DEA Delays Implementation of Final Teleprescribing Rules—What’s Next for Telehealth Prescribing?

On March 24, 2025, the U.S. Drug Enforcement Administration (DEA), in coordination with the Department of Health and Human Services (HHS), announced a delay until December 31, 2025, for the implementation of two highly anticipated—and controversial—final rules governing the prescribing of controlled substances via telemedicine. These rules, originally issued on January 17, 2025, aimed to leverage telehealth capabilities to expand access to pharmaceutical care, particularly for Veterans and patients with opioid use disorder (OUD).

The delay follows continued stakeholder feedback and growing concerns over the operational challenges posed by these rules.

Which Rules Are Impacted?

1. Expanded Telehealth Prescribing for Veterans Affairs (VA) Patients

This rule allows VA practitioners to prescribe controlled substances via telemedicine without first conducting an in-person exam, provided that any VA practitioner has previously conducted such an evaluation. Once an in-person evaluation is completed by one VA provider, it establishes a provider-patient relationship applicable to all VA practitioners for teleprescribing purposes.

2. Increased Access to Buprenorphine Treatment via Telemedicine

This rule improves access to OUD treatment by allowing practitioners to prescribe up to a six-month supply of buprenorphine—a Schedule III controlled substance—through audio-only or audio-visual telemedicine visits, without requiring an initial in-person evaluation.

The controversy arises after the six-month period, when patients must complete an in-person visit to continue treatment—raising concerns about continuity of care and access barriers, especially for vulnerable populations.

What About the "Special Registration" Rule?

It’s important to note that a third proposed rule—the long-awaited "Special Registration for Telemedicine" pathway—was not finalized in January 2025 and is not part of this delay.

This special registration process, mandated by the SUPPORT Act of 2018, was intended to establish a permanent framework allowing qualified providers to prescribe controlled substances via telemedicine without an initial in-person visit, beyond the narrow contexts of VA care or buprenorphine treatment. The DEA has yet to finalize this broader rule, leaving telemedicine prescribing in other contexts reliant on temporary flexibilities.

Why the Delay?

Upon returning to office, President Trump issued a Regulatory Freeze Pending Review memorandum on January 20, 2025, pausing recent final rules across federal agencies. In response, the DEA postponed implementation to March 21, 2025, and solicited public comment.

Of the 32 comments received, only three explicitly requested a further delay. These came from:
- The Alliance for Connected Care (including Amazon Health and CVS Health)
- The National Association of Chain Drug Stores
- The American Pharmacists Association (APhA)

While supporting telemedicine flexibilities in principle, these stakeholders raised practical concerns about how the final rules—particularly the buprenorphine provisions—would function in real-world settings.

Key Concerns Raised:
- “Positive ID” Requirement: Pharmacies must confirm with prescribers that telemedicine buprenorphine prescriptions comply with in-person vs. telehealth rules, creating administrative burdens and potential delays for patients.
- Verification at Pickup: Pharmacists must verify that individuals collecting buprenorphine prescriptions are either the patient or a household member—posing privacy concerns and potential stigmatization for patients in OUD treatment.
- Rigid Six-Month Timeline: The requirement for an in-person visit after six months limits flexibility and could disrupt ongoing care for patients benefiting from telemedicine.

The DEA cited these concerns in extending the implementation date to December 31, 2025, emphasizing that no continuity-of-care issues should arise due to the ongoing COVID-era telemedicine flexibilities, which remain in effect through the same date.

What Happens Next?

For now, providers can continue to rely on the temporary flexibilities extended in November 2024, allowing controlled substance prescriptions via telemedicine without an initial in-person visit—subject to DEA guidance and state law compliance.

Given the DEA’s responsiveness to stakeholder feedback, it is likely that the agency will revisit the language of the final rules before year-end. Focus areas may include:
- Reducing administrative burdens on pharmacies.
- Reevaluating identity verification requirements.
- Addressing concerns about strict in-person visit timelines.

While stakeholders broadly support codifying pandemic-era telemedicine prescribing flexibilities into a consistent regulatory framework, the challenge remains balancing access to care with regulatory oversight.

It is unclear whether the DEA will issue revised rules or seek further public comment before December 31, 2025. The status of the broader special registration pathway also remains unresolved, leaving the future of teleprescribing in a state of uncertainty.