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A proposal is not a rule. Read that twice before you rebuild anything.
On January 17, 2025 the DEA published a proposed rule that would create a permanent path for prescribing controlled substances by telemedicine. Plenty of headlines made it sound settled. It is not. This piece is about what is actually on the table, what is still open, and the boring preparation that costs little and saves a lot if the rule lands.
Educational, not legal advice. Talk to healthcare counsel about your own prescribing.
What did the DEA propose on January 17, 2025?
The DEA announced three telemedicine rules on January 16 and the special registration proposal was published in the Federal Register the next day.12 The DEA's own framing is that it wants to make some COVID-era flexibilities permanent while adding patient protections.
The scope is narrower than the headlines
The DEA is explicit that these rules do not apply to telemedicine visits where the patient has already been seen in person by a medical provider. They also do not apply when a telemedicine visit does not involve prescribing a controlled medication. They apply only when a patient has never been seen in person by the provider and is being prescribed a controlled medication.1
That single paragraph changes who needs to worry. Read it before you read anyone's hot take.
Why now
The agency had received more than 38,000 public comments on its original March 2023 draft and held listening sessions in September 2023, then revised the approach.1
- Nov 15, 2024DEA and HHS extend the flexibilities through 2025
- Jan 16-17, 2025Three rules announced, special registration proposal published
- Mar 18, 2025Comments due on the proposed rule
- A final ruleNot issued, and not final as proposed
- Dec 31, 2025The current flexibilities end unless extended
38,000+
What are the three special registrations?
Based on the DEA's announcement and law firm summaries of the proposed text, here is the structure.13
| Registration | Who it covers, as proposed |
|---|---|
| Telemedicine Prescribing Registration | Qualified clinicians prescribing Schedule III to V controlled substances |
| Advanced Telemedicine Prescribing Registration | Board-certified specialists, such as psychiatrists, hospice and palliative care physicians, long-term care physicians, pediatricians and neurologists, for Schedule II to V |
| Telemedicine Platform Registration | Covered online platforms that connect patients and clinicians and result in prescriptions |
State registrations and fees
The proposal also adds a State Telemedicine Registration, a DEA-issued credential for each state where a registrant treats patients by telemedicine. The summaries I reviewed describe proposed fees of $888 for each special registration and per-state fees of $50 for clinicians and $888 for platforms.3 Treat the numbers as proposed, not final.
Safeguards worth knowing
- Prescription drug monitoring checks. Special registrants would check the relevant monitoring programs, and the DEA says the rule requires building toward a national PDMP.1
- Platforms registering. For the first time, online platforms that facilitate connections between patients and clinicians resulting in prescriptions would have to register with the DEA. The DEA cites providers on online platforms who used flexible rules to put profit ahead of patients.1
- Records and reporting. Summaries describe recordkeeping for telemedicine encounters and monthly aggregate reporting by pharmacies.3
DEA's goal is to provide telehealth access for needed medications while ensuring patient safety and preventing the diversion of medications into the illicit drug market.
Why does the in-person visit matter so much?
Because it is the hinge for the whole framework. The DEA says that once a patient has had an in-person visit with a medical provider, that provider may prescribe any medications through telemedicine indefinitely.1 The special registrations exist for the case where that visit never happened.
For a clinic, that turns a legal question into an operations question. How many of your patients have a prior in-person relationship with the prescribing clinician? If the honest answer is "almost none," you are the case the proposal is written for.
The other two rules in the same announcement
The DEA announced three rules together. Besides the special registration proposal, one would let a patient receive a six-month supply of buprenorphine through a telephone consultation, with further prescriptions requiring an in-person visit. The third exempts Department of Veterans Affairs practitioners from the special registration requirements once a VA provider has examined the patient in person.1 Both are narrower, but they show the direction: more access at the start, more checks as time goes on.
What is still not final?
Almost everything. The DEA asked for comment on several open questions, including whether the Schedule II special registrant should be physically in the same state as the patient, and whether to limit Schedule II telemedicine prescribing to practitioners whose telemedicine prescribing is below 50 percent of their practice.1 Those are not settled.
Mar 18, 2025
The flexibilities still apply today
On November 15, 2024 the DEA and HHS extended the existing telemedicine flexibilities through the end of 2025 (my note on that is here).4 So the practical situation this week has not changed. The proposal describes the DEA's intended destination. It does not move you today.
Does this apply to a GLP-1 clinic?
Probably not for prescribing. GLP-1 medications such as semaglutide and tirzepatide are not controlled substances, and the DEA's description is limited to controlled medications.1 But clinics rarely stay in one lane. If you also offer testosterone, ADHD treatment, ketamine or buprenorphine, you are in the scope the DEA is talking about.
The marketing side
I come at this from the paid traffic side, and one thing is plain. If your ad or landing page implies you can prescribe a controlled medication with no visit, your copy has to match your legal pathway, and that pathway may change. Review claims whenever the underlying rule moves, not once at launch.
How should a clinic prepare now?
- List every controlled substance you prescribe or plan to. Include the schedule. If the list is empty, note that and move on.
- Map your patient flow. For each product, record whether a patient is ever seen in person before the first prescription.
- Map the states. Per-state registrations are proposed, so know where your patients and clinicians are located (see licensing across state lines).
- Check your monitoring workflow. Where would a prescription monitoring check sit in your intake today?
- Ask counsel what happens if the rule is final as written. Get the answer in writing, with a plan B for any product that would not qualify.
- Put the date on a calendar. The flexibilities end December 31, 2025 unless extended, so decisions need lead time. My 2025 outlook has the other dates on one page.
What should operators watch next?
Watch three things: whether the DEA finalizes the rule as proposed, whether the 2025 end date for the flexibilities moves, and whether your own product mix is drifting toward controlled substances.
Do not rebuild an offer on a proposal. Build it so you can adapt when the final text lands. If you want to talk through how the marketing side adapts, start at my telehealth page.
Keep building.Ekai
Questions people ask
What is the DEA special registration for telemedicine?
It is a proposed framework, published in the Federal Register on January 17, 2025, that would let qualified clinicians and online platforms prescribe or dispense controlled substances through telemedicine without a prior in-person visit, under three new registration types and added safeguards.
Is the DEA special registration rule final?
No. It is a notice of proposed rulemaking. Comments were due March 18, 2025, and the DEA has not published a final rule. Until it does, nothing in the proposal is binding.
Does the proposal affect clinics that only prescribe GLP-1 medications?
Generally not for the prescribing itself. The telemedicine rules the DEA describes apply when a patient has never been seen in person and is being prescribed a controlled medication. GLP-1 medications are not on the DEA's schedules, but check with counsel about every product you offer.
What are the current telemedicine flexibilities for controlled substances?
The DEA and HHS extended the COVID-era telemedicine flexibilities through December 31, 2025, in an extension announced on November 15, 2024. The special registration proposal is the DEA's plan for what comes after.
Sources
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