The Telemedicine Prescribing Rule Has Reached the White House

The final rule for special telemedicine registrations is now under review at the Office of Management and Budget. The review began August 25, and the federal agenda forecasts publication in November.¹

The agenda forecast can change. The temporary prescribing flexibilities expire at the end of December 31, 2026, leaving organizations four months to prepare for a final rule, another extension, or a return to narrower authorities.²

What expires in December

The current temporary rule allows a federally registered practitioner to prescribe controlled medications in Schedules II through V after a telemedicine encounter even when the practitioner has not conducted an in-person medical evaluation. The practitioner must satisfy the conditions in the temporary rule and all other applicable federal and state requirements.³

The Ryan Haight Act generally requires at least one in-person medical evaluation before a practitioner prescribes a controlled substance over the internet. Congress created exceptions for defined forms of telemedicine and directed the creation of a special-registration pathway. The current temporary rule supplies broad authority while the permanent registration framework remains unfinished.⁴

If the government neither finalizes the new framework nor extends the temporary one, the broad no-prior-examination pathway ends on January 1. Statutory exceptions will remain, and two narrower final rules govern qualifying buprenorphine treatment and specified care for patients of the Department of Veterans Affairs.⁵

The remaining implementation window

The pending action is a final rule titled “Special Registrations for Telemedicine and Limited State Telemedicine Registrations.” The Office of Information and Regulatory Affairs identifies it as economically significant and lists a statutory deadline. Its review page does not disclose the final text.⁶

A November publication could leave only weeks to evaluate practitioner eligibility, registration type, state authority, prescription limits, patient verification, monitoring-program checks, records, and technology changes before January 1.¹

The agency has already extended the flexibilities four times. A fifth extension would preserve more time, although no federal action has committed the agency to one.⁷

Build the prescribing map now

In my assessment, a patient-to-prescription map gives leadership the clearest view of exposure. The organization should be able to connect each remote prescription to the authority that permits it.

That review should identify:

• The medication and its federal schedule.
• The practitioner, federal registration, and state authority.
• The patient’s location during the encounter.
• Whether the practitioner or another qualifying clinician completed an in-person evaluation.
• The federal pathway supporting the prescription.
• Any prescribing limits, identity checks, monitoring-program review, documentation, or pharmacy verification attached to that pathway.
• The systems and vendors that must change if the temporary rule expires.

Leadership should also separate three patient groups: those who already satisfy the general in-person requirement, those who fit a durable statutory or regulatory exception, and those who depend on the temporary rule. That separation shows where continuity risk is concentrated.

The published text will determine the final operating duties. Until then, organizations can preserve current access, track the federal action, and prepare a controlled transition for patients and prescribers who rely on temporary authority.

Review other health-law analyses, see areas of experience, or read the author’s background.