BRIDGE Prescribing by Telemedicine Updates to Controlled Substance Regulations

In general, under 21 U.S.C. 829(e), a prescription for a controlled substance is valid only if the practitioner has conducted at least one in-person medical evaluation of the patient. An exception to this in-person visit requirement was enacted during the COVID-19 public health emergency. This exception, known as "telemedicine flexibilities," has been extended multiple times to allow for continuity of care as new regulations are developed.

For 2026, the Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications permits all controlled substances to be prescribed via telemedicine without an in-person medical evaluation until December 31, 2026. Most telemedicine controlled substance prescriptions are expected to be written pursuant to this fourth extension or 21 U.S.C 829(e).

However, the DEA and HHS have recently proposed and promulgated new telemedicine rules to replace the COVID-19 flexibilities and create new exceptions to 21 U.S.C. 829(e):

Expansion of Buprenorphine Treatment via Telemedicine Encounter went into effect on December 31, 2025. More information is available below. For 2026, unless a practitioner explicitly states a prescription was issued under this specific rule, buprenorphine prescriptions can be assumed to fall under the Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications, delaying the need to implement the additional requirements in the buprenorphine-specific rule.

Special Registrations for Telemedicine and Limited State Telemedicine Registrations is a proposed rule that would apply to all controlled substances. Until a rule is finalized by the DEA, the rule in effect continues to be the Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications.

Buprenorphine for OUD

Effective December 31, 2025, if a prescriber explicitly states a prescription is written pursuant to this rule.

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, 2026, unless a practitioner explicitly states a prescription is written pursuant to this rule, buprenorphine prescriptions may be filled under the Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications, which does NOT include a 6-month limit or identity verification requirements.

All Controlled Substances

Effective January 1, 2026 through December 31, 2026

Fourth 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 January 9, 2026. 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 should refer to the eCFR and guidance documents from the DEA and Kentucky Board of Pharmacy when making dispensing decisions.