DEA’s Telemedicine Prescribing Proposal and How Prescribers Can Push Back

Imagine you prescribe a Schedule II medication to just two established patients. Both have been stable on treatment, and neither has ever met with you in person. Under the DEA’s January 2025 proposal, even if you could move one patient’s prescription onto a lawful pathway outside the proposed special registration, the other prescription would still account for exactly 50% of your Schedule II prescribing that month. The proposal requires less than 50%. The patient’s treatment could depend on what else you prescribed that month. DEA proposed rule, § 1306.45(c)

This is a national issue for independent practices, multistate prescribers, and the patients who rely on them. As of November 9, 2026, the draft final rule was still under review at the White House Office of Information and Regulatory Affairs (OIRA). The current federal flexibility allows qualifying Schedule II–V prescribing by telemedicine without a prior in-person evaluation through December 31, 2026, subject to applicable requirements. The public proposal is dated January 17, 2025. OIRA review status · DEA and HHS temporary extension

What DEA proposed

The special registration would create a pathway for prescribing controlled substances remotely when the prescriber has never personally evaluated the patient in person. DEA proposed three registrations. January 2025 proposed rule

Proposed registration	What it would cover
Telemedicine Prescribing Registration	Schedule III–V prescribing by qualifying clinicians
Advanced Telemedicine Prescribing Registration	Schedule II–V prescribing by qualifying specialists. The proposed eligibility language includes clinicians board certified in treating psychiatric or psychological disorders, which provides a pathway for qualifying PMHNPs.
Telemedicine Platform Registration	A separate registration for certain covered online platforms involved in controlled-substance prescribing

Two proposed restrictions apply only to Schedule II. The first would require a prescriber’s Schedule II prescriptions under special registration to account for less than half of all Schedule II prescriptions they issue in a calendar month. The second would require the prescriber to be physically in the same state where the patient was located during the telemedicine encounter when the prescriber issues the prescription. Dropping the cap alone would still leave out-of-state clinicians facing the geographic restriction. Proposed § 1306.45(b)–(c)

The cap counts prescriptions, so a prescriber who writes 100 Schedule II prescriptions in a month could issue up to 49 under special registration. The other 51 would need another lawful basis. A qualifying in-person evaluation previously conducted by the prescribing clinician can generally support later telehealth prescribing outside the special-registration pathway, subject to applicable requirements. The cap does not call for 51 in-person visits every month. DEA proposed rule · 21 U.S.C. § 829(e)

Schedules III–V would still carry new requirements under the proposed pathway. These include applicable state prescribing authority, DEA-issued telemedicine registration for each patient state unless exempt, expanded prescription drug monitoring program (PDMP) checks, patient identity verification, and electronic prescribing. DEA generally proposes real-time audio-video for these encounters, with a limited audio-only exception for certain opioid use disorder follow-ups. DEA proposed rule

What would it cost?

An individual clinician would generally keep a conventional DEA registration at $888 per three-year cycle and pay a separate $888 for the telemedicine special registration, plus $50 per patient state where the clinician uses that pathway. For a clinician who already has a conventional DEA registration, using the proposed pathway in two states would add $988 in new fees. Including one conventional registration, the total in that example would be $1,876 over three years. Proposed fee schedule, § 1301.13(e)

What prescribers can do right now

1.        Request a meeting with OIRA. The formal DEA comment period closed on March 18, 2025. While White House review is pending, an individual prescriber, a practice, or a group of practices can request an Executive Order 12866 meeting. Ask OIRA and DEA to remove both proposed Schedule II restrictions in § 1306.45(b)–(c). Bring a one-page summary showing how many established patients depend on cross-state prescribing, how many have a local clinician who could take over, and how long that transfer would take. OIRA publishes meeting materials, so use aggregate figures and de-identified examples. Request a meeting for RIN 1117-AB40 · OIRA meeting guide

2.        Contact your U.S. representative and both senators. Ask for the staffer who handles health policy. Ask the office to press DEA and HHS for a fifth temporary extension through at least December 31, 2027, and to urge DEA and OMB to drop both Schedule II restrictions from the permanent rule. Give them one concrete number from your district or state, such as how many patients would need a new prescriber before their next prescription is due. Find your representative · Find your senators

3.        Work with a national coalition. The Alliance for Connected Care’s November 2 letter calls for a fifth extension. Signers include AANP, ATA Action, the American Psychiatric Association, and CHADD. Ask your professional association to share your practice’s data in its follow-up with federal officials. A shared brief from independent practices across multiple states can show how the same provisions affect patients in very different communities. Coalition letter and signers

DNP Consulting supports safeguards that address diversion while preserving access to treatment. DEA can use tools such as patient identity verification, PDMP review, and targeted oversight to identify prescribing that warrants scrutiny. A patient’s ability to stay in care should never hinge on how many other Schedule II prescriptions their clinician happened to write that month.

Sources

·        Drug Enforcement Administration. “Telemedicine Prescribing of Controlled Substances.” Federal Register, proposed rule, January 17, 2025. https://www.federalregister.gov/d/2025-01099

·        21 U.S.C. § 829(e), “Dispensing of controlled substances by means of the Internet.” https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title21-section829&num=0&edition=prelim

·        Office of Information and Regulatory Affairs. “RIN 1117-AB40: Telemedicine Prescribing of Controlled Substances” (review status). https://www.reginfo.gov/public/do/eoDetails?rrid=1510512

·        Drug Enforcement Administration and Department of Health and Human Services. “Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications.” Federal Register. https://www.federalregister.gov/d/2025-24123

·        Office of Information and Regulatory Affairs. “Request a Meeting for RIN 1117-AB40.” https://www.reginfo.gov/public/do/eo/neweomeeting?rin=1117-AB40

·        Office of Information and Regulatory Affairs. “How to Request a Meeting.” https://www.reginfo.gov/public/do/eo/eomHowTo

·        U.S. House of Representatives. “Find Your Representative.” https://www.house.gov/representatives/find-your-representative

·        U.S. Senate. “Contacting U.S. Senators.” https://www.senate.gov/senators/contact/

·        Alliance for Connected Care. “DEA Telemedicine Prescribing Flexibilities: Coalition Letter and Signers,” November 2, 2026. https://aahd.us/2026/11/dea-telemedicine-prescribing-flexibilities/