Telemedicine in 2025: The DEA’s latest regulations and their impact on healthcare

The U.S. Drug Enforcement Administration (DEA) has introduced new telemedicine prescribing regulations for controlled substances, aiming to balance expanding virtual healthcare access with necessary safeguards against prescription misuse. These rules include a Proposed Rule on Special Registrations for Telemedicine and two final rules focusing on veterans and opioid use disorder treatment.

While these updates promise greater access to essential medications, they also introduce compliance complexities that healthcare organizations and telemedicine providers must navigate. In response, the American Telemedicine Association (ATA) has raised concerns about certain restrictive measures that may inadvertently limit patient access to care.

Telemedicine special registration framework

The DEA’s proposed rule establishes a new framework that allows healthcare providers to legally prescribe controlled substances without requiring an in-person consultation.

This rule seeks to address long-standing concerns under the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, which previously required at least one in-person medical evaluation before prescribing controlled substances. The proposed framework introduces three distinct categories of special registration.

1. Telemedicine prescribing registration: This registration allows qualified healthcare providers to prescribe Schedule III-V controlled substances, including medications for pain management, sleep disorders, and mental health conditions. Examples include codeine-based medications, anabolic steroids, and sedatives like Ambien.

2. Advanced telemedicine prescribing registration: This category extends to specialist physicians such as psychiatrists, palliative care experts, and pediatricians, permitting them to prescribe Schedule II-V controlled substances via telemedicine. Schedule II medications, such as opioids (morphine, oxycodone, hydrocodone), stimulants (Adderall, Ritalin), and strong pain relievers, have a higher potential for abuse. The rule seeks to expand access while implementing safeguards against overprescription.

3. Telemedicine platform registration: A significant development in the rule is the introduction of telemedicine platform registrations, allowing online healthcare providers to dispense controlled substances under strict regulatory oversight.

Platforms must meet several requirements to ensure compliance and patient safety. They must verify the identity of patients before prescribing controlled substances. Additionally, they are required to conduct mandatory Prescription Drug Monitoring Program (PDMP) checks to track prescriptions and prevent misuse. Compliance with electronic prescribing and proper recordkeeping is also essential to maintain transparency and adherence to regulations.

These platforms must also obtain state-specific registrations for each state where they operate, ensuring they comply with local telehealth laws and regulations.

Concerns from the ATA and telemedicine providers

While the framework provides a structured pathway for remote prescribing, the ATA and ATA Action have raised several concerns, particularly regarding the fairness and practicality of these rules.

50% prescription limit for schedule II substances: The proposed rule limits a provider’s Schedule II prescriptions to less than 50% of their total controlled substance prescriptions per month. The ATA argues that this arbitrarily restricts specialists such as psychiatrists and pain management experts, who frequently prescribe these medications.

Lack of clarity on provider exclusions: The rule does not explain why certain providers may be excluded from telemedicine prescribing, which could disrupt patient care.

Administrative burdens: The ATA has urged the DEA to simplify compliance processes, including a universal DEA number per provider, to prevent unnecessary delays.

Final rules for veterans & opioid treatment

Alongside the Proposed Rule, the DEA has finalized two key regulations designed to expand access to care for vulnerable populations. These rules take effect on February 18, 2025, and focus on VA patients and opioid use disorder treatment.

VA telemedicine exemption

The first final rule exempts VA healthcare providers from special registration requirements when prescribing controlled substances via telemedicine. However, a VA provider must have previously conducted an in-person evaluation of the patient before another provider can prescribe medication remotely.

This exemption ensures continuity of care for veterans, particularly those in rural areas where access to in-person medical care is limited. With a growing demand for mental health and chronic pain management services, this rule removes regulatory barriers that previously hindered veterans from receiving timely treatment.

Buprenorphine expansion for opioid treatment

The second final rule expands access to buprenorphine, a critical medication for treating opioid use disorder (OUD). Under the new rule, authorized practitioners can prescribe an initial six-month supply of buprenorphine via telemedicine, even during an audio-only consultation—as long as they review the patient’s PDMP data to prevent doctor-shopping and misuse.

This change aligns with efforts to combat the opioid crisis by making treatment more accessible to those struggling with addiction, especially in areas where substance abuse treatment facilities are scarce.

Telehealth compliance & state regulations

While the DEA’s new regulations create opportunities for expanding telehealth services, they also introduce compliance hurdles for healthcare providers. States still maintain their own telehealth laws, meaning providers must navigate complex, overlapping regulations.

Geographic restrictions and state registrations

A major challenge posed by the new rule is the requirement for state-specific telemedicine registrations. Unlike previous DEA regulations that focused on federal compliance, these new rules mandate that telemedicine providers obtain registrations in each state where they prescribe controlled substances.

For multi-state telehealth providers, the new regulations bring additional administrative burdens, requiring compliance with each state’s specific rules. These changes may also lead to potential licensing conflicts, which could prevent providers from prescribing controlled substances in certain states. As a result, patients might experience delays in accessing necessary medications if providers must wait for state approvals before issuing prescriptions.

Mandatory PDMP checks and E-prescribing

To combat misuse and diversion, the new rules require mandatory checks of state-run PDMPs before prescribing controlled substances. While PDMPs are essential in tracking prescriptions and preventing abuse, they also vary by state, creating additional challenges for telehealth practitioners working across multiple jurisdictions.

Additionally, the rules emphasize the importance of electronic prescribing systems (EPCS), requiring telemedicine providers to maintain secure records and comply with DEA auditing protocols. This requirement aims to increase transparency and reduce fraudulent prescriptions but may require providers to invest in costly electronic health record (EHR) systems.

The future of telemedicine prescriptions

The DEA’s updated regulations bring notable changes to the prescribing of controlled substances through telemedicine. These rules improve access to essential medications but also introduce compliance challenges that may limit some healthcare providers’ use of telehealth services.

Public comment period and potential changes

The Proposed Rule is open for public comment until March 18, 2025, allowing feedback from healthcare groups and telemedicine providers. Key areas, like geographic restrictions, may be revised.

Adjustments to Prescription Drug Monitoring Program (PDMP) requirements are being considered to align with state reporting systems. Expanding special registration eligibility is also under discussion. A new administration in 2025 could lead to revisions or delays, as lawmakers debate telehealth regulations and controlled substance oversight.

Healthcare industry adaptation

To comply with the new rules, telehealth providers, hospitals, and private practices must update their policies and procedures. This includes upgrading electronic health record (EHR) systems to align with the DEA’s prescribing requirements.

Staff training will also be essential, ensuring compliance with Prescription Drug Monitoring Program (PDMP) regulations and state-specific telehealth laws. Additionally, healthcare providers may need to establish partnerships with in-person practitioners to facilitate necessary medical evaluations before prescribing controlled substances.

As telemedicine continues to evolve, healthcare organizations must stay informed and proactive to ensure seamless patient care while adhering to the latest DEA regulations.

The DEA’s new telemedicine prescribing rules represent a pivotal moment in healthcare regulation. They aim to increase access to essential medications for veterans, individuals with opioid use disorder, and patients requiring controlled substances while implementing safeguards against misuse.

However, these rules also present challenges for healthcare providers, particularly in navigating state-specific telehealth laws, complying with PDMP requirements, and ensuring seamless patient care. With a public comment period open until March 2025, stakeholders still have an opportunity to shape the future of telemedicine prescribing.

As the landscape of telehealth continues to expand, the healthcare industry must adapt, comply, and advocate for practical policies that balance accessibility, safety, and regulatory oversight.