Another Extension Expected for Virtual Prescribing, Same Uncertainty

In November, the Office of Management and Budget (OMB) indicated that the DEA may soon offer a fourth extension of telehealth e-prescribing flexibilities. For the last 5 years since the Covid PHE began, temporary extensions have been critical for patients prescribed controlled medications via telehealth and for whom in-person requirements create serious barriers to care continuity. While another extension beyond the last day of 2025 would certainly be welcomed by providers and patients who’ve been caught in a multi-year cycle of uncertainty surrounding telehealth e-prescribing of controlled substances, we hold out hope that 2026 will be the year DEA finalizes meaningful and permanent regulatory policy around telehealth e-prescribing allowances.

It’s important to take a moment here to revisit where things stand. The core issue remains that the DEA exceptions allowing e-prescribing of controlled substances via telehealth without an initial in-person visit are about to expire again. While the Ryan Haight Act of 2008 was intended by Congress and DEA to clarify policy around telehealth e-prescribing allowances, it has been fraught with misinterpretation, confusion, and lack of alignment in federal and state legislation and prescribing flexibilities. 

Clinicians have relied on federal and state telehealth flexibilities to prescribe essential treatments for ADHD, anxiety disorders, depression, and other serious behavioral health conditions — medications that help patients maintain stability, function, and safety. For many patients, these medications are a critical part of treatment in psychiatry, family medicine, and pediatrics, not a luxury. Interruptions in access often lead to destabilization, safety risks, and worsening symptoms.

The cycle continues, still no clarity

While another extension would provide temporary relief, it would not address the fact that providers, patients, and health systems still lack the permanent regulatory clarity they need to plan care delivery with confidence going forward. From late November through Christmas, practices and pharmacies experience a surge of calls from patients and parents asking whether they will still be able to access their medication, sadly leaving many patients and families in prescription limbo. This uncertainty is unfolding on top of ongoing medication shortages already negatively impacting patients and frustrating providers and pharmacists.

For families managing ADHD, anxiety and other behavioral health conditions, these medications are life-changing. Clinicians consistently emphasize that these medications address real physiological imbalances in brain chemistry, just as other medications address physical imbalances throughout the body. When access is interrupted, the consequences are tangible. Children struggle in school, behavioral issues escalate, family stress increases, and in some cases, there’s an increased risk of involvement with the juvenile justice system.

Regulatory whiplash is a clinical problem

The disruption caused by regulatory uncertainty isn’t limited to prescribing controlled substances. During the recent government shutdown, Dr. Helen Hughes, Media Director for the Office of Telemedicine at Johns Hopkins Medicine, described the situation in Healthcare IT News: “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.”

Her remarks mirror what clinicians experience when telehealth policy is governed by temporary fixes. Whether the issue is Medicare coverage or DEA prescribing authority, last-minute extensions interfere directly with patient care, on top of being an administrative burden with canceled visits, delayed refills and panicked patients. Clinicians are forced to focus on managing uncertainty rather than giving their full attention to practicing medicine. 

What this looks like inside a practice

The Ryan Haight Online Pharmacy Consumer Protection Act contains an in-person visit requirement that remains the legislation’s greatest source of confusion.

Providers routinely ask:

• Will all patients need to be seen in person starting in the near future?
• Can care continue if another psychiatrist or clinician saw the patient in person within the past several months?
• Are prescriptions written immediately after an extension protected?

There are no clear answers. As a result, practices are left redesigning schedules, documenting defensively rather than clinically, debating whether to bring patients in unnecessarily and managing increased call volume from pharmacies, parents and schools.

Providers shouldn’t be forced to guess

Throughout this prolonged period of ambiguity, clinicians have heard very little from the DEA. Many in the medical community view that silence as unacceptable, given the stakes for patients.

The DEA’s lack of communication is frequently attributed to concerns about diversion. Diversion prevention is intended to reduce the misuse and unlawful distribution of controlled substances. While it remains an important objective, providers emphasize that effective regulation should distinguish so-called pill mills from legitimate prescribers. It shouldn’t make clinicians afraid to treat patients appropriately.

Medical professionals shouldn’t be expected to decode legislation that even legal scholars struggle to interpret. In the absence of clear rules, many rely on good-faith clinical judgment informed by legal counsel, documentation and patient need. When regulations are vague, good-faith interpretation has been seen as valid for clinicians who are acting in the patient’s best interest.

Extension is not a solution

In a MedCity News article on navigating virtual prescribing policy changes last year, I offered several practical strategies to help providers operate amid continued regulatory uncertainty.

At a high level, the guidance emphasized:

• Tightening compliance processes
• Strengthening coordination with pharmacies and care teams
• Maintaining clear patient communication 
• Carefully documenting clinical decision-making

I also called on policymakers to provide permanent, workable guidance. These recommendations remain relevant today.

Extensions may delay disruption, but they don’t resolve the underlying problem. Until clear, lasting DEA guidance exists, the cycle will continue. Every November and December, clinicians will wait as care delivery remains vulnerable to policy delays.

Photo Credit: Big Stock Photo

This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.