The DEA’s special registration proposal would replace the pandemic telehealth flexibilities with three new federal registrations, a further DEA registration for every state where your patients sit, and a set of records no telehealth program keeps today. It was proposed on January 17, 2025. As of September 17, 2026, a final version is under White House review and its text is not public.
Read this as a proposal, because that is all anyone has
Congress told the DEA to write these regulations by October 24, 2019 (21 U.S.C. § 831(h)(2)). The proposal arrived more than five years late, at 90 Fed. Reg. 6541, and drew more than 6,400 comments. The DEA’s own agenda entry says it “is considering various alternatives in drafting a Final Rule.”
A final rule under the same number, RIN 1117-AB40, reached the White House review office on August 25, 2026. Everything below describes the proposal. Any item may have been cut, softened or kept. Use it to see what the agency was worried about, then read the final text the day it publishes. The three scenarios for January 1, 2027 covers the timing.
Three registrations, plus one for every patient state
The proposal defines three kinds of special registration:
- Telemedicine Prescribing Registration. For a clinician, covering “Schedules III through V controlled substances.” This is the testosterone and ketamine tier.
- Advanced Telemedicine Prescribing Registration. For a clinician, covering “Schedules II through V controlled substances.” This is the stimulant tier, and it is limited to listed specialties.
- Telemedicine Platform Registration. For a “covered online telemedicine platform,” covering Schedules II through V.
On top of that, every special registrant “shall obtain a State Telemedicine Registration” for “every state in which patients to whom special registration prescriptions will be issued are located.” The preamble is careful to say this is “a DEA-issued registration and not a registration issued by the individual states.” A prescriber with patients in thirty states would hold thirty of them. The proposal set one fee level for the main registrations and for each platform state registration, and a much lower one for each clinician state registration, on a three-year cycle.
An applicant must also show “a legitimate need.” For the basic tier, the proposed test is that in-person evaluations “could impose significant burdens on the patients.” A special registration also rides on the prescriber’s ordinary DEA registration. Lose that one and the special registrations go with it.
Schedule II is where the proposal is strictest
The advanced tier is open to six kinds of practitioner: psychiatrists, hospice physicians, palliative care physicians, practitioners treating at long term care facilities, pediatricians, and neurologists treating conditions other than pain. Board certification in one of those fields also qualifies. Each Schedule II prescription must match the specialty’s purpose.
Two further limits were proposed for Schedule II:
- Same state. No Schedule II special registration prescription “unless the individual special registrant is physically located in the same state in which the patient was located at the time of the telemedicine encounter.”
- Under half. In any calendar month, a registrant’s Schedule II special registration prescriptions “shall constitute less than 50 percent of the total number of Schedule II prescriptions issued in that calendar month” across telemedicine and in-person practice combined.
The preamble then hedges: “DEA anticipates imposing one or both of the proposed requirements based on the comments received by stakeholders.” If either survives, a multi-state telehealth ADHD program staffed by remote prescribers does not fit it.
The platform definition reaches companies that never write a prescription
This is the part online brands should read twice. A covered online telemedicine platform is an entity that connects patients and clinicians by audio-video in a way “that may result in the prescription of controlled substances, but is not a hospital, clinic, local in-person medical practice, or insurance provider,” and that meets one or more of four criteria:
- It “explicitly promotes or advertises the prescribing of controlled substances through the platform.”
- It has financial interests “tied to the volume or types of controlled substance prescriptions issued through the platform,” including pharmacy ownership or rebates.
- It exercises control or influence over clinical decisions, for example through protocols, prescribing metrics used in hiring or pay, quotas, or preferred pharmacies.
- It “has control or custody of the prescriptions or medical records of patients who are prescribed controlled substances through the platform.”
A management company or brand that holds the EHR contract would meet the fourth test on that fact alone. The carve-out for a “local in-person medical practice” is narrow: all offices “within 100 miles of each other,” and “less than 50 percent” of controlled substance prescriptions issued by telemedicine in any month.
In our structure the professional entity holds the chart and approves the protocols. The brand does neither. Under this definition that separation would decide whether the brand itself needs a DEA registration.
What a special registrant would have to do for each prescription
| Requirement | Proposed section | What it says |
|---|---|---|
| Audio-video visit | § 1306.44 | Every special registration prescription issued through audio-video. Audio-only is limited to certain opioid use disorder treatment after an audio-video start. |
| Electronic prescribing | § 1306.42 | Prescriptions issued “through Electronic Prescribing for Controlled Substances (EPCS).” |
| PDMP check | § 1306.43 | Check the patient’s state, the prescriber’s state, and any state with a reciprocity agreement. A nationwide check of all fifty states would begin three years after the effective date. |
| Photo identification | § 1304.04(i) | “capture a photographic record of the patient presenting their federal or state-issued photo identification card or other acceptable documents.” |
| Encounter record | § 1304.04(j) | “a record of the date and time of the telemedicine encounter, the address of the patient during the telemedicine encounter, and the home address of the patient.” |
| State law | § 1306.46 | Comply with the law of the prescriber’s state and the patient’s state for each encounter. |
| Prescriber location | § 1306.41 | The prescriber must be physically in the United States. |
| Annual report | § 1304.61 | New-patient counts by state for Schedule II and a listed group of Schedule III through V drugs. |
One detail matters for hormone programs. The listed group for pharmacy and prescriber reporting names ketamine, tramadol and benzodiazepines. Testosterone is not on it. Ketamine programs would carry the heavier reporting load.
Patients you have seen in person are outside the rule
The proposal says it does “not affect practitioner-patient relationships in cases where an in-person medical evaluation has occurred at any point within the relationship.” One in-person evaluation by the prescriber takes that relationship out of the Ryan Haight framework and out of the special registration. That is why a hybrid model, with a physical evaluation point, survives every version of this rule.
What this means for you
Do not build to the proposal, and do not ignore it. Four items cost little and fit any final version: a PDMP check on every controlled substance prescription, a saved photo ID, a record of where the patient was during the visit, and electronic prescribing. If you run a brand, write down who holds the patient records and who approves clinical protocols, and test that answer against the four platform criteria. If you run a multi-state provider network, count the states per prescriber now. That number becomes a registration count if the state registration survives.
Related reading
Frequently asked questions
Is the DEA special registration rule final?
Not as of September 17, 2026. The DEA proposed it on January 17, 2025, at 90 Fed. Reg. 6541. A final version was received by the White House regulatory review office on August 25, 2026, and the government’s agenda targets final action in November 2026. The final text has not been published, so nobody can register yet.
Who would need a DEA special registration for telemedicine?
Under the proposal, any practitioner prescribing controlled substances by telemedicine to a patient they have never examined in person, outside the other statutory exceptions. Platforms that meet the proposed definition would need their own registration. Prescribers who have examined the patient in person at least once would not need one for that patient.
Would a telehealth platform need its own DEA registration?
Under the proposal, yes, if it meets any one of four criteria: advertising controlled substance prescribing, financial interests tied to prescription volume, control or influence over clinical decisions, or custody of prescriptions or medical records. Hospitals, clinics, insurers and small local practices were carved out. Whether this survives in the final rule is not public.
Could nurse practitioners prescribe Schedule II stimulants under the special registration?
The proposal limited the advanced registration to listed specialties and said mid-level practitioners would have to be board certified in one of them. It also proposed a same-state rule and a cap below half of monthly Schedule II prescriptions. State law would still decide whether a nurse practitioner may prescribe Schedule II at all.
Does the proposed special registration cover testosterone?
Testosterone is Schedule III, so it would fall under the basic Telemedicine Prescribing Registration, which covers Schedules III through V. Testosterone does not appear on the proposal’s list of drugs that trigger extra pharmacy and prescriber reporting. Ketamine, tramadol and benzodiazepines do. The final rule may differ.
This is general information, not legal advice. Rules vary by state and change. Confirm your own facts with counsel.