Can a psychiatrist still prescribe a stimulant or benzodiazepine over video to a patient they have never seen in person? Yes, through December 31, 2026. That is the end date of the DEA and HHS Fourth Temporary Extension of the COVID-era telemedicine flexibilities, published December 31, 2025. What replaces it on January 1, 2027 depends on a final rule that is under White House review right now.
For an outpatient psychiatry practice with a telehealth panel on Schedule II stimulants, this is the single biggest regulatory date on the calendar. Here is what is in effect, what is coming, and what to prepare this quarter.
What is in effect today
Under the fourth extension, a DEA-registered practitioner may prescribe Schedule II–V controlled medications through an audio-video telemedicine encounter without a prior in-person evaluation, as long as the prescription is for a legitimate medical purpose and complies with DEA regulations and state law. Audio-only is permitted for FDA-approved Schedule III–V medications for opioid use disorder.
Two permanent final rules also took effect on December 31, 2025:
- Expansion of Buprenorphine Treatment via Telemedicine Encounter. Allows an initial six-month supply of buprenorphine for opioid use disorder through telemedicine, including audio-only, with a PDMP check, followed by further prescriptions through other permitted pathways.
- Continuity of Care via Telemedicine for VA Patients. Lets VA practitioners prescribe to patients already seen in person by another VA practitioner.
Through the end of 2026, practitioners covered by those rules may keep using the broader temporary flexibilities, which carry fewer requirements.
What is coming: the special registration
The Ryan Haight Act of 2008 created a path for a special registration for telemedicine. DEA proposed the framework on January 17, 2025, and sent the final rule (RIN 1117-AB40) to the Office of Information and Regulatory Affairs on August 25, 2026. The final text is not public yet. The proposal included:
- A Telemedicine Prescribing Registration for Schedule III–V, and an Advanced Telemedicine Prescribing Registration for Schedule II, limited to certain specialties. Psychiatry was on the proposed list.
- A State Telemedicine Registration for each state where you treat patients remotely.
- Limits on Schedule II telemedicine prescribing, including a proposal that telemedicine prescriptions make up no more than half of a registrant's Schedule II prescriptions, and a requirement for the prescriber to be in the same state as the patient for Schedule II in most cases.
- PDMP checks before prescribing, with a move toward checks across all states over time.
- Separate registration for telemedicine platforms that dispense or facilitate controlled-substance prescribing.
Expect the final rule to change some of these details. Commenters pushed hard on the 50% Schedule II cap and the same-state rule, both of which bite hardest for psychiatry practices that see ADHD patients across state lines.
Three scenarios for January 1, 2027
- Final rule publishes with a workable effective date. You apply for the special registration and any state registrations, then move patients onto the new requirements.
- DEA issues a fifth extension. It has done this four times. The flexibilities continue while the final rule phases in.
- The flexibilities lapse with no replacement in effect. The Ryan Haight in-person evaluation requirement returns for new controlled-substance prescriptions to patients you have never examined in person, outside the buprenorphine and VA rules.
Plan for the third scenario now. It is the one that disrupts care if you wait.
What to do this quarter
- Pull a list of every active patient on a Schedule II–V medication who has never had an in-person visit with your practice. That list is your exposure.
- Schedule in-person evaluations for patients on that list who live within reach of an office, starting with Schedule II stimulants. An in-person evaluation by you, or in some cases by a covering practitioner, puts the patient outside the Ryan Haight requirement going forward.
- Map patient locations by state. If the final rule keeps a same-state requirement for Schedule II, you need to know where each patient is physically located during visits, and that location has to be documented.
- Confirm your DEA registrations match every state where you prescribe, and that each address is current.
- Build PDMP checks into the visit, so the check is documented on every controlled-substance prescription regardless of what the final rule requires.
- Prepare a patient message explaining that controlled-substance rules for telehealth are changing and that the practice may ask for an in-person visit. Patients take it better in October than in late December.
The bottom line
The current authority ends December 31, 2026. A permanent framework is close, and its details will determine how much of your Schedule II telehealth panel can continue as it runs today. The practices that come through this smoothly will be the ones that already know which patients need an in-person visit and have scheduled them.