There are two new Drug Enforcement Administration (DEA) rules in play this year in 2025.
Is your addiction treatment organization ready to adapt?
This post will cover the most frequently asked questions we hear about these two new rules, both of which concern telemedicine, as well as give insights into how these new rules may impact behavioral health businesses going forward.
Let’s get started!
What are the two new DEA rules for telemedicine providers and addiction treatment organizations?
Here’s the two new DEA rules:
Expansion of Buprenorphine Treatment via Telemedicine Encounter, which concerns how telemedicine may be used when initially prescribing buprenorphine to OUD patients
And
Special Registrations for Telemedicine and Limited State Telemedicine Registrations, which concerns the establishment of a “Special Registration Framework” for three levels of telemedicine providers who are empowered to use telemedicine visits to prescribe buprenorphine
Can you tell me more about the “Expansion of Buprenorphine Treatment Via Telemedicine Encounter” rule?
The “Expansion of Buprenorphine Treatment Via Telemedicine Encounter” rule describes exactly when and how a provider may prescribe buprenorphine.
It was originally supposed to go into effect on February 18, 2025, but a subsequent notice was made that stated the rule would be delayed until March 21, 2025.
It is considered a “final rule” rather than a “proposed rule,” meaning that it’s not a suggestion, or an idea, but an official policy statement.
Under the new rule, providers are able to do the following:
Prescribe an initial 6 month supply of buprenorphine after a telemedicine encounter
Use audio-only (phone call) telemedicine encounters to prescribe buprenorphine
Allow pharmacists to verify the identity of the patient before dispensing medicine
Prescribe additional prescriptions past the 6 month mark with “other forms of telemedicine as authorized under the Controlled Substances Act”
Choose to prescribe additional prescriptions for buprenorphine after the 6 month mark at following an in-person appointment with the patient
The DEA states that the point of this new rule is to “prevent lapses in care” and continue to extend "some of the telemedicine flexibilities” that were established for SUD and OUD patients during the COVID-19 pandemic.
Can you tell me more about the “Special Registration for Telemedicines and Limited State Telemedicine Registrations” Rule?
The “Special Registration for Telemedicines and Limited State Telemedicine Registrations” rule is considered a “proposed rule,” meaning it has not yet taken effect - it is a notice of a proposed change in DEA rulemaking.
Electronic comments are being gathered on this proposed rule through March 18th, 2025. After they are reviewed, the process will either move forward or be scrapped, depending on the results of the comment period.
This proposed rule would entail the following:
The creation of a “Special Registration Framework” to designate providers who are engaged in a “practice of telemedicine” such that they are exempt from the in-person medical evaluation requirements outlined in the Ryan Haight Act
The establishment of three different types of “Special Registrations” under this new framework
Additional prescription, recordkeeping, and reporting requirements for those operating under “Special Registration”
The DEA explains that the intentions behind this new proposed rule would be the expansion of access to life-saving medicines like buprenorphine, coupled with the management of the risk of medication diversion.
What has the Trump Administration said about these new telemedicine rules for addiction treatment? Will they be honored by the Trump Administration?
The Trump Administration has yet to weigh in on these DEA rules. They were set in motion before Trump took office, and many personnel changes have occurred since they were first drafted, so it is unclear what the future may hold for telemedicine rules.
However, the DEA did issue a temporary rule that extends telemedicine prescribing exemptions for MAT medications for a third time since they were first established in response to the COVID-19 pandemic. That rule covers all telemedicine prescription activities through the end of 2025, filling in any gaps that may occur as we wait for various rules to go into effect.
For now, providers can rely on either the temporary rule - which is effective immediately - or the “Expansion” rule when it takes effect in March 2025. Both rules will apply after March 2025 until the end of the year.
What do addiction treatment providers need to know about these new rules?
Obviously, any prescribing physician will need to keep these rules in mind when writing new prescriptions for MAT medications for Opioid Use Disorder patients.
But what about other types of behavioral health providers and technicians?
Well, providers and professionals who deal with behavioral health in general - without prescribing ability - would also do well to take note of these rule changes. If a resident at a recovery residence or sober living home says that they were prescribed buprenorphine in a telehealth appointment, a sober living home manager who is not familiar with the rule change may doubt this story and create an unnecessary headache for the organization. A case manager may insist that a patient schedule an in-person visit with a prescribing physician when a telehealth appointment would be an easier, more accessible choice.
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