Navigating Virtual Prescribing Policy Changes in 2025

Telehealth prescribing has reshaped behavioral healthcare delivery across the U.S., making essential medications more accessible than ever before. Recent data shows the proportion of Medicaid beneficiaries accessing buprenorphine treatment through telehealth increased year over year from 2% to over 15% in states like Kentucky and Ohio.

While the Drug Enforcement Administration has extended virtual prescribing flexibilities through 2025, the lack of permanent regulations creates uncertainty for behavioral health providers and patients who rely on these services. The continuity of care for those receiving controlled substances through telehealth — from addiction treatment medications to behavioral health prescriptions — hangs in the balance.

Establishing permanent frameworks that preserve virtual care accessibility while ensuring patient safety requires immediate policy action. Through collaboration between regulators and healthcare stakeholders, telehealth prescribing can continue to expand treatment access while maintaining proven safety standards.

The rise of telehealth prescribing

The landscape of virtual prescribing changed dramatically in 2020. Before then, the Ryan Haight Online Pharmacy Consumer Protection Act required healthcare providers to conduct at least one in-person medical evaluation before prescribing controlled substances, with a few narrow exceptions. However, during the Covid-19 pandemic, the DEA recognized the urgent need for change and waived this requirement, allowing providers to prescribe these medications through video appointments.

Healthcare providers quickly embraced this flexibility to maintain patient care. As a result of this regulatory shift, 62% of prescribers frequently used electronic prescribing for controlled substances by 2021, up from 37% in 2019. For mental health conditions specifically, virtual prescribing rose from 1.4% in 2019 to 38.4% by 2022 for certain medications.

These changes proved particularly valuable for addiction treatment. A study published in JAMA Psychiatry found that Medicare patients receiving virtual care for opioid use disorder had a 33% lower risk of fatal drug overdose.

These results demonstrate that telehealth prescribing is more than a pandemic-era convenience; it’s a powerful tool for expanding healthcare access and improving patient outcomes. However, as the industry approaches the 2025 deadline for current flexibilities, providers and patients may face mounting challenges in maintaining these gains.

Challenges of the post-pandemic transition

Virtual prescribing faces three key challenges as regulators consider permanent policies. One of them is patient safety concerns, which have emerged through high-profile cases. In June 2024, Done Health executives faced charges for allegedly facilitating improper Adderall access. In a separate case, Cerebral agreed to pay over $3.6 million in fines in 2024 for practices that promoted unauthorized distribution of controlled substances. These examples underscore the need for robust oversight systems.

Next, healthcare providers face mounting administrative pressures as they attempt to maintain compliant prescribing practices amid shifting regulations both at the state and federal level. Without permanent guidelines from the DEA, clinicians must continuously adapt their protocols and documentation processes, taking time away from patient care. This regulatory uncertainty makes it difficult for providers to establish consistent, long-term treatment plans for patients who benefit from virtual care.

Last, any restrictions on telehealth prescribing disproportionately affect rural and underserved communities due to limited access to in-person psychiatric care, longer travel distances to medical facilities and fewer local providers who can prescribe controlled substances. These populations, which gained unprecedented access to mental healthcare and addiction treatment during the pandemic, risk losing vital services if permanent regulations create barriers to virtual care. The progress made in states with increased access to treatment medications through telehealth could be reversed under more restrictive policies.

While these challenges are significant, healthcare stakeholders can and should develop proactive approaches to address them before the 2025 deadline.

Strategies for navigating the uncertainty

Healthcare stakeholders can take specific actions to ensure continued access to telehealth prescribing while maintaining safety standards:

For providers:

• Strengthen compliance protocols – Stay current with DEA regulations and document virtual prescribing practices thoroughly, including checking state Prescription Drug Monitoring Programs (PDMPs) as directed by state and federal law.
• Build collaborative networks – Partner with pharmacists to enhance medication safety monitoring and identify potential prescribing issues early.
• Enhance care coordination – Work closely with therapists and mental health counselors to ensure comprehensive treatment plans that support medication management.

For patients:

• Understand treatment options – Work with providers to develop plans that include both virtual and in-person care possibilities.
• Document treatment success – Share positive outcomes with advocacy groups to support evidence-based policy decisions.

For policymakers:

• Use existing evidence – When developing permanent frameworks, consider successful outcomes, such as increased addiction medication access among Medicaid beneficiaries.
• Maintain stakeholder dialogue – Continue DEA listening sessions with healthcare providers, patients and public health experts to create balanced guidelines. 

The success of permanent telehealth prescribing policies depends on continued collaboration between providers, patients and policymakers. By working together now to establish effective guidelines, we can ensure that millions of Americans maintain access to essential medications through safe, monitored virtual care.

Photo: ronnachaipark, Getty Images

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