I. Overview of Telehealth and Tele-Prescribing Landscape
Since the end of the Public Health Emergency (“PHE”) exceptions in 2023, states have continued to re-evaluate the broad telehealth and tele-prescribing flexibilities granted during the pandemic. Over the past year, many jurisdictions, including New York, California, Delaware, Florida, New Hampshire, and Texas, have either enacted or proposed legislation codifying, modifying, or rolling back pandemic-era waivers related to remote patient care. These regulatory changes touch on several key areas of remote care, including the use of telehealth modalities for the initial “in-person” visit requirement for prescribing controlled substances remotely and remote visitation protocols in institutional specialty care. Concurrently, the federal government has also extended certain temporary flexibilities through the end of 2025. During this period, the federal government is developing a longer-term regulatory framework around the use of telehealth and tele-prescribing for controlled substances. Healthcare providers, digital health startups, and their respective regulatory counsel must remain diligent in navigating the complex legal landscape shaped by overlapping federal rules and increasingly divergent state laws.
II. Federal Extension of Pandemic Era Telehealth Flexibilities
In late 2024, the U.S. Drug Enforcement Administration (the “DEA”), in coordination with the U.S. Department of Health and Human Services (“HHS), extended telemedicine prescribing waivers through December 31, 2025. The extended federal waivers temporarily suspended the in-person evaluation requirement under the Ryan Haight Act, allowing qualified providers to prescribe controlled substances, including Schedules II-V substances, via telemedicine, without first conducting a prior “in-person” physical examination. The waiver extensions provide short term stability while the DEA seeks to finalize a new framework for tele-prescribing.
Prior to the 2024 waiver extension, in March of 2023, the DEA also issued a proposed rule which would establish a “special registration” system permitting fully remote prescribing of controlled substances in limited circumstances (the “Proposed Rule”). The Proposed Rule outlined three types of special registrations: (i) standard, (ii) advanced (for higher-risk drugs and specialties like psychiatry), and (iii) platform based, which would come with enhanced identity verification, prescription drug monitoring program access, and diversion control measures.
While not finalized, the Proposed Rule has significantly influenced how states have approached telehealth regulations.
III. State-Level Developments: Codifying or Replacing Emergency Rules
Ahead of the anticipated federal rule, several states have implemented or proposed permanent regulations to replace temporary PHE orders. Notable developments include:
New York’s Final Rule
In May 2025, the New York State Department of Health (“NYSDOH”) finalized a rule (the “Final Rule”) governing the prescription of controlled substances through telemedicine and other telehealth modalities. The Final Rule closely aligns with the DEA’s Proposed Rule (discussed above), requiring an in-person medical evaluation prior to the prescription of controlled substances, with certain exceptions.[1] These exceptions include:
- Recent “In-Person” Evaluation: A consulting or referring provider has performed an in-person evaluation for the same condition within the previous 12 months.
- Temporary Coverage: A covering provider may prescribe on a temporary basis if they have sufficient access to, or communication with, the initial prescriber.
- Emergency Situations: In emergency situations involving a new condition, remote prescribing is permitted provided certain safeguards are met.
- Consistency with Federal and State Guidance: When such exception is consistent with state laws and regulations and the laws, rules, and regulations of the DEA.[2]
New York’s Final Rule remains subject to the DEA federal waiver which is set to expire in December 31, 2025. As such, New York State providers should consult both the DEA federal waiver and the Final Rule before making a determination on the need for a prior in-person medical evaluation.
Tele-prescribing Changes in Other States
While New York’s Final Rule mirrors key terms of the DEA’s Proposed Rule, other states have moved in varying directions with respect to the exceptions afforded for prior in-person visits prior to prescribing controlled substances. The following states have also issued or have proposed changes to their existing telehealth and/or prescribing regulations in order to address the end of the federal waiver extensions:
- California: In California, the state legislature has proposed Assembly Bill 1503 (AB 1503), which would modify California’s existing Pharmacy Law that currently requires providers utilize a “good faith” standard to perform a prior examination before issuing a dangerous drug or device to a new “appropriateness” standard.[3] Notably, as defined in AB 1503, an “appropriate prior examination” would not require a synchronous interaction between the patient and the provider, and instead allows for prior examinations to be achieved through the use of telehealth modalities (i.e., a self-screening tool, a questionnaire, etc.) as long as the issuing provider complies with the state’s appropriate standard of care.[4] AB 1503 continues to work its way through the California legislature, with the latest set of amendments being discussed as of July 17, 2025.
- Delaware: In Delaware, Governor Matt Meyer signed Senate Bill 101 (“SB 101”) into law on July 21, 2025. SB 101 aims to resolve a conflict between Delaware’s Uniform Controlled Substances Act[5] (the “Uniform Controlled Substances Act”), which mandates an in-person examination before prescribing controlled substances for opioid use disorder, and Delaware’s Telehealth Access Preservation and Modernization Act of 2021 (the “Delaware Telehealth Act”), which, as discussed in our prior article on the Delaware Telehealth Act, waives the need for the in-person examination. By amending the definition of “patient-practitioner relationship” in the Uniform Controlled Substances Act, SB 101 clarifies that a practitioner may treat opioid use disorder via telemedicine using Schedule III through V medications approved for this purpose.
- Florida: Under Florida law, telehealth providers may not prescribe Schedule II controlled substances via telehealth modalities except in specific situations. These exceptions include treatment for psychiatric disorders, inpatient care at licensed hospitals, patients receiving hospice services, or residents of nursing home facilities. Outside of these scenarios, such prescriptions are prohibited via telehealth.[6]
- New Hampshire: New Hampshire recently adopted Senate Bill 252 (“SB 252”), which authorizes licensed physicians, physician assistants, and advanced practice registered nurses to prescribe non-opioid and Schedule II through Schedule IV medication through telemedicine. SB 252 removes the requirement for a prior “in person exam” and instead requires that “a subsequent evaluation be conducted by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition, and drug, but not less than annually.” SB 252 will take effect beginning on August 23, 2025.
- Texas: Texas has taken a hybrid approach, permitting telehealth prescribing for mental health and chronic care management, but prohibiting the remote prescribing of certain Schedule II substances absent an in-person visit. When prescribing for chronic pain via telemedicine, a physician must generally use two-way audio and video communication. However, this requirement does not apply if the patient is an established patient receiving the identical prescription issued at their previous visit and has been seen by the physician or their delegate within the last 90 days, either in-person or via audio and video communication.[7]
These changes collectively enhance access to care, particularly in underserved areas, while supporting public health goals and aligning state policies with federal standards. However, continued attention to federal developments and careful compliance with both state and federal requirements are essential as the regulatory landscape for telehealth and tele-prescribing continues to evolve.
IV. Practical Takeaways for Controlled Substance Prescribing
The ability to prescribe controlled substances via telemedicine remains one of the most sensitive and closely watched aspects of healthcare regulations this year. Although the federal waiver extension temporarily preserved PHE era flexibilities, the DEA’s proposed special registration system, if finalized, would become the governing structure for providers in the years ahead. As such, it is important for healthcare providers, digital health companies, and their respective legal counsel to consider the following:
- Monitor Federal Developments: Providers and platforms must keep a close eye on the DEA’s rulemaking process regarding special registrations, which may impose new obligations by 2026.
- State-Specific Compliance is Essential: Even if federal waivers remain in effect, states may impose stricter limits requiring additional registration, documentation, or limiting prescribing authority altogether.
- Plan for Post-Waiver Transition: Providers relying heavily on current federal flexibilities should begin operational planning for more restrictive post-2025 conditions.
- Assess Risk in Prescribing Practices: Prescribing controlled substances via telemedicine, even when permitted, carries reputational and legal risk. Clear documentation, identity verification, and patient drug monitoring program usage are increasingly required.
- Telehealth Service Design Should Be Jurisdiction-Specific: Customizing telehealth policies, workflows, and informed consent procedures based on local law remain the gold standard.
V. Conclusion
With the PHE era federal waivers expected to end on December 31, 2025, and state laws increasingly diverging from these PHE era exceptions, the legal framework for telehealth and tele-prescribing is entering a period of rapid change and heightened complexity. Providers must not only understand the current rules but now prepare for the post-pandemic regulatory landscape. Legal counsel advising digital health platforms, health systems, and prescribers must stay vigilant as both federal and state regulators move from temporary emergency measures to permanent regimes.
We continue to monitor developments across the country relating to adoption, amendments, and other changes to telehealth and tele-prescribing regulations.
FOOTNOTES
[1] See N.Y. Comp. Codes R. & Regs. tit. 10, § 80.63(d)(1).
[2] See N.Y. Comp. Codes R. & Regs. tit. 10, § 80.63(e).
[3] See Cal. Bus. & Prof. Code § 4130 (2024).
[4] See Cal. Bus. & Prof. Code § 2242 (2024).
[5] See 16 DE Code § 4711 (2024).
[6] See Fla. Stat. § 456.47 (2019).
[7] See 22 Tex. Admin. Code § 175.3 (2025).