As of September 17, 2026, the federal rule that lets you prescribe a controlled substance by telehealth with no in-person visit expires at the end of December 31, 2026. Three outcomes are possible: a fifth extension, a final special registration rule, or a lapse. A final rule is already under White House review. Its text is not public.
The authorization ends by its own terms
Nothing has to be repealed for this to stop. The regulation carries its own end date: “This section is in effect until the end of the day December 31, 2026. The authorization granted in paragraph (b) of this section expires at the end of December 31, 2026” (21 C.F.R. § 1307.41(a)).
That section is the fourth temporary extension of the pandemic flexibilities, published December 31, 2025. It lets a DEA-registered practitioner prescribe Schedule II through V drugs by telemedicine without a prior in-person evaluation, on four conditions: a legitimate medical purpose, a live interactive telecommunications system, a proper DEA registration, and compliance with the rest of the prescription rules.
The underlying statute never changed. The Ryan Haight Act still requires “at least 1 in-person medical evaluation of the patient” before a controlled substance is prescribed over the internet, unless the practice fits a listed telemedicine category.
Where the rulemaking stands in September 2026
- The DEA proposed a permanent framework, the special registration, on January 17, 2025 (90 Fed. Reg. 6541). It drew more than 6,400 comments.
- A final rule under the same docket number, RIN 1117-AB40, was received by the White House regulatory review office on August 25, 2026. Stakeholder meetings on it are scheduled for September 18 through 24, 2026.
- The government’s regulatory agenda targets final action in November 2026. That is a target. Agenda dates slip.
- No fifth extension, final rule or withdrawal has been published in the Federal Register as of September 17, 2026.
Nobody outside the government has read the final text. Anyone who tells you what it requires is describing the January 2025 proposal, which may or may not survive.
The three scenarios, side by side
| Scenario | What it takes | What changes for you on January 1 |
|---|---|---|
| A fifth extension | A joint DEA and HHS temporary rule. The first four were issued without notice and comment and changed only the dates. | Nothing, if it follows the pattern. The same four conditions apply for another period. |
| A final special registration rule | Publication of the rule now under review, with an effective date. | Unknown. The proposal required a new registration, a registration for each patient state, PDMP checks, photo identification and new records. The last extension said its purpose was to give providers time to comply with whatever is adopted. Whether a transition period comes with the final rule is not public. |
| A lapse with no replacement | Nothing. The section expires. | The in-person rule governs every new controlled substance patient you have never examined in person. |
What the statute leaves if nothing replaces it
The statute lists seven kinds of telemedicine that are exempt from the in-person rule (21 U.S.C. § 802(54)). After a lapse, here is what each offers an ordinary telehealth program:
- The patient is physically in a DEA-registered hospital or clinic during the visit.
- The patient is in the physical presence of another DEA-registered practitioner during the visit.
- Indian Health Service and tribal practitioners with a specific designation.
- A declared public health emergency with a drug and area designation. The COVID designation ended with the emergency on May 11, 2023.
- A special registration. None can be held until a final rule is published and takes effect.
- Department of Veterans Affairs emergencies, limited to a five-day supply.
- Anything else DEA and HHS allow by joint regulation. After a lapse that means two narrow rules in effect since December 31, 2025: buprenorphine for opioid use disorder (21 C.F.R. § 1306.51) and VA patients (§ 1306.52).
For a telehealth testosterone, ketamine or stimulant program, only the first two are practical. Both put the patient in a room with a DEA registrant.
Who is not affected
Patients you have examined in person once. DEA said so in the fourth extension: “Once a practitioner has conducted at least one in-person medical evaluation of a particular patient, the specific requirements of the Ryan Haight Act related to remote prescribing of controlled substances no longer apply to that specific practitioner-patient relationship.” The visit must be by the prescribing practitioner. A visit with someone else in your network does not carry over, except through the statute’s narrow covering-practitioner rule.
Drugs that are not scheduled. Semaglutide, tirzepatide, estradiol and progesterone do not appear in the federal schedules as of September 16, 2026. A weight management program built on GLP-1s is outside this deadline at the federal level. State scheduling can differ. Testosterone and ketamine are Schedule III. Amphetamine, methylphenidate and lisdexamfetamine are Schedule II.
The Medicare date is a different date
Congress extended the Medicare telehealth waivers through December 31, 2027 (Pub. L. 119-75, § 6209). That law governs what Medicare pays for. It says nothing about the Controlled Substances Act. We searched both appropriations laws passed this cycle for the DEA provisions and found nothing extending the flexibilities. If a vendor tells you telehealth was extended to the end of 2027, ask which telehealth.
Congress has not moved the in-person rule
As of September 17, 2026, the bills we found that would amend the in-person requirement sit in committee. The TREATS Act (H.R. 1627, S. 3048) reaches only drugs approved for substance use disorder. H.R. 6994 reaches mental health drugs. A VA-only bill, H.R. 1107, passed the House in September 2025 and is in a Senate committee. None of them covers testosterone or a cash-pay ketamine program. We could not run a complete bill search, so treat this list as what we found.
What to do under all three scenarios
- List every controlled substance patient who has never been examined in person by their current prescriber. That list is your exposure.
- For patients who have had an in-person visit, make sure the chart shows the date, the place and the examiner.
- Build an in-person path now: your own location, or a DEA-registered practitioner who can be in the room while your prescriber joins by video.
- Confirm each prescriber’s DEA registration and state prescribing authority for every state where their patients sit. How we credential providers describes the file.
- Make PDMP checks, identity verification and a record of the patient’s location routine. The proposal required all three, and the buprenorphine rule already requires a PDMP review.
- Watch RIN 1117-AB40 on reginfo.gov and the Federal Register’s public inspection list. Do not rely on the Medicare date.
Step three is the one that takes months. An online brand with no physical footprint cannot stand one up in the last week of December.
What this means for you
Plan for the lapse and treat an extension as a bonus. Four extensions have trained the market to expect a fifth, and this time a final rule is sitting at the last review step. Count your never-examined patients this month. Decide where an in-person evaluation could happen in each state you sell into. If your program is telehealth TRT, the whole panel is exposed at once, so start there.
Related reading
Frequently asked questions
When do the DEA telemedicine flexibilities expire?
At the end of December 31, 2026. The regulation, 21 C.F.R. § 1307.41, states its own end date, and it is the fourth temporary extension. As of September 17, 2026, no fifth extension has been published, and a final special registration rule is under White House review with no public text.
Will the DEA extend telemedicine flexibilities into 2027?
Nobody outside the government knows. The DEA extended four times, each by a temporary rule that changed only the dates. This cycle is different because a final special registration rule reached the White House review office on August 25, 2026. An extension, a final rule with a transition period, or a lapse are all possible.
Can I keep prescribing testosterone by telehealth after December 31, 2026?
For any patient you have personally examined in person at least once, yes, because the in-person rule is already met for that relationship. For patients you have never examined in person, it depends on whether the DEA extends the flexibilities or publishes a final rule before the date. Testosterone is Schedule III.
Does the deadline affect semaglutide or tirzepatide prescribing?
Not at the federal level. The in-person rule applies only to controlled substances, and neither drug appears in the federal schedules as of September 16, 2026. State law can schedule drugs differently, and state telehealth and licensure rules still apply to every prescription you write.
Did Congress extend telehealth through 2027?
Congress extended the Medicare telehealth waivers through December 31, 2027. That law governs Medicare payment. It does not amend the Controlled Substances Act, and it does not extend the DEA rule that allows controlled substance prescribing without an in-person visit. The two deadlines are a year apart and unrelated.
This is general information, not legal advice. Rules vary by state and change. Confirm your own facts with counsel.