By Ben Steinberg and Shalyn Watkins

The U.S. Drug Enforcement Administration (DEA), jointly with the U.S. Department of Health and Human Services (HHS), issued a fourth temporary rule extending the full set of COVID19 telemedicine flexibilities for prescribing controlled substances through December 31, 2026. This extension prevents a lapse in telemedicine prescribing authority that otherwise would have occurred at the end of 2025.

The extension affords the DEA additional time to finalize permanent regulations aimed at balancing access to care with robust safeguards against drug diversion. At same time, it ensures practitioners have ample opportunity to come into compliance with any final rules.

The DEA has relied on a series of temporary rules to preserve emergency telemedicine flexibilities that allow practitioners to prescribe Schedule II-V controlled substances without an initial inperson medical evaluation since March 2020.

First Temporary Rule – May 2023: Extended these flexibilities through November 2023 and created a oneyear grace period for existing telemedicine relationships

Second Temporary Rule – October 2023: Expanded the extension to all patients through December 2024

Third Temporary Rule – November 2024: Continued the flexibilities through December 2025

Fourth Temporary Rule – January 2026: Continues the same through the end of 2026

Avoiding a “Telemedicine Cliff”

The fourth temporary rule ensures uninterrupted access to telemedicinebased controlledsubstance prescribing while the DEA continues work on permanent regulations. The DEA and HHS explain that the extension is necessary to avoid a “telemedicine cliff” that could disrupt care for millions of patients who rely on remote prescribing for behavioral health treatment, substance use disorder care, chronic pain management and other controlledsubstance therapies.

The agencies cite data showing that a substantial share of controlled substance prescriptions continue to be issued via telemedicine without a prior inperson evaluation and that abrupt expirations of telehealth authorities have historically led to immediate and significant declines in access to care. They further note that without this extension a backlog of patients requiring in-person appointments for medical evaluations, as well as those patients who have already come to rely on these flexibilities, would quickly develop.

Under the new rule, practitioners may continue to prescribe Schedule II-V controlled substances via telemedicine without an initial inperson examination when the prescription is issued for a legitimate medical purpose and complies with all other federal and state requirements. The rule applies uniformly to all practitionerpatient relationships, regardless of when they were established, and does not impose any new documentation, registration or technology requirements.

The DEA describes this oneyear extension as a “bridge,” providing “additional time to finalize and implement effective regulations that balance access to care with the necessary safeguards against diversion” of controlled substances, while also ensuring that all relevant stakeholders have adequate time to adapt and comply with the forthcoming permanent regulations.

2 Telemedicine Final Rules Effective December 31, 2025

DEA and HHS previously issued two final rules, both originally expected to take effect in 2024 but later delayed to align with the third temporary rule’s timeline. Holland & Knight previously discussed these final rules alongside the third temporary rule.

Expansion of Buprenorphine Treatment via Telemedicine Encounter

This rule creates a permanent pathway for practitioners to prescribe buprenorphine for opioid use disorder (OUD) via telemedicine without an initial inperson evaluation. It establishes specific conditions under which telemedicine encounters qualify, including requirements related to practitioner registration, documentation and the use of synchronous audiovisual technology.

The rule’s implementation was delayed to ensure that providers would not face conflicting requirements while temporary flexibilities remained in effect. It ultimately took effect on December 31, 2025.

Continuity of Care via Telemedicine for VA Patients

This rule allows certain U.S. Department of Veterans Affairs (VA) Veterans Health Administration (VHA) practitioners to prescribe controlled substances via telemedicine to veterans who previously received an inperson evaluation from another VHA clinician. It is designed to support continuity of care across the VA system, particularly for veterans in rural or underserved areas.

Like the buprenorphine rule, its effective date was postponed to December 31, 2025, to avoid overlap and confusion during the temporaryrule period.

How These Final Rules Interact with the 4th Temporary Rule

The fourth temporary rule clarifies that the final rules will coexist with the temporary extension. Importantly, practitioners may rely on the temporary rule even if they qualify under one of the final rules because the temporary rule imposes fewer restrictions.

As a result, the temporary rule effectively serves as the broadest and most flexible pathway for telemedicine prescribing during the transition period, while the final rules provide more structured, conditionspecific options that will become increasingly relevant once the temporary flexibilities expire.

Final Regulations in 2026

The fourth temporary rule demonstrates that the DEA is continuing to evaluate how best to balance patient access with diversion control in the telemedicine context. The agencies note that they are still reviewing extensive public comments on the proposed permanent rules and intend to issue final regulations before the new 2026 deadline.

In the meantime, practitioners, telehealth providers and digital health companies may continue to rely on the extended flexibilities while preparing for a more structured regulatory framework likely to come.

Ben Steinberg is an associate based in Holland & Knight’s New York office. Shalyn Watkins, a senior counsel in Holland & Knight’s Los Angeles office, is a University of Alabama School of Law graduate who is still licensed in Alabama and practiced for a number of years in Birmingham.