlled substances via telehealth generally track the current expiration date of the active flexibility rather than assuming it is indefinite, and continue to comply with any state-specific rules layered on top of the federal baseline, since state requirements do not automatically loosen just because federal flexibilities are in effect.
Requirements vary by state and change over time — always confirm current requirements directly with the relevant state board or agency before making a compliance decision.