Can telehealth doctors prescribe controlled substances in 2026?

Yes, for now. Through December 31, 2026, federal rules let a DEA-registered clinician prescribe controlled substances by telehealth without first seeing you in person, as long as every other legal requirement is met. What happens on January 1, 2027 depends on a permanent DEA rule that, as of early November 2026, had been reported as under final White House review but had not been published. If you take a controlled medication through telehealth, this is worth understanding now.

What counts as a controlled substance

Controlled substances are medications the federal Controlled Substances Act places in Schedules I through V, based on accepted medical use and potential for misuse. Schedule II includes many stimulants for ADHD and most opioid painkillers. Schedule III includes testosterone, ketamine and buprenorphine. Schedule IV includes benzodiazepines such as alprazolam, sleep medications such as zolpidem, and phentermine, an older weight-loss medication.

Many medications people associate with telehealth are not controlled at all. Semaglutide and tirzepatide, most antidepressants, most blood pressure medications and most hormone therapies for women are not scheduled, so these rules do not apply to them. Testosterone is the exception in hormone care.

Medical cannabis is a separate matter. A cannabis certification or recommendation under Michigan, Illinois or California law is not a prescription and is not filled at a pharmacy, so the DEA telemedicine rules are not what governs it. State program rules do.

The Ryan Haight Act, in plain terms

The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 was passed after the death of a teenager who obtained controlled painkillers from an online pharmacy. The law generally requires that a prescriber has conducted at least one in-person medical evaluation before a controlled substance is prescribed via the internet. It includes narrow exceptions for situations such as a patient being physically in a registered hospital or clinic during the telemedicine visit. Those exceptions did not fit direct-to-home telehealth.

How the 2020 waiver became a six-year arrangement

When the COVID-19 public health emergency was declared in 2020, the DEA allowed registered practitioners to prescribe controlled substances by telemedicine without a prior in-person visit. The emergency ended in May 2023. Instead of letting the flexibility lapse, the DEA and HHS issued a series of temporary rules extending it. The fourth extension, issued in late 2025, runs from January 1 through December 31, 2026.

Under it, a practitioner can prescribe Schedule II through V medications by telemedicine without having seen you in person, provided the prescription is for a legitimate medical purpose, is issued in the usual course of professional practice, uses a real-time two-way audio and video connection, and meets every other federal and state requirement. Audio-only visits are allowed for buprenorphine and similar treatment of opioid use disorder.

The rules that are already permanent

In January 2025, the DEA published two final rules alongside its broader proposal. After delays, both took effect on December 31, 2025.

Buprenorphine for opioid use disorder. Clinicians can prescribe an initial supply of buprenorphine for opioid use disorder by telemedicine, including audio-only, without an in-person visit. The initial period is limited to six months, after which further prescribing needs either an in-person evaluation or one of the other permitted forms of telemedicine. The rule also requires the prescriber to check the state prescription drug monitoring program.

VA patients. A VA practitioner can prescribe controlled substances by telemedicine to a veteran who has previously had an in-person evaluation with another VA practitioner.

These rules sit alongside the temporary extension. If the extension expires, they continue.

Special registration: the permanent rule still pending

The broader permanent framework is a proposed "special registration for telemedicine," published in January 2025. As proposed, it would create a registration allowing clinicians to prescribe Schedule III through V medications by telemedicine without an in-person visit, a more restrictive advanced registration for certain specialists to prescribe Schedule II, a registration for telemedicine platforms, and conditions such as nationwide prescription monitoring checks and limits on the share of Schedule II prescriptions written by telemedicine.

The proposal drew heavy comment. Legal and trade publications reported in late summer 2026 that a final version had been sent to the White House Office of Information and Regulatory Affairs for review, usually the last step before publication. As of early November 2026, the final text had not been published, and nobody outside government knows how closely it will follow the 2025 proposal.

What could change for you in 2027

If you receive a controlled medication through telehealth and have never seen that prescriber in person, the honest answer is that your arrangement may need to change in 2027. Depending on the outcome, you might need an in-person evaluation, a prescriber holding a new registration, or nothing different at all.

Practical steps now:

• Ask your prescriber directly what their plan is if the flexibilities lapse.
• Keep your own record of your medication, dose, start date and the clinician's name.
• Do not wait until late December for a refill, in case of disruption.
• If an in-person visit may be needed, find out now where that could happen.

State law still applies

Federal rules set a floor, not a ceiling. States can and do add requirements for controlled substance prescribing, including telehealth-specific rules, monitoring program checks and limits on particular drugs. A clinician must follow both the federal rules and the rules of the state where you are physically located during the visit. For how location affects licensure, see can I see a telehealth doctor licensed in another state?

Other limits that do not change with the DEA rule

Some rules apply regardless of how you were seen. Federal law does not permit refills on Schedule II prescriptions. Schedule III through V prescriptions can be refilled no more than five times within six months of being written. Pharmacists have their own legal duty to check that a controlled substance prescription is legitimate, which is one reason telehealth prescriptions sometimes get extra questions, covered in what to do if a pharmacy won't fill a telehealth prescription.

Some treatments have additional restrictions of their own. Spravato, the branded esketamine nasal spray, can only be given in a certified healthcare setting under an FDA safety program, so it is never sent home. Compounded ketamine prescribed for home use is a different treatment with different risks, discussed in at-home ketamine safety.

What a careful prescriber does either way

The legal permission to prescribe without an in-person visit is not a clinical judgment that doing so is right for every patient. A careful clinician still takes a full history, checks the prescription monitoring program, orders baseline labs where relevant, sets a follow-up schedule and refers you for in-person assessment when a screen is not enough. That applies to testosterone and ketamine as much as to any other controlled medication.

If you are considering testosterone therapy or ketamine therapy through telehealth, ask how the practice will handle 2027 before you start, not after.

Questions patients ask us

Can a telehealth doctor prescribe testosterone without seeing me in person?

Through December 31, 2026, federal rules allow it if the clinician is DEA-registered and meets all other federal and state requirements, because testosterone is a Schedule III controlled substance covered by the current telemedicine flexibilities. After that date the answer depends on what the DEA finalizes. A clinician can also decide an in-person evaluation is clinically needed regardless of the law.

What is the Ryan Haight Act?

It is a 2008 federal law that generally requires a prescriber to have conducted at least one in-person medical evaluation before prescribing a controlled substance over the internet. It has narrow exceptions that do not fit most direct-to-home telehealth. Since 2020 the in-person requirement has been waived by a series of temporary DEA and HHS rules.

When do the current DEA telemedicine flexibilities end?

The fourth temporary extension runs through December 31, 2026. As of early November 2026, the DEA had not published a permanent rule or announced another extension, though reports said a final special registration rule was under White House review. Check the DEA Diversion Control Division's website or the Federal Register for the current status.

What is DEA special registration for telemedicine?

It is a permanent framework the DEA proposed in January 2025. As proposed, clinicians would hold a special registration to prescribe Schedule III through V medications by telemedicine without an in-person visit, with a more restrictive version for Schedule II and extra conditions such as prescription monitoring checks. The final version had not been published as of early November 2026 and may differ.

Is semaglutide or tirzepatide a controlled substance?

No. Semaglutide and tirzepatide are not scheduled under the Controlled Substances Act, so the DEA telemedicine rules do not apply to them. Ordinary prescribing and state telehealth rules still apply. Phentermine, an older weight-loss medication, is a Schedule IV controlled substance and is covered by the DEA rules.

Does the DEA rule affect medical cannabis certifications?

Not directly. A medical cannabis certification or recommendation under Michigan, Illinois or California law is not a prescription and is not filled at a pharmacy. State program rules govern who can certify a patient and how. Those rules have their own requirements, and they change, so check with the state program.

Can buprenorphine still be prescribed by telehealth after 2026?

Yes, under a separate permanent DEA rule that took effect on December 31, 2025. It allows an initial supply of buprenorphine for opioid use disorder by telemedicine, including audio-only visits, for up to six months, after which further prescribing requires an in-person evaluation or another permitted form of telemedicine. Prescribers must also check the state prescription monitoring program.

Can states have stricter rules than the DEA?

Yes. Federal rules set a minimum, and states can add their own requirements for controlled substance prescribing, including telehealth-specific limits and monitoring program checks. A clinician has to follow the rules of the state where you are physically located during the visit, as well as federal law.

What should I do now if I get a controlled medication by telehealth?

Ask your prescriber what their plan is if the flexibilities lapse on December 31, 2026. Keep a record of your medication, dose and prescriber. Request refills early rather than at the last minute in December. If an in-person visit may become necessary, find out now where and how it could happen.

Can a pharmacy refuse a controlled substance prescription from telehealth?

Yes. Under DEA rules, pharmacists have a corresponding responsibility to fill only prescriptions issued for a legitimate medical purpose, and they may decline or ask to speak with the prescriber if they have concerns. Most of these situations are resolved once the pharmacist and prescriber talk.