Overview
Telehealth prescribing policies are governed by a mix of federal and state laws. The Center for Connected Health Policy (CCHP) offers an excellent introductory primer:
Historical Context: The Ryan Haight Act
What the Act Requires
Passed in 2008, the Ryan Haight Online Pharmacy Consumer Protection Act prohibits delivering, distributing or dispensing controlled substances without a valid prescription, which requires:
- A practitioner who has conducted at least one in-person medical evaluation of the patient; or
- A covering practitioner acting on behalf of the original provider.
Pre-COVID-19 Exceptions
Before the pandemic, limited exceptions allowed prescribing controlled substances without an in-person visit when:
- The patient was located in a DEA-registered facility (e.g., hospital or clinic).
- The patients was in the physical presence of another DEA-registered practitioner.
- The telemedicine encounter met special conditions including:
- Indian Health Service (IHS) providers designated as an Internet Eligible Controlled Substances Provider by the DEA.
- Veterans Health Administration (VHA) practitioner during a VHA-declared medical emergency.
- HHS declared Public Health Emergencies (PHEs)
- A practitioner had obtained a special telemedicine registration (never implemented)
Special Registration: A Long Delay
Congress required the DEA to create a special registration pathway in the 2018 SUPPORT for Patients and Communities Act but no regulations were issued for years. In response, Alliance for Connected Care led 80+ organizations urging the DEA to finalize the process.
COVID-19 PHE: Temporary Telehealth Flexibilities
The March 2020 declaration of the COVID-19 PHE triggered a Ryan Haight Act exception, allowing controlled-substance prescribing via telemedicine without an in-person visit.
Congressional Pressure for Permanent Flexibilities
- May 2021: Senator Warner sent a letter pressing DOJ on their long overdue regulations
- April 2022: Senators Portman and Whitehouse sent a letter urging DEA and HHS to protect tele-MAT access post PHE.
- February 2023: DEA releases proposed rules for permanent telemedicine flexibilities, but did not include a provider registry. The Center for Connected Health Policy (CCHP) created the following detailed explainer video about the proposed rules:
Post PHE Policy Timeline
The PHE ended on May 11, 2023, but temporary prescribing flexibilities were repeated extended.
Temporary Rule Extensions
- May 9, 2023: DEA/SAMHSA extended flexibilities to November 11, 2023. Established patients prior to November 11, 2023 could continue flexibilities through November 11, 2024.
- October 6, 2023: DEA and HHS extended the flexibilities to December 31, 2024.
- November 11, 2024: DEA and HHS extended the flexibilities through December 31, 2025
- November 10, 2025: DEA posted a notice of Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications" signaling an intention to further extend the flexibilities. The text of the new rule is not yet available for public review.
Proposed Special Registration Rule (January 17, 2025)
After years of delay, DEA released proposed regulations establishing a process for telemedicine-specific prescribing registration.
Key Documents:
- Full text of the Proposed Rule – Special Registrations for Telemedicine and Limited State Telemedicine Registrations
- CCHP Summary of the Proposed Special Registration Rule
Public Input
- Comments were due by March 18, 2025
- July 22, 2025: ATA, ATA Action and 200+ healthcare stakeholders urged the DEA through this letter to finalize a workable pathway that did not require an in-person visit.
Rules for Prescribing Through Telehealth by Opioid Treatment Programs (OTPs)
Background
During the COVID-19 PHE, the Substance Abuse and Mental Health Services Administration (SAMHSA) allowed OTPs to:
- Conduct evaluations for buprenorphine via audio-video or audio-only telehealth
- Waive the usual in-person physical evaluation under defined conditions
Final Rule: Expansion of Buprenorphine Treatment via Telemedicine Encounter (Implementation delayed until December 31, 2025 for further review)
DEA-registered providers may prescribe buprenorphine (Schedule III-V) via telemedicine if they:
- Review state prescription drug monitoring program (PDMP) data for the patient's location before prescribing
- Document PDMP checks (or attempted checks) every 7 days when PDMP is inaccessible
- Issue prescriptions covering up to 6 months (single or multiple prescriptions)
- Ensure that pharmacists verify patient identity prior to dispensing.
Rules for Prescribing via Telehealth for Veterans Affairs Patients
Background
A March 2023 DEA proposal allowed VA practitioners to prescribe controlled substances via telemedicine without an in-person exam, if a different VA practitioner had previously examined the patient in person.
Final Rule: Continuity of Care via Telemedicine for Veterans Affairs Patients (Implementation delayed until December 31, 2025 for further review)
VA practitioners may prescribe controlled substances via telemedicine without an in-person evaluation when:
- Another VA provider has previously conducted an in-person evaluation
- The encounter falls within the practitioner's scope of VA employment
Key requirements:
- Review both the patient’s VA electronic health record (EHR) and the prescription drug monitoring program (PDMP) data for the state in which the VA patient is located
- If either is unavailable, limit the prescription to 7 days until full review is possible
- Note: does not apply to contracted community-care network providers)
State-Specific Telehealth Prescribing Laws
Federal rules create the broad framework, but states dictate many critical details, including:
- Whether controlled substances may be prescribed via telehealth
- In-state vs. out-of-state licensure requirements
- State PDMP obligations
- Restrictions on schedule II–V medications
Providers must keep up with state-level requirements.
