By Sean Orr, M.D. | November 2, 2026 | Florida Doctor Magazine
If you prescribe controlled substances by telemedicine, the federal rule that lets you do it without a prior in-person visit ends on December 31, 2026. The DEA’s permanent replacement has been under White House review since August 25 and has not been published. That leaves Florida physicians with fewer than sixty days and no final text to plan around. Here is what is settled, what is not, and what to do before the new year.
What the December 31 Date Actually Covers
The DEA has kept telemedicine prescribing alive through a series of temporary rules since 2020. The fourth, published in the Federal Register on December 31, 2025, runs from January 1 through December 31, 2026. Under it, a DEA-registered practitioner can prescribe Schedule II through V controlled substances to a patient seen only by audio-video telemedicine, provided the other conditions of that rule are met.
When it lapses, the older rule returns. Under the Ryan Haight Act, a practitioner generally needs at least one in-person medical evaluation before prescribing a controlled substance over telemedicine, with a short list of exceptions. For a practice that built its buprenorphine, ADHD, or anxiety follow-up care around remote visits, that is a change in how the patient list works, not a paperwork update.
The Permanent Rule Is Late and Its Content Is Unknown
The DEA sent its telemedicine special registration final rule (RIN 1117-AB40) to the Office of Information and Regulatory Affairs on August 25, 2026. As of the end of October it was still in review, and legal analysts tracking it report that stakeholder meetings were held in September and October, with more scheduled for November. Review at that office is usually the last step before publication, but nobody outside the agency has seen the text.
The January 2025 proposal described three registrations: a Telemedicine Prescribing Registration for Schedules III through V, an Advanced Telemedicine Prescribing Registration for Schedules II through V aimed at specialists such as psychiatrists and hospice physicians, and a Telemedicine Platform Registration for online platforms. The final rule may differ. It may also take effect on a delay, which is why a fifth temporary extension remains possible. Do not count on one. Plan as if December 31 is real and treat an extension as a favor.
Where Florida Law Sits on Top of the Federal Rule
Federal permission is only half of the question. Section 456.47, Florida Statutes, governs telehealth in this state and, as I read it, restricts prescribing Schedule II controlled substances by telehealth to a narrow set of settings, including psychiatric disorders, inpatient hospital treatment, hospice, and nursing home residents. A federal rule that allows more does not override a state statute that allows less. Have your health care attorney confirm how the statute applies to your specialty before you rely on any federal flexibility.
Patients who are not in Florida add a second layer. In general you need licensure in the patient’s state, or an applicable exception, and DEA registration that covers the state where the patient is located. Snowbirds who return north in April are the common trap.
Medicare telehealth coverage runs on a different clock. The core waivers were extended through December 31, 2027, so a visit can still be payable and still fail the DEA rule. Check both.
What to Do Before December 31
- List every controlled-substance patient you manage remotely. Sort by schedule, by the date of their last in-person evaluation, and by the state where they are located.
- Book the in-person visits now. A patient with a documented in-person evaluation on file is the easiest to keep prescribing for under any version of the rule. December schedules fill quickly.
- Check your DEA registration and state licenses against patient locations. Fix gaps in November, not in the last week of the year.
- Ask your telehealth platform what it is doing. If the final rule requires a platform registration, your vendor’s plan matters to your continuity of care.
- Write a fallback for abrupt stops. Decide in advance how you will bridge patients on stable regimens if the rule lapses without a replacement. None of this constitutes legal advice, so run the plan past counsel.
- Watch the Federal Register and reginfo.gov for RIN 1117-AB40. Set an alert. A rule that appears in late December could leave days to comply.
The Bigger Picture
Physicians have asked for a permanent, workable framework since 2020 and have received four temporary extensions instead. The cost lands on patients who rely on remote care in rural counties from the Panhandle to the Keys. Telehealth advocacy groups have pressed the DEA to avoid requiring prescribers to check every state’s prescription monitoring database and to avoid geographic restrictions that make little clinical sense. If the final rule misses that mark, the Florida Medical Association and the specialty societies will need physician voices to say so. That is how policy gets done with us, and it only happens when we show up.
For related coverage, see our hubs on Medicare and payer changes for 2027 and on Florida scope and regulation.
Frequently Asked Questions
When do the DEA telemedicine prescribing flexibilities end?
They end on December 31, 2026, under the fourth temporary rule. The DEA’s permanent special registration rule has been under White House review since August 25, 2026, and has not been published.
Can Florida physicians prescribe Schedule II drugs by telehealth?
Section 456.47, Florida Statutes, limits Schedule II prescribing by telehealth to a short list of settings, including psychiatric disorders, inpatient hospital care, hospice, and nursing home residents. Confirm how it applies to your practice with counsel.
What happens if the DEA does not publish a final rule or an extension?
The pre-pandemic requirement returns. A practitioner generally needs at least one in-person medical evaluation before prescribing a controlled substance by telemedicine, subject to limited exceptions.
Are Medicare telehealth waivers expiring on the same date?
No. The core Medicare telehealth waivers run through December 31, 2027. Medicare payment rules do not control DEA prescribing rules, so check both.
This article is general information for physicians and is not legal advice. Consult a Florida health law attorney about your practice’s specific obligations.
This article was drafted with the assistance of AI writing tools, then reviewed, edited, and approved by Dr. Sean C. Orr, M.D., who holds full editorial responsibility for its content. Illustration created with AI image tools.
References
- DEA and HHS, Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities, Federal Register, December 31, 2025.
- Frier Levitt, DEA Telemedicine Special Registration Final Rule Reaches White House Review.
- OIRA, RIN 1117-AB40 review status.
- Florida Legislature, Section 456.47, Florida Statutes.
- Greenbaum, Rowe, Smith & Davis, Medicare Telehealth Flexibilities Extended Through 2027.