The U.S. Drug Enforcement Administration (DEA) and U.S. Department of Health & Human Services (HHS) recently released a third extension of their telemedicine flexibilities for the prescription of controlled substances, effective as of Jan. 1, 2025. Known as the Third Temporary Rule, it allows practitioners to continue prescribing Schedule II-V controlled medications via telemedicine through the end of 2025.
Signed into law by then-President Bush, the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 only allowed providers to prescribe controlled substances via telemedicine if they had first seen the patient in person. The purpose was to curb access to and abuse of controlled substances by patients without proper provider supervision.
The COVID-19 pandemic, however, wrought substantial barriers for patients who desperately needed prescriptions but were unable to safely meet their providers in person due to safety protocols ushered in by the pandemic. Legislatures and executive agencies at the state level began addressing this gap by extending telemedicine requirements to promote access to non-emergency and preventative healthcare services, such as medication management services commonly provided through routine office visits, without crowding facilities strained by providing urgent and emergency healthcare services during the pandemic.
The DEA and HHS operated under an exception in the Act when they issued the first set of telemedicine flexibilities that permitted the prescribing of controlled medications without in-person encounters through the use of compliant telemedicine platforms. Since then, DEA and HHS extended the same and other flexibilities through 2024, and now through 2025.
Requirements Under the Third Extension
The Third Temporary Rule mirrors the stipulations of the original extensions. To permissibly prescribe a Schedule II-V controlled substance via telemedicine in lieu of an in-person visit, the following must be present:
- Legitimate Medical Purpose. The prescription must be issued for a valid, legitimate medical reason in the ordinary course of practice.
- The prescription must be issued pursuant to a communication using an interactive telecommunications system. Audio-visual communication is the standard requirement, with audio-only communication permitted in certain instances of treating a mental health disorder to patients in their homes.
- Authorized or Exempted Physician. Prescribing physicians must either be authorized under their registration to prescribe such controlled substances or exempt from obtaining a registration to dispense controlled substances.
- Compliance with the remaining regulatory requirements at 21 C.F.R. Part 1306.
ACR/ARP members should email the ACR’s advocacy team at [email protected] with any questions and comments. We will monitor the rule’s implementation and serve as an educational resource for members on its provisions and the impact they will have on rheumatology.
