In this episode of Telemedicine Talks, Phoebe Gutierrez breaks down the coming 2026 DEA rule changes that will reshape digital health prescribing. Learn what telemedicine founders, physicians, and clinicians must do now to stay compliant, avoid penalties, and keep virtual care running smoothly under the new federal and state registration requirements.
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What happens when the DEA ends pandemic-era flexibilities and telemedicine companies aren’t ready?
In this episode of Telemedicine Talks, Phoebe Gutierrez delivers a timely and urgent breakdown of the 2026 DEA prescribing regulations that will redefine virtual care. From the expiration of COVID-era telemedicine flexibilities to the new four-tier DEA registration model, Phoebe unpacks what’s changing, who’s impacted, and how digital health companies can prepare.
She explains the layers of the new system — including Telemedicine Prescribing Registration, Advanced Prescriber Rules, Telemedicine Platform Registration, and State-Based Licensure — and why these changes matter for clinicians, startups, and patients alike.
Phoebe warns that companies relying on outdated processes risk shutdowns or investigations, and outlines a practical roadmap for compliance, from auditing prescriptions to automating ID verification and PDMP checks. Her closing message is clear: the DEA is watching, and telemedicine leaders must act now to future-proof their operations.
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[00:00:00] Welcome to Telemedicine Talks. So this is Phoebe, and over the next couple of episodes, I am going to be giving what I consider my consultant take on some compliance predictions. For 2026, I am going to do my best to make sure that I am sharing some basic information on what I'm advising most of my clients on in this last quarter of the year.
So we have. Technically 60 days until the end of the year, and that is like a bananas if you think about it, especially considering there are so many rule changes that are going live come January, 2026. So over these next couple of episodes, I am going to do what I consider. My take on the rules, the changes, and just some [00:01:00] general recommendations on how you can prepare as a physician, as a clinician, as a telemedicine company, as somebody who's thinking of starting a company as somebody who just wants to learn about all the different rules that are impacting healthcare today.
This is my take on Phoebe's predictions for next year.
So to get started, I'm gonna talk about the big one that I think is a huge game changer, and also something that is just like not on the radar of a lot of companies, and it kind of freaks me out to be 100% honest. So what's really wild is I always like to use the last 60 days of the year with clients to really prepare them and talk to them about, the different things that they're struggling with, where they're, you know, going to build in a different operational flows protections come, the following year.
And the question on my mind for most of my clients is, are you really ready [00:02:00] for these DEA like flexibilities to end and. The answers I'm getting from clients are you know, nerve wracking. Either the, oh, we don't prescribe controlled substances, so we're totally fine. Or even worse, like, oh no, they're gonna get extended.
Don't worry about it. Which, oh my gosh, just like makes my little regulatory and government affairs heart sink. The thing about the changes in prescribing are that they are global, and I just wanna like really, really, really emphasize that it is going to hit everyone. Physicians, nurse practitioners, PAs, telehealth, startups, compounding pharmacies, patients who rely on virtual care.
Anybody who has been getting prescriptions from a telemedicine company, whether or not their schedule twos are going to be impacted by these rules. Now, that doesn't mean that you're not gonna have the ability to [00:03:00] prescribe, but from an operational standpoint, companies that don't understand the rules that they need to comply with that's the problem here.
There might be a good chunk of companies that aren't complying and are gonna have to cease operations, which ultimately are going to impact the providers, the patients, the whole thing. So whether you write scripts, you don't currently hold a DEA registration, or you run a digital health platform that connects patients with prescribers, you're going to be in some cross hairs coming up here in 2026.
So let's talk about what's actually changing, who's impacted and why this is bigger than most people realize. So to get started, I'm gonna talk a little bit about what's ending. So the pandemic era, flexibilities, the PHE rules that allowed telemedicine prescribing, you know, during COVID, like, come on.
We all remember exactly why it happened. It was mainly because like nobody could get to the [00:04:00] offices. So you know, Ryan het act where you had to have an in-person visit for controlled substance prescribing before, having it authorized, those rules went away and that actually, really helped with the whole telemedicine boom.
That was one of the big game changers around, why, telemedicine got so big during COVID, so over the last few years, those flexibilities have really been the backbone of this virtual care. Boom. They have let clinicians, start treating patients on, you know, from A DHD, anxiety hormone therapy.
Oh, the dreaded GLP ones, which, sorry, I know GLP ones are good, but gosh, like just the extent of how companies do it, you know, drives me a little. I digress though thyroid, all the way just through general telehealth visits, right? But like the beauty of it was like you were able to get, what you needed prescribed.
You didn't have to have the burden of going in person and seeing a provider [00:05:00] to meet the compliance requirements. and so that big flexibility is what made it possible for a lot of, companies row calibrate. Cerebral, HIMSS and hers. A lot of companies that are, now pretty big names and hundreds, if not thousands of smaller clinics really to grow at light speed because at the end of the day, we all know that we go to doctors mainly to get certain things prescribed to us, especially when we're in a state of need.
So when this policy is set to expire at the end of the year, December 31st, the DEA proposed a whole new rule and regulation set and framework to replace it so that it could continue ultimately in a safe and consumer friendly way. and at this time, the way that it is set up, it doesn't just impact controlled prescriptions, it actually impacts the whole, drug schedule.
[00:06:00] So you wanna think about it. Clinicians who prescribe any schedule twos through five medications through telemedicine are impacted. Telemedicine companies that are connecting patients. Or facilitating any workflows through asynchronous care, synchronous care, any telemedicine company, compounding pharmacies and tele pharmacies that are dispensing these drugs.
And then of course, like, as I said patients of course, are going to be incorporated into these new rules because a lot of the rule sets are built around them to protect them. So even if your platform is primarily hormones or GLP ones or peptides, that doesn't mean that you're exempt because those are schedule threes.
You know, those are regulated drugs, andagain, part of these rules is to say that if you're a telemedicine company, like we have our eyes on you and we're watching what you're doing, regardless of what you're prescribing. So [00:07:00] now I want to really kind of like jump into, the core issue, which is not so much like what you're prescribing, but how you're prescribing, how you're overseeing those prescriptions.
And you know, of course like. Ultimately, what is replacing these PHE rules in this new era of regulation? And it's really these four regulation layers that are being built in. So when this new role takes place, Jan 1 20 26. There's these four major registration categories that are going to govern telemedicine prescribing.
The first one is telemedicine prescribing registration. So for most clinicians who prescribe Schedule three through five controlled substances via telemedicine without an in-person exam, this covers like bread and butter medications of modern [00:08:00] telemedicine. And really the idea around this is.
Everything has to be audio video, communication. There has to be built in patient identity verifications, which oh my gosh, please tell me, most companies already have built in, which means that you're just verifying a state Id. You have to complete your PD MP checks to make sure that there aren't being multiple things prescribed.
This one, I'd like to say is a little bit new because historically, I'd like to say most companies did this for Schedule twos, but not so much for other drugs, which is why I see on Reddit. So many consumers that have gotten GLP ones on 10 different platforms, and nobody's checking to see what was prescribed to the same person.
And then of course, you must document the encounter, the, you know, method of verification, the PDMP lookup, the whole thing, right? Your whole documentation chain, which again, most companies have this set, [00:09:00] right? The second registration is for more advanced telemedicine prescribing rules and registrations.
So it's for specialized providers, psychiatrists, neurologists, pediatricians, palliative care, hospice, and that is mainly around schedule twos, through fives via telemedicine. and again, this is where it gets interesting because it is going to vary state by state. But for schedule two, in some states, the provider may need to physically be located in the same state as the patient.
There's a proposed cap limiting how much a provider's, total schedule two prescribing can occur via telemedicine. Roughly right now it's saying 50%, meaning you cannot be a sole prescriber of telemedicine if there are those caps. And you have to demonstrate specialized training and clinical rationale for telemedicine use.
So these are kind of newer rules around this set. [00:10:00] And again, one of the things that I think is really interesting, and this'll kind of get to it towards the end, but they are gonna be layeringin-person visits. So even though telemedicine is something that we want to empower and expand, there are certain limitations that we need to factor in specifically around not seeing people in person after a certain timeframe.
And so. For some of these advanced, when you're coming to, schedule two prescribing or anything that's delegated from Schedule Twos, this is going to be kind of like a big one to think about how to comply with. The next one, I would say is like where the money's at it's big for digital health companies.
This is the telemedicine platform registration, and. I want to go on the record and say, I think this is a brilliant and much needed thing. I have been one of the key [00:11:00] advocates saying that nobody is really regulating digital health companies. I've seen providers get burned. I've seen physicians get burned.
I've seen patients get burned, and it's mainly because there's no. Governing body or regulatory body that really is responsible for overseeing telemedicine compliance with really anything. We have corporate practice of medicine. We have supervision rules, but at the end of the day, you look at those and those fall on the physician or the clinician.
Nothing really falls on the company. This one does. So if your business facilitates or profits from any sort of prescribing, which we all know. These digital health companies do. you are gonna have to register as a telemedicine platform through this new telemedicine platform registration process.
And it makes your company or your platform itself, a DEA registrant. and so it means that, you're attesting [00:12:00] that your system logs. Audit records, ID checks PDMP verifications and you're now subject to DEA inspection. So you can expect a lot higher of a compliance bar that you're gonna have to meet.
As well as, the things I have been kind of harping on, you know, policies for provider. Credentialing and vetting and validations, real time monitoring, documentation. Really having all of that in place because now as a prescriber, you technically are on, in this regulatory body and you know, could be audited.
The next thing is the state telemedicine registrations. And this is where things get really granular, I'd like to say, if you're prescribing to patients across multiple states, you are going to have to apply in every single state where you are prescribing right now. That is in addition to your federal DEA registration as well.
[00:13:00] For clinicians, it's about 50 bucks. And for platforms or telemedicine companies, it's like around $700 and it is mandatory. So each registration must appear on the, prescription. So regulators can verify legitimacy. And so as you're thinking as a telemedicine company, you're going to have to think about that cost factor.
So for every single state, for every single provider, as well as your platform. So if you're a company that operates in. All 50 states, you are going to have to apply for that in all 50 states. And then if you have other providers, let's say you have five providers, you are gonna also have to apply for that for all five providers in all 50 states.
So it is going to become a super labor intensive drill to make sure that your entire provider team meets all of these requirements. As I [00:14:00] have, again, continuously harped on, I know for a fact most physicians and providers are not complying with the DEA registration rules. They will have a DEA in one state and use that across state lines.
And I am telling you, I don't think it's a good idea, and I strongly think that you need to comply with the DEA rules. Because this is going to be looking at that under a microscope.
So you know, as I already kind of mentioned, most telemedicine companies are already checking for a lot of these things, right? You're checking for IDs, you're checking PDMP. You are credentialing your teams, right? The big thing here is like, what is the proof? Where are the audit logs? Where is the documentation and making sure that your system can show that data so that you are complying.
So it's that real data audit trail that you [00:15:00] are wanting to make sure that you have . And for clinicians, this is where like liability really tightens up. For you. You know, historically most telemedicine companies would verify DEA and state licenses. Once it onboarding, we know some of the rules now, for CAQH compliance, it's monthly.
The expectation now across the board, cash pay , everything is this continuous monitoring of monthly verifications, whether the DEA registrations are active, whether, the licenses are matching, where the patient is located, whether the telemedicine and, licenses are valid in that specific state.
Having those collaborative and supervisory agreements, you know, that they're valid for the drugs that are being prescribed. So on and so forth. There's so many different things that you wanna make sure that you are checking from a, clinician side. And so, if. One of those things lapses, or if [00:16:00] you have just, let's say a license in Arkansas, but you don't have a valid DEA, but you are told to prescribe and everything's fine.
Like you need to be sure that you are asking the right questions so that you don't accidentally violate a major compliance rule. For companies it's really important that you have a centralized. Automated tracking system where you can, monitor and oversee these things and build operations around it.
None of this stuff is too complicated. It's Really tedious, I will say, but you wanna make sure that you have these things set up for scale. For example, I am, helping a very, you know, kind of boots on the ground company right now, scale to over 30. States, and one of the big things that I'm working with them on is exactly this.
How are we making sure that we have all of our registrations tracked with [00:17:00] key dates so that we can make sure nothing lapses, we can follow up with our providers as things are getting, close and that we as the oversight body can make sure that everybody complies just to, you know, help our providers and of course, help the clinic.
So from a founder and digital health perspective, this is the part that like, few founders really want to think about. And you know, like I just wanna say as a platform, you are now stepping into territories where you're actually accountable for provider compliance. I've heard so many clinicians and physicians.
Again, to have to take the brunt of things that weren't necessarily their responsibility. The tech company did it, or the system was built this way, or you know, blah, blah, blah. Like I'm just a clinician. These boards didn't care about that. But here now that's kind of slightly shifting and changing. from a telemedicine perspective, from an operational [00:18:00] perspective, you're gonna definitely wanna just think about your policies and your technical controls around how you're vetting providers, how you are monitoring those registrations, how those PDMP lookups are happening.
And again, like can you actually. Monitor that they're happening. You can tell your providers all day to do it, but can you actually verify that it's happening? Those are the key questions that you need to ask yourself. Convenience without oversight is like exactly what this rule was designed to stop and put an end to.
So again, compliance is tedious and hard and very nuanced and. Gets a lot tougher if you don't have it right at the beginning. So. Real quick, just to kind of like quickly recap, and I know I talked a lot and it's probably so dense without Leo here. Leo lightens it up. I am the thorn in your side because I care.
But here is how you can prepare for 2026 and I don't wanna hear anyone [00:19:00] go, oh, the rules are gonna change or it's gonna get extended. I can tell you we're 60 days out right now, the government is still shut down. So you do not have a minute to waste thinking that this isn't going to happen, because if it doesn't happen in January it very will, happen very, very soon thereafter.
so to prepare for this, audit your prescribing universe, list every medication being prescribed. And identify which ones are tying to the different DEA schedules. 'cause that's exactly going to tell you the different registrations that you as a company, as a clinician, as a physician, need to apply for.
You're gonna wanna map the different states that you're practicing in. So for every prescriber, you wanna confirm the states where they're, of course, licensed and prescribing, and you're gonna wanna make sure that You have, like let's say you're a company that has patients in all 50 states.
You need to make sure and kind of like start to map all of that out from all your different providers, [00:20:00] physicians again. So you can start that registration process. You're gonna wanna think about some lightweight automations and this is where like I'd love to help. So just let me know. But you know, you're gonna want to implement some monthly checks.
To verify and validate that the different things that are now required are happening. ID checks PDMP, lookups id, verifications, different kinds of documentation. So it's really like a QA sample so you can make sure that some of these operational changes that are now gonna be enforced are actually being met.
You're going to want to establish a really solid internal oversight process. And that really means designing compliance owners, figuring out an internal process for y'all to meet and talk. I say once a month. Once a month, force yourself, throw an hour meeting on the books and talk compliance and set an agenda and.[00:21:00]
Make sure that it is a priority, because otherwise you're going to be down the road six months and it will never be a priority because this is not sexy. This is not fun. This is why people hire compliance officers and people who do it because it's not the fun stuff, but it is the stuff that you have to do to keep the lights on.
You definitely wanna establish a team training. So clinicians, admin, patient coordinators, qa, you know, everybody needs to understand that what the changes in these roles mean and how they're gonna impact your business long term. And then the last is you wanna apply for the DEA registration.
Start that process. Now I can tell you because some of this stuff is gonna be future coming, right? We all know the government, it's slow. So like some of the things that they're saying that you have to apply for might not exist today. But I can tell you getting practitioners registered in all states where they are prescribing today with [00:22:00] active DEA registrations.
That is available today. You can look on the DEA website physicians that are delegating services and delegating prescriptive authority to providers, but don't actually have a DEA in that state. Apply for your DEA that is available today. Do all the pre-work today so that when the actual registrations are ready.
You have done all the pre-work, so you can hit the ground running. You don't wanna have to wait and do all of this stuff. And again, I can tell you like this is gonna be a financial burden. So for a lot of companies, you're gonna want to think about, do we actually need all these providers prescribing?
It's gonna be a really good time for you to recalibrate your staffing and your, operational structure from end to end. I just wanna say I'm not trying to be the, bearer of bad news, but from a perspective of where we're going in 2026, this is the biggest shift because it's [00:23:00] been so flexible for so long.
We've had the ability to prescribe via telemedicine. There haven't been in-person visits, and a lot of that is changing. You know, coming in 2026, there are going to be, rules around, every six months having an in-person visit. How are you gonna comply with that? If you're doing schedule twos, you know, you wanna start thinking about these things now.
So you can get creative, you can think what works for your business. You can adjust your strategy and ultimately you can walk your way back into compliance. Thank you so much for listening to this episode of Telemedicine Talks. If you have questions or you need any help or you're stuck understanding any of this stuff, we'll link some resources in the show notes, but also happy to chat with you about these rules again.
I would not play with the DEA [00:24:00] because there's a reason that every single regulation package gets pushed out. And the way I read this is they are watching telemedicine companies that prescribe, are you gonna be in the news? Are you gonna be on the OIG because you chose to not comply, or are you gonna come into compliance?