DEA Extends Telemedicine Prescribing Through
⚠️ Updated March 2026
This post has been updated to reflect the fourth DEA extension issued December 30, 2025. The original post covered the third extension through December 2025. The flexibilities are now extended through December 31, 2026.
DEA Extends Telemedicine Prescribing Through 2026
On December 30, 2025, the Drug Enforcement Administration (DEA) and the Department of Health and Human Services (HHS) issued a fourth temporary extension of telemedicine flexibilities for prescribing controlled substances. The extension runs from January 1, 2026 through December 31, 2026 — preventing the "telemedicine cliff" that would have abruptly restored pre-pandemic Ryan Haight Act restrictions.
For patients and providers at Isha Health, nothing changes: ketamine-assisted psychotherapy remains fully accessible via telemedicine in California, New York, Texas, Florida, Colorado, Arizona, Georgia, Oregon, and Washington.
What the Fourth Extension Covers
The fourth temporary rule preserves the same flexibilities that have been in place since the COVID-19 public health emergency:
- DEA-registered practitioners may prescribe Schedule II–V controlled substances via telemedicine without a prior in-person evaluation
- Audio-video telemedicine encounters remain authorized for all Schedule II–V prescribing
- Audio-only telemedicine remains permitted for Schedule III–V narcotics used in opioid use disorder treatment
- No new requirements are imposed on patients or providers during this extension period
- Ketamine (Schedule III) continues to be prescribable via telemedicine under these flexibilities
The extension does not change the existing requirement that prescriptions must be issued for a legitimate medical purpose by a licensed practitioner in compliance with federal and state law.
Why the Fourth Extension Was Issued
The DEA cited several reasons for the extension:
- Avoiding disruption: Expiration without a permanent rule would have abruptly cut off telemedicine access for millions of patients relying on remote prescribing for behavioral health, pain management, and substance use disorder care
- Time for permanent rulemaking: The extension gives DEA and HHS additional time to finalize permanent regulations, including the proposed Special Registration for Telemedicine framework
- Implementation runway: Providers, patients, pharmacies, and platforms need adequate time to adapt to whatever permanent requirements are eventually adopted
What Comes Next: Permanent Rules
The longer-term regulatory picture is still developing. In January 2025, the Biden administration proposed a Special Registration for Telemedicine framework that would create permanent pathways for telehealth practitioners to prescribe controlled substances. The proposal includes requirements around prescription drug monitoring, identity verification, audio-video technology, data reporting, and record retention.
As of early 2026, the Trump administration has not moved forward with finalizing that proposed rule. The DEA has stated that the 2026 extension provides time to promulgate a final rule before year end. Providers should continue operating under the current extension while monitoring for updates.
What This Means for Isha Health Patients
If you are receiving ketamine-assisted psychotherapy through Isha Health, nothing changes. No in-person visit is required to begin or continue treatment.
We serve patients via telemedicine in:
We will update this post as permanent regulations develop. Check your availability →
For a complete overview of ketamine's legal status, see our comprehensive guide to ketamine legality.
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