DEA extends telemedicine flexibilities through 2026

The temporary rule keeps the flexibilities in place since March 2020 running for another year: licensed practitioners can prescribe Schedule II through V controlled substances through audio-video telehealth visits, with no initial in-person medical evaluation, through December 31, 2026. If your brand offers testosterone replacement therapy, or plans to, this sets your regulatory ground for the year.

01What just happened: the fourth extension

The operative language of the temporary rule is short, and worth reading in the original:

“A DEA-registered practitioner is authorized to prescribe schedule II-V controlled substances via telemedicine to a patient without having conducted an in-person medical evaluation of the patient if all of the conditions listed in paragraph (c) of this section are met.”

DEA Fourth Temporary Rule, December 31, 2025

The covered medications include testosterone, which is Schedule III and the foundation of every TRT program; combination protocols that pair GLP-1s with controlled substances; certain ADHD medications; and certain anti-anxiety medications. GLP-1s on their own, semaglutide and tirzepatide included, are not controlled substances and were never exposed to this rule.

The conditions in paragraph (c) are the heart of the rule. Every controlled-substance prescription issued under the extension must satisfy all five:

1. The prescription is issued for a legitimate medical purpose.
2. The practitioner is acting in the usual course of their professional practice.
3. The evaluation happens over an interactive audio-video telecommunications system, not chat or an intake questionnaire alone.
4. The practitioner holds a DEA registration for that class of controlled substance.
5. The prescription complies with all other DEA regulations, including 21 CFR part 1306.

02Why the extension was necessary

Regulators used a blunt phrase for the alternative: a telemedicine cliff. Letting the flexibilities lapse would have reinstated pre-pandemic rules overnight, requiring an in-person visit before any controlled-substance prescription and pushing millions of stable patients into appointment backlogs. The scale of what was at stake is visible in the DEA's own numbers.

The 24 percent figure comes from a real lapse. When Medicare's separate telemedicine flexibilities expired on September 30, 2025, before Congress restored them, fee-for-service telemedicine visits fell 24 percent in seventeen days, and by 40 percent or more in states like Florida, Louisiana, Washington, Tennessee, Maryland, Oklahoma, and New York. The DEA watched that experiment run and chose not to repeat it.

03Why this matters specifically for TRT

Testosterone sits on Schedule III of the Controlled Substances Act. Without the extension, every new TRT patient would need an in-person visit before their first prescription, which unwinds the economics of a national telehealth brand: geographic reach collapses to wherever you can put a provider in a room, acquisition costs absorb a physical visit, and existing patients face disruption at their next renewal.

If you have been holding a TRT or men's health launch until the rules settled, this is the window. The prescribing pathway is fixed for at least a year, which is longer than most category launches take to find their footing.

04How Cuvo satisfies each condition

The conditions are where brands get hurt. Cuvo's infrastructure satisfies each one at the platform level, so no one on your team maintains a compliance checklist. Requirement by requirement:

05What the extension does not change

The rule lifted exactly one requirement: the initial in-person evaluation. Everything else that governs a telehealth business is still in force, and those rules are the ones that actually catch operators off guard, because they apply whether or not you touch controlled substances.

Corporate Practice of Medicine doctrine, a state-level body of law, still requires that medical practices be physician-owned, still prohibits non-physicians from employing doctors, and still prohibits non-physicians from controlling medical decisions. This is why Cuvo operates a three-entity structure: your brand runs marketing and the customer relationship, Cuvo's Management Services Organization provides the infrastructure, and independent, physician-owned medical groups employ the providers and own every clinical decision.

The federal Anti-Kickback Statute still prohibits paying for referrals or prescriptions, still requires fair-market-value physician compensation, and still requires payments that do not depend on clinical outcomes. Cuvo's physician compensation is a flat per-consult fee at fair market value, paid whether or not the physician prescribes, and never tied to business volume.

06What brand partners should do

If you already operate a brand on Cuvo, the required action list is short: nothing. Your patient acquisition, consult flow, prescribing process, and compliance framework continue exactly as they run today. The extension simply confirms the model you are already operating is authorized through year-end 2026.

07Four extensions, one direction

This is the fourth consecutive extension of the same flexibilities, and the trajectory matters as much as the rule. Agencies do not extend a policy four times while drafting its permanent replacement unless they intend the pathway to survive.

1. March 2020

   COVID-19 public health emergency flexibilities granted

2. May 2023

   First temporary rule extends telemedicine prescribing

3. October 2023

   Second temporary rule

4. November 2024

   Third temporary rule

5. December 2025

   Fourth temporary rule, in effect through Dec 31, 2026

08What happens after December 31, 2026

The permanent framework is already in motion. On January 17, 2025, the DEA published a Notice of Proposed Rulemaking proposing a Special Registration for Telemedicine: a new registration category for practitioners who prescribe controlled substances remotely, with added recordkeeping and reporting requirements and a defined framework for direct-to-consumer telemedicine platforms. The comment period drew more than 6,475 public responses, and the DEA has said the current extension exists to give it time to finalize regulations that balance access to care against diversion risk.

The final shape is still open, so predictions would be guesses. Cuvo's regulatory team tracks every filing, and when the permanent rule lands, the required changes ship inside the platform for every brand we operate. If the special registration becomes reality, Cuvo's medical groups obtain it; if reporting requirements expand, the platform produces the reports. Your patients keep their treatment, and you read about the rule change here rather than in an audit.

09The bottom line

For compliant operators the fourth extension is good news, and it doubles as a filter: the conditions that make prescribing legal are the ones casual operators skip, so the extension rewards infrastructure that takes them seriously.

Key takeaways

• The DEA and HHS extended telemedicine flexibilities through December 31, 2026 in a fourth temporary rule issued December 31, 2025.
• No initial in-person visit is required to prescribe Schedule II–V controlled substances, including testosterone, via audio-video telemedicine.
• Five conditions attach to every prescription; Cuvo's platform enforces all of them at the infrastructure level.
• CPOM and AKS obligations are unchanged; only the in-person evaluation requirement was lifted.
• A permanent rule is in progress, and Cuvo ships the required changes inside the platform when it lands.

Frequently asked questions

Sources and references

• DEA Fourth Temporary Rule extending telemedicine flexibilities through December 31, 2026 (issued December 31, 2025)
• DEA Notice of Proposed Rulemaking, Special Registration for Telemedicine (January 17, 2025)
• Drug Enforcement Administration and U.S. Department of Health and Human Services, joint temporary rules (2023–2025)
• 21 CFR part 1306: prescription requirements for controlled substances