BRIDGE Prescribing by Telemedicine Updates to Controlled Substance Regulations

In general, under 21 U.S.C. 829(e), a valid prescription for a controlled substance requires a practitioner to have conducted at least one in-person medical evaluation of the patient.

However, the DEA and HHS have recently proposed and promulgated new telemedicine rules that allow exceptions to the requirements in 21 U.S.C. 829(e).

Expansion of Buprenorphine Treatment via Telemedicine Encounter was scheduled to be effective February 18, 2025 but has been delayed to December 31, 2025. This rule specifically applies to prescribing buprenorphine for opioid use disorder (OUD). The current regulation in effect is the Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications, which permits all controlled substances to be prescribed via telemedicine without an in-person medical evaluation until December 31, 2025.

Special Registrations for Telemedicine and Limited State Telemedicine Registrations is a proposed rule that would apply to all controlled substances, including buprenorphine. Until that rule is finalized by the DEA, the regulation in effect is the Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications, which permits all controlled substances to be prescribed via telemedicine without an in-person medical evaluation until December 31, 2025.

Buprenorphine for OUD

Delayed until December 31, 2025 (Originally effective February 18, 2025)

Expansion of Buprenorphine Treatment via Telemedicine Encounter

DEA-registered clinicians may prescribe buprenorphine for the treatment of OUD via telemedicine (including audio-only) without conducting an in-person medical evaluation of the patient for a period not to exceed 6 calendar months. After 6 months, the clinician may only continue prescribing buprenorphine via telemedicine if they have conducted at least one in-person medical evaluation or are otherwise authorized to prescribe controlled substances via telemedicine.

In addition, the pharmacist must verify the identity of the patient who receives a buprenorphine prescription for OUD via telemedicine. Verification requires inspecting “the patient's state or Federal Government-issued photographic identification card, or in the absence of such identification, any other form of documentation showing that the patient is the same person as the patient listed on the prescription.” The pharmacist may accept identification from any qualifying “ultimate user,” which includes the patient or a member of the patient’s household.

All other state and federal requirements of buprenorphine prescribing must be met, including ensuring prescriptions are issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice.

Until December 31, 2025, the current regulation in effect is the Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications, which permits all controlled substances to be prescribed via telemedicine without an in-person medical evaluation.

Other Controlled Substances

Effective January 1, 2025 through December 31, 2025

Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications

All controlled substance prescriptions may be issued via telemedicine by DEA-registered practitioners without the practitioner conducting an in-person medical evaluation of the patient. Although this allowance was originally part of the COVID-19 public health emergency, the DEA has temporarily extended it while they consider permanent regulatory changes.

Telemedicine requires an interactive telecommunications system, which is a two-way, real-time interactive communication between the patient and practitioner using audio and video. Audio-only two-way, real-time interactive communication is allowed only for mental health disorders and when the patient is not capable of or does not consent to the use of video.

All other state and federal requirements of controlled substance prescribing must be met, including ensuring prescriptions are issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice.

This page was last updated on March 22, 2025. The information contained herein is not legal advice. Although the P2P team will make every attempt to keep this information updated as telemedicine allowances change, pharmacists are encouraged to refer to the eCFR and guidance documents from the DEA when making dispensing decisions.