The Drug Enforcement Administration (DEA) will extend pandemic-era telehealth prescribing flexibilities for one year, through Dec. 31, 2025, according to an unpublished rule that hit the Federal Register on Friday night.
The temporary rule punts the issue to the incoming Trump administration, which will have to act on it in its first year.
The “Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications” entered the White House’s Office of Management and Budget registry Oct. 15 and left Nov. 14.
It was the first signal that the DEA would not let the pandemic-era flexibilities lapse at the end of 2024. The agency has been in gridlock with the Department of Health and Human Services (HHS) about the future of controlled substance prescribing, according to sources.
The prescribing flexibilities put forward during the COVID-19 pandemic allowed licensed DEA providers to prescribe Schedule 2-5 controlled substances via telehealth.
The flexibilities were set to expire Dec. 31, 2024, in just 43 days. Lawmakers said they were ready to step in and extend the prescribing flexibilities if the DEA failed to act.
The unpublished temporary rule will officially publish on the Federal Register on Nov. 19. The incoming Trump administration can vacate any action taken within the last 60 days of the Biden administration without congressional approval. The DEA telemedicine rule has narrowly avoided this window and would have to be reviewed by Congress to be repealed.
Now that the DEA has finalized a one-year extension, Congress does not have to act to prevent the prescribing flexibility from lapsing. It is still expected to pass some type of end-of-year healthcare package that would extend the ability for more patients and providers to conduct Medicare telehealth visits by two years.
But the DEA must still contend with the issues of controlled substance prescribing when the patient and provider do not know each other and have not had an in-person visit. The DEA has tried to solve the issue twice in two separate proposed rules.
Both the DEA and the HHS will have new faces, and it remains to be seen how the two agencies will work together to solve the issue.
President-elect Donald Trump will nominate former independent presidential candidate Robert F. Kennedy Jr. to lead the HHS. The Department of Justice, which houses the DEA, could potentially by led by former Florida congressman Matt Gaetz, who Trump chose for U.S. attorney general. Gaetz resigned from Congress on Nov. 13.
Kennedy and Gaetz must be confirmed by the Senate.
Lobbyists close to the matter said the DEA has struggled with the question of whether to allow Schedule 2 substances like Adderall and oxycodone to continue to be prescribed via telehealth with no in-person guardrails.
It's not clear where the incoming Trump administration stands on the issue. Kennedy said on a YouTube Latino Town Hall in July that he would create government funded "wellness camps" for Americans to wean off of Adderall and other controlled substances.
"I’m going to create these wellness farms where they can go to get off of illegal drugs, off of opiates, but also illegal drugs, other psychiatric drugs, if they want to, to get off of SSRIs, to get off of benzos, to get off of Adderall, and to spend time as much time as they need—three or four years if they need it—to learn to get reparented, to reconnect with communities," he said on the podcast.
The DEA’s congressional mandate is to prevent the diversion and abuse of controlled substances, and the agency has worried about the higher potential for the more addictive Schedule 2 substances to be misused if they are easily accessible online.