The DEA’s New Telehealth Prescribing Rules: What You Need to Know

The U.S. Drug Enforcement Administration (DEA) just dropped three big updates impacting how controlled substances can be prescribed via telehealth. These long-awaited rules include a proposed registration process for telehealth prescribing and two finalized rules on buprenorphine treatment and prescribing for Veterans Affairs (VA) providers. Here’s a breakdown of what’s happening, how it affects telemedicine, and what you need to watch for as a practitioner.

What’s Changing?

For those who’ve been following the shifting landscape of telemedicine and controlled substance prescribing, you’ll know that the DEA’s policies have been in flux since the COVID-19 public health emergency (PHE) temporarily waived in-person prescribing requirements. These new rules aim to create permanent telehealth exceptions but won’t be as broad as the temporary flexibilities seen during the PHE.

The Three New Rules at a Glance

1. Proposed Rule: Special Registrations for Telemedicine and Limited State Telemedicine Registrations – Lays out a new framework for obtaining special DEA registration for telehealth-based controlled substance prescribing.
2. Final Rule: Expansion of Buprenorphine Treatment via Telemedicine – Allows for continued prescribing of buprenorphine via telemedicine, including audio-only encounters.
3. Final Rule: Continuity of Care for VA Patients – Permits VA practitioners to prescribe controlled substances via telemedicine without an in-person visit under certain conditions.

Let’s dig into each of these rules in more detail in the video below 

Special Registration for Telemedicine Prescribing (Proposed Rule)

This is the DEA’s long-overdue attempt to establish a special telemedicine registration process, something Congress mandated back in 2008. This rule is still in the proposed stage, meaning there’s room for feedback before it becomes final.

Here’s how the special registration framework breaks down:

• Three types of special telemedicine registrations:
  1. Telemedicine Prescribing Registration – Allows qualified clinicians to prescribe Schedule III-V controlled substances.
  2. Advanced Telemedicine Prescribing Registration – Allows specialized practitioners (e.g., psychiatrists, hospice physicians) to prescribe Schedule II-V controlled substances.
  3. Telemedicine Platform Registration – Authorizes online telemedicine platforms to dispense Schedule II-V substances through registered providers.

Additional Requirements:

• Telemedicine encounters must be conducted via audio-video communication (no audio-only for special registrants).
• Special registrants need to obtain a State Telemedicine Registration from the DEA for each state where they treat patients (unless exempt).
• Prescriptions must be issued through Electronic Prescribing for Controlled Substances (EPCS) systems.
• Practitioners must conduct nationwide Prescription Drug Monitoring Program (PDMP) checks (though this requirement will be phased in over three years).
• For Schedule II drugs, additional safeguards include:
  • The prescriber must be in the same state as the patient.
  • Schedule II prescriptions via special registration cannot exceed 50% of total Schedule II prescriptions written by the provider each month.

This rule also sets specific guidelines for online telemedicine platforms, particularly those using a direct-to-consumer (DTC) model. The DEA wants to prevent platforms from incentivizing overprescription or restricting provider access to patient records.

What’s Next?

This rule is still open for public comment until March 18, 2025. If you have concerns or recommendations, now is the time to make your voice heard.

Buprenorphine Treatment Expansion (Final Rule)

The DEA has finalized its Expansion of Induction of Buprenorphine via Telemedicine rule, which was initially proposed in March 2023. The final version brings a few key updates:

• Practitioners can prescribe up to a six-month supply of buprenorphine for opioid use disorder (OUD) via audio-only or audio-video telemedicine (previously limited to 30 days for audio-only).
• PDMP checks are mandatory before prescribing.
• If the PDMP system is unavailable, providers can issue renewable seven-day prescriptions while attempting to access the PDMP.
• Pharmacists must verify patient identity before dispensing.

Effective Date: February 18, 2025.

This rule is a win for increasing access to medication-assisted treatment (MAT) for opioid use disorder, especially for patients in rural or underserved areas.

Veterans Affairs Telemedicine Prescribing (Final Rule)

This rule allows VA-employed practitioners to prescribe controlled substances via telehealth without an in-person evaluation, so long as another VA practitioner has previously seen the patient in person.

Key Conditions:

• Providers must review VA electronic health records (EHRs) and PDMP data for the state where the patient is located.
• If PDMP access is unavailable, providers are limited to prescribing a seven-day supply until PDMP review is completed.
• This rule applies only to VA-employed practitioners (not contractors or community care providers).

Effective Date: February 18, 2025.

While this is a VA-only exception, the DEA has hinted that they may consider expanding similar flexibilities to non-VA providers in the future.

Final Thoughts: What This Means for You

While these DEA rules offer some permanent telehealth prescribing flexibilities, they are far more restrictive than the policies we saw during the pandemic-era waivers. Here’s the big picture:

✔️ Buprenorphine prescribing has been expanded, especially for audio-only visits. ✔️ VA providers now have clearer guidelines for telehealth prescribing. ❗ The Special Registration rule is still a proposal, and it comes with a lot of red tape. ❗ Nationwide PDMP checks and prescribing limits for Schedule II drugs will increase compliance burdens.

If you’re a telemedicine provider, these rules will affect how you practice, so it’s important to stay informed and prepare for compliance. Also, if you have concerns about the Special Registration rule, take action now—public comments are open until March 18, 2025.

Want to dig deeper? Check out the full regulations:

• Special Registration for Telemedicine (Proposed Rule)
• Buprenorphine Treatment Expansion (Final Rule)
• VA Telemedicine Prescribing (Final Rule)

Stay Compliant and Stay Informed

Navigating the legal landscape of telemedicine and controlled substance prescribing is complex. If you’re running a telehealth practice, it’s critical to stay compliant with both DEA and state-specific laws. Have questions about how these rules apply to your practice? Functional Lawyer is here to help.

📩 Need guidance? Let’s talk!