Controlled Substances by Telehealth: TRT, Ketamine and the DEA's December 31, 2026 Deadline
A clinic that prescribes testosterone or ketamine by telehealth is working under temporary federal rules that are scheduled to end at the close of 2026. The special registration the DEA proposed to replace them was still under review in early October. Here is what is certain and how to plan.
Key Highlights
- Testosterone and ketamine are Schedule III controlled substances under federal law.
- The Ryan Haight Act generally requires at least one in-person medical evaluation before prescribing a controlled substance over the internet, with exceptions for the practice of telemedicine as defined.
- The DEA and HHS fourth temporary extension of the telemedicine flexibilities runs through December 31, 2026, published December 31, 2025.
- A special registration rule proposed in January 2025 had not been finalized in that notice. Clinics should plan for a rule change or a lapse and not build on the 2025 proposal.
Which Drugs
Under the federal schedules, testosterone is a Schedule III controlled substance, and so is ketamine. That matters because both are common in telehealth wellness practices, hormone therapy and ketamine-assisted treatment, and controlled substances carry rules that ordinary prescriptions do not.
The Ryan Haight Act
The Ryan Haight Online Pharmacy Consumer Protection Act, codified at 21 U.S.C. 829(e), requires that internet dispensing of controlled substances rest on a valid prescription, meaning one issued for a legitimate medical purpose in the usual course of practice by a practitioner who has conducted at least one in-person medical evaluation, or a covering practitioner. The in-person requirement does not apply to a practitioner engaged in the practice of telemedicine, which the statute defines with specific exceptions, including special registration under 21 U.S.C. 831(h).
The Temporary Flexibilities
During and after the pandemic the DEA and HHS have temporarily allowed DEA-registered practitioners to prescribe Schedule II through V controlled substances by telemedicine without a prior in-person evaluation, if the prescription is legitimate and issued through an interactive telecommunications system. The fourth temporary extension, published December 31, 2025, runs through December 31, 2026. It adds no new requirements, and state law still applies on top of it.
The Special Registration Proposal
In January 2025 the DEA proposed a special registration framework with different tiers of telemedicine prescribing authority, platform registration, prescription monitoring program checks and state-by-state registration. According to law firm reporting in September 2026, a final rule had been sent to the White House's regulatory review office in August 2026, but its text was not public, and we did not find a final rule or a fifth extension as of the latest reporting we could confirm. The 2025 proposal is not a rule and should not be used to design a clinic's compliance program.
How to Plan
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Disclaimer
This article is general educational information, not legal advice. Telehealth rules differ by state and change often, so confirm specifics with health care regulatory counsel in each state where you treat patients. Federal controlled-substance rules were in flux when this was written, so check the DEA's current guidance before relying on it.
MedGrid MSO provides management services to independently owned practices; it does not practise medicine and does not direct clinical decisions. Requirements vary by state and by service, and change over time — nothing on this page is legal or medical advice. Talk to us or your own counsel before making a structural decision for your clinic.