LUGPA Policy Update - Expected DEA Extension of Telemedicine Prescribing Flexibilities Through 2025

November 4, 2024 

Following strong advocacy from Congress and the White House, the DEA has proposed a rule to extend current telemedicine prescribing flexibilities for controlled substances. On October 11, 2024, the DEA submitted the proposed rule, which is expected to extend existing policies for at least one additional year, potentially two. This rule would continue critical waivers on in-person exam requirements and state-by-state DEA registrations and is anticipated for public review by year’s end.

In late August, POLITICO reported on an internal DEA draft proposing restrictions that would render telemedicine prescribing of controlled substances nearly unworkable. Though this restrictive draft rule was not officially released, HHS raised significant concerns, formally opposing its release at least three times with 400 line-item objections. The report triggered a swift public backlash from patients, clinicians, and advocacy groups. Lawmakers emphasized the necessity of extending telemedicine flexibilities to ensure access to essential treatments, particularly in rural and underserved areas.

The DEA has faced longstanding criticism for delays in creating a “special registration” process, originally mandated by the 2008 Ryan Haight Act. This process was intended to allow telemedicine prescribing of controlled substances without in-person visits for specially registered providers. Though the DEA faced renewed mandates under the SUPPORT Act of 2018, no permanent registration rule has been finalized. After receiving record-breaking criticism on a proposed rule in early 2023, the DEA issued two temporary extensions to allow time for a revised approach.

If approved, this extension would allow telemedicine prescriptions for Schedule II-V controlled substances without requiring an in-person visit, buying more time to draft a workable, permanent rule. This extension could also delay further rulemaking until the next administration.

Should the flexibilities expire, clinicians prescribing controlled substances via telemedicine would need to:

• Meet strict in-person examination requirements under the Ryan Haight Act or satisfy one of seven narrow exceptions; and
• Obtain DEA registration in each state where their patients are located.

Non-compliance may lead to severe penalties, including DEA registration revocation, disciplinary actions, and disclosures to state licensing boards and federal healthcare programs, which could jeopardize patient care and disrupt practice operations.

LUGPA strongly supports the extension of telemedicine flexibilities to maintain patient access to care and reduce barriers that inhibit practice efficiency. We continue to advocate for balanced, workable telemedicine regulations that protect patient access to vital treatments without imposing undue administrative burdens on clinicians.