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Clinics that prescribe controlled substances over video got a very specific gift this month: a calendar.
On November 15, 2024 the DEA, jointly with HHS, extended its current telemedicine flexibilities through December 31, 2025.1 Today the extension is published in the Federal Register.3 The clock that was running out at the end of this year now runs out a year later.
A year is not a permanent answer. It is runway. The question is what you build on it.
Telehealth Growth Desk is where I translate regulatory news into operating decisions. This is educational, not legal advice. Talk to a healthcare attorney about your own situation.
What exactly did the DEA and HHS extend?
The flexibilities that have let telemedicine prescribing of controlled medications continue without a prior in-person visit.
The short history
In 2023, the DEA received more than 38,000 comments on its proposed telemedicine rules and held two days of public listening sessions. In response it extended the flexibilities through the end of 2024.2 This new extension is the third of its kind, titled the "Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications."1
What the rule says
According to the Federal Register notice, the extension is effective January 1, 2025 through December 31, 2025, and the authorization period it describes runs from May 12, 2023 through December 31, 2025.3 A DEA-registered practitioner may prescribe Schedule II to V controlled substances by telemedicine without having conducted an in-person medical evaluation of the patient, but only if all of these conditions are met:3
- The prescription is issued for a legitimate medical purpose in the usual course of professional practice.
- It results from a communication using an interactive telecommunications system, as referenced in 42 CFR 410.78(a)(3).
- The practitioner is authorized under their DEA registration to prescribe that class of drug, or is exempt from registration.
- The prescription is consistent with 21 CFR part 1306.
The notice also says prescriptions must otherwise comply with DEA guidance, DEA regulations and applicable federal and state law.3
What did the extension not change?
More than it might sound like from the headlines.
It is temporary
The DEA states that it continues to consider the input received and is working to promulgate a final set of telemedicine regulations.1
Working to promulgate a final set of telemedicine regulations.
The temporary rule itself does not give a timeline for those final rules.3 That is the honest summary: more time, no clarity yet on what comes after.
- May 12, 2023The flexibility authorization period begins
- Nov 15, 2024DEA and HHS announce the third extension
- Jan 1, 2025The extension takes effect
- Dec 31, 2025Flexibilities end unless extended or replaced
- Permanent ruleNo timeline given by the DEA
It does not replace state rules
State licensing, state prescribing rules and your own malpractice and payer requirements keep their force. The conditions above require that prescribing comply with federal and state law, so a clinic operating across several states has several rulebooks to follow (see my piece on licensing across state lines).3
It does not touch non-controlled medications
If your clinic prescribes only medications that are not controlled substances, this rule is not about you. Check your formulary against the DEA's schedules if you are unsure. The point is to know, not to assume.
How should a clinic use the extra year?
With five concrete moves.
- Inventory your exposure. List every controlled medication you prescribe, in which states, by which clinicians. This is the map of what the rule affects.
- Document your process. Write down how a telemedicine encounter works in your clinic: identity checks, the communication system you use, how decisions are recorded. A clear, consistent process is easier to defend and to adapt.
- Build a contingency path. If an in-person step becomes necessary later, how would your patients complete it? Partners, referral networks or scheduled in-person days are easier to arrange in 2025 than in the last month before a deadline.
- Stress-test the revenue. What share of your revenue depends on controlled prescribing by telemedicine? What happens if that share pauses for 90 days?
- Set a monitoring habit. Put the Federal Register and DEA announcements on a monthly review. A rule change usually arrives with a date, and the date is what you plan around.
Where marketing fits in
I run ads. So let me be plain about the marketing side. Do not advertise a flexibility as a permanent feature of your service, and keep the rest of the copy as careful as the rules in what a clinic can and cannot claim. If your ads or pages promise that patients will never need an in-person visit, you are making a promise that depends on a rule with a published end date.
I would write the claims around what the clinic does, not around what the regulation currently allows, and have a healthcare attorney review ad copy and landing pages before they go live. Ad platforms also have their own health and wellness policies, which I will cover separately.
What should you ask your healthcare attorney?
Bring a short list. It makes the hour you pay for count.
Five good questions
- Which of our current prescribing workflows rely on the temporary flexibility, and which do not?
- In each state where we have patients, what does state law require on top of the federal conditions?
- Is our telecommunications system and our documentation consistent with the conditions in the temporary rule?
- How should our patient consent forms and intake language describe telemedicine care without promising something that could change?
- What would you want us to have in place by mid-2025 if the rules change?
You are not looking for a prediction. You are looking for a map of your exposure and a checklist you can act on.
What do we still not know?
A few things, and it is worth saying so.
The open questions
- What the permanent rule will look like, and when it will arrive.
- Whether any ongoing pathway for telemedicine prescribing will carry new conditions or additional steps.
- How state boards will respond as federal timelines shift.
I am not predicting any of those. I am saying that a clinic that writes down its answers to "what if" today will be ahead of a clinic that waits for the headline.
A deadline you can see is a gift. Spend the year earning the right to keep growing after it.
A pattern repeats in every market I have bought ads in: the operators who treat a regulatory window as a planning period come out stronger than the ones who treat it as a finish line. If you want to talk through how the marketing side fits, start at my telehealth page.
Keep building.Ekai
Questions people ask
What did the DEA and HHS announce on November 15, 2024?
They jointly extended current telemedicine flexibilities for prescribing controlled medications through December 31, 2025. The extension is titled the Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications.
Does the extension allow prescribing without an in-person visit?
Under the temporary rule, a DEA-registered practitioner may prescribe Schedule II to V controlled substances via telemedicine without an in-person medical evaluation, if conditions are met, including a legitimate medical purpose, an interactive telecommunications system and compliance with federal and state law.
Is this a permanent rule?
No. The DEA says it is working to promulgate a final set of telemedicine regulations, and it gave no timeline in the temporary rule.
Does the extension override state law?
No. The conditions require that prescribing comply with applicable federal and state law, so state licensing and prescribing rules still apply.
Sources
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