U.S. DEA likely to extend telehealth prescribing, uncertainty persists
NEW YORK, UNITED STATES — The United States Drug Enforcement Administration is expected to extend pandemic-era telehealth prescribing flexibilities once again, averting an immediate disruption in care but prolonging uncertainty for providers and patients who rely on virtual treatment.
The outlook was outlined in a recent analysis of federal policy signals by Dr. Tom Milam, who serves as chief medical officer at Iris Telehealth and president of Iris Medical Group and who guides teams of clinicians on telemedicine and industry best practices.
In November 2025, the Office of Management and Budget indicated the DEA may soon issue a fourth extension allowing clinicians to prescribe certain controlled substances via telehealth without an initial in-person visit.
The current waiver expired last December 2025, and health systems across the U.S. are once again bracing for last-minute regulatory decisions that shape care delivery.
Telehealth extension offers relief, but planning suffers
For hospitals, health systems, and outpatient clinics, another extension would provide short-term stability but little ability to plan long-term telehealth services.
Clinicians have relied on federal and state flexibilities to treat patients with ADHD, anxiety, depression, and other behavioral health conditions—medications that are central to maintaining safety and function.
Milam noted that interruptions in access “often lead to destabilization, safety risks, and worsening symptoms,” a concern that resonates deeply with providers managing behavioral health shortages and rising demand.
Health systems report that each approaching deadline triggers waves of patient inquiries, pharmacy calls and internal compliance reviews, diverting clinical and administrative resources.
The uncertainty compounds existing pressures, including medication shortages and workforce constraints.
From late November through December, practices frequently face “a surge of calls from patients and parents asking whether they will still be able to access their medication,” leaving families and care teams in limbo.
Ryan Haight rules fuel telehealth regulatory whiplash
The confusion centers on the Ryan Haight Online Pharmacy Consumer Protection Act, particularly its in-person visit requirement.
Providers are left asking, “Will all patients need to be seen in person starting in the near future?” and “Are prescriptions written immediately after an extension protected?”
The lack of clear answers forces clinics to redesign schedules, document defensively, and consider unnecessary in-person visits.
The disruption mirrors broader telehealth policy challenges.
“Seeing the government shutdown stall our telehealth progress has been deeply disheartening and disruptive. As we watch vital access to care slip away, we hope Congress will act swiftly to permanently restore these essential services for our patients,” said Dr. Helen Hughes of Johns Hopkins Medicine during a recent government shutdown.
Why permanent DEA telehealth rules matter
For providers, the pattern of temporary fixes is itself a clinical problem. While extensions may delay disruption, Milam emphasized they are “not a solution.”
Without permanent DEA guidance, hospitals and clinics remain locked in an annual cycle of uncertainty—one that affects not just compliance planning but patient care itself.
Until the DEA issues durable, clearly defined telehealth prescribing regulations, providers expect the cycle to repeat.
Each year brings renewed anxiety for patients and renewed operational strain for health systems—underscoring the growing consensus among clinicians that temporary extensions, while necessary, fall short of what modern healthcare delivery requires.
