The Drug Enforcement Administration has published its fourth extension of telehealth prescribing flexibilities, continuing the pandemic-era rules that allow providers to prescribe controlled substances via telehealth without an initial in-person visit. For dermatology practices offering teledermatology, this extension provides continued flexibility — but the clock is ticking on permanent rules.
What the Extension Means
Under the continued flexibilities, dermatology providers can:
- Prescribe Schedule II-V controlled substances via telehealth without requiring an initial in-person examination
- Continue existing telehealth prescribing relationships established during the pandemic
- Initiate new prescribing relationships via video consultation
For dermatology specifically, this primarily affects prescriptions for controlled topical medications and certain pain management prescriptions related to dermatologic procedures.
Why This Keeps Getting Extended
The DEA has been working on permanent telehealth prescribing rules since 2023 but has faced pushback from both providers (who want maximum flexibility) and law enforcement (who want tighter controls). Each extension gives the DEA more time to finalize rules that balance access with safety.
Each extension is temporary. When permanent rules are eventually finalized, they will likely include more restrictions than the current flexibilities. Start building compliant workflows now so you’re not scrambling when the rules change.
What Your Practice Should Do
- Document all telehealth prescribing encounters with the same rigor as in-person visits
- Verify state-specific telehealth prescribing rules — some states have stricter requirements than federal rules
- Build a transition plan for when permanent rules require in-person visits for certain prescriptions
- Track your telehealth prescribing volume so you can assess the impact of future rule changes
Key Takeaways
- DEA has extended telehealth prescribing flexibilities for the fourth time
- Providers can still prescribe controlled substances via telehealth without in-person visits
- This is temporary — permanent rules will likely be more restrictive
- Document all telehealth encounters thoroughly
- Check state-specific rules which may be stricter than federal