DEA Extends Telemedicine Flexibilities Through December 2026What This Means for Medstra Partners
The federal government just extended critical telemedicine protections through the end of 2026, ensuring uninterrupted access to testosterone replacement therapy and other controlled medications for telehealth patients nationwide.
Medstra Legal Team
Regulatory Compliance
On December 31, 2025, the Drug Enforcement Administration (DEA), jointly with the Department of Health and Human Services (HHS), issued their fourth extension of COVID-19 era telemedicine flexibilities, allowing practitioners to continue prescribing controlled substances (including testosterone) via audio-video telemedicine through December 31, 2026, without requiring an initial in-person medical evaluation.
For Medstra Brand Partners, especially those focusing on testosterone replacement therapy (TRT), this is exceptionally good news.
Here's what you need to know, why this matters, and what this means for your business.
Extension Period
January 1, 2026 → December 31, 2026
12 months of regulatory certainty for telehealth TRT operations
01What Just Happened: The Fourth Extension
The Regulatory Update
On December 31, 2025, the DEA and HHS published a temporary rule extending telemedicine flexibilities that have been in place since March 2020.
A DEA-registered practitioner is authorized to prescribe schedule II-V controlled substances via telemedicine to a patient without having conducted an in-person medical evaluation of the patient if all of the conditions listed in paragraph (c) of this section are met.
DEA Fourth Temporary Rule
What This Covers
Schedule II-V Controlled Substances including:
- •Testosterone (Schedule III)(Critical for TRT)
- •Semaglutide/Tirzepatide combinations with controlled substances
- •Certain ADHD medications
- •Certain anti-anxiety medications
- •Other controlled medications prescribed via telehealth
Requirements (All Must Be Met)
- Prescription issued for legitimate medical purpose
- Practitioner acting in usual course of professional practice
- Communication via interactive telecommunications system (audio-video)
- Practitioner is DEA-registered for the controlled substance class
- Prescription complies with all other DEA regulations
Why the Extension Was Necessary
The DEA warned of an impending “telemedicine cliff”: the abrupt reinstatement of pre-pandemic restrictions that would have required in-person visits before any controlled substance prescriptions via telemedicine, creating massive backlogs and disrupting care for millions nationwide.
44.6M
Controlled substance prescriptions in 2024
Across 258 organizations
7M
Issued without in-person evaluation
Approximately 16% of total
24%
Reduction when Medicare expired
In first 17 days
What Happened with Medicare
When Medicare's telemedicine flexibilities expired on September 30, 2025 (before Congress extended them), the impact was immediate:
- • 24% reduction in fee-for-service telemedicine visits in the first 17 days
- • Nearly 40% or more reduction in states like Florida, Louisiana, Washington, Tennessee, Maryland, Oklahoma, and New York
02Why This Matters Specifically for TRT
Testosterone is a Schedule III controlled substance under the DEA's Controlled Substances Act. Without telemedicine flexibilities, prescribing testosterone would require an in-person visit first.
Without Extension
- ✗In-person visits required for new patients
- ✗Existing telehealth patients disrupted
- ✗Geographic barriers restored
- ✗Massive operational restructuring needed
- ✗Loss of competitive advantage
With Extension
- ✓New patients onboard via telemedicine
- ✓Existing patients continue care
- ✓National access maintained
- ✓Business as usual operations
- ✓Competitive advantage preserved
For Medstra Brand Partners
If you're operating a TRT-focused telehealth brand through Medstra, here's what this means:
03What Makes Medstra Compliant with This Extension
The DEA extension requires practitioners to meet specific conditions. Medstra's infrastructure is designed to satisfy all of these requirements.
Legitimate Medical Purpose
DEA Requirement
“The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice.”
How Medstra Complies
Independent Medical Group (IMG) physicians:
- • Conduct comprehensive medical history reviews
- • Review lab work (testosterone levels, complete metabolic panel, etc.)
- • Make independent clinical determinations
- • Prescribe ONLY when medically appropriate
- • Exercise independent medical judgment (not influenced by business considerations)
Audio-Video Telemedicine
DEA Requirement
“The prescription is issued pursuant to a communication between a practitioner and a patient using an interactive telecommunications system.”
How Medstra Complies
Medstra's platform uses HIPAA-compliant audio-video telemedicine for all controlled substance consultations. Not just forms or questionnaires, but actual audio-video physician consultations with real-time interaction.
DEA-Registered Practitioners
DEA Requirement
“The practitioner is authorized under their registration to prescribe the basic class of controlled substance specified on the prescription.”
How Medstra Complies
All Independent Medical Group (IMG) physicians are:
- • DEA-registered to prescribe controlled substances
- • Licensed in the states where they practice
- • Authorized to prescribe Schedule III controlled substances (testosterone)
- • Credentialed by Medstra's compliance team
All Other DEA Regulations
DEA Requirement
“The prescription is consistent with all other requirements of 21 CFR part 1306.”
How Medstra Complies
All prescriptions meet standard DEA requirements:
- • Valid prescription elements (patient name, address, date, etc.)
- • Issued for legitimate medical purpose in usual course of practice
- • Proper documentation maintained
- • State-specific requirements followed
- • Pharmacy verification processes in place
04What This Extension Does NOT Change
It's important to understand what remains the same.
Corporate Practice of Medicine (CPOM) Still Applies
CPOM laws (state-level):
- • Still require physician ownership of medical practices
- • Still prohibit non-physicians from employing doctors
- • Still prohibit non-physicians from controlling medical decisions
Medstra's three-entity structure still required: Brand Partner (your marketing company), MSO (infrastructure provider), IMG (100% physician-owned medical practice)
Anti-Kickback Statute (AKS) Still Applies
AKS (federal criminal law):
- • Still prohibits paying for referrals or prescriptions
- • Still requires Fair Market Value physician compensation
- • Still requires outcome-independent payments
Medstra's safe harbor-compliant payment structure: Flat-fee physician compensation ($60/consult whether they prescribe or not), Fair Market Value rates, compensation NOT tied to business volume.
What DID Change
Only one thing changed: The requirement for an initial in-person medical evaluation before prescribing controlled substances via telemedicine.
Before Extension
Required in-person visit before prescribing testosterone via telemedicine
With Extension
Can prescribe via audio-video telemedicine without initial in-person visit
05What Medstra Brand Partners Should Know
For Current Brand Partners
What You Need to Do
Nothing.
Your operations continue exactly as they have been. Same patient acquisition process, same audio-video telemedicine consultations, same physician prescribing process, same compliance framework, same business model.
For Prospective Brand Partners
If you're considering launching a TRT brand through Medstra:
For TRT-Focused Partners
This extension is critical to your business. Testosterone is Schedule III. Without telemedicine flexibilities, your business model would require in-person initial consultations for every patient.
With this extension, you can continue the audio-video only model through Dec 31, 2026, maintain national patient acquisition capability, keep cost structure lean (no physical clinic infrastructure), and preserve 78% gross margins on patient economics.
Questions about this extension?
Contact your Medstra partnership team for personalized guidance.
06Looking Ahead: What Happens After December 31, 2026?
The DEA is working on permanent regulations for telemedicine prescribing of controlled substances.
The Special Registration for Telemedicine NPRM
On January 17, 2025, the DEA published a Notice of Proposed Rulemaking (NPRM) proposing a new registration category for practitioners prescribing controlled substances via telemedicine, with additional requirements for recordkeeping and reporting, plus a framework for direct-to-consumer (DTC) telemedicine platforms.
Public Comment Period
Over 6,475 comments received. DEA is reviewing feedback which will inform final regulations.
Provide the DEA with additional time to finalize and implement effective regulations that balance access to care with the necessary safeguards against diversion.
DEA Statement
Medstra's Preparation
When final regulations are published, Medstra will:
Brand Partners will not need to navigate new regulations alone. Medstra will handle compliance at the infrastructure level.
07Why This Extension Represents Regulatory Maturity
This is the fourth extension of telemedicine flexibilities. The pattern is clear: The DEA and HHS consistently extend these flexibilities because they work.
March 2020
COVID-19 PHE flexibilities granted
May 2023
First Temporary Rule
October 2023
Second Temporary Rule
November 2024
Third Temporary Rule
December 2025
Fourth Temporary Rule
The Federal Government's Position
By extending flexibilities four times, the federal government has demonstrated:
This is not a temporary accommodation. This is the foundation for permanent telemedicine access to controlled medications.
08What Medstra Has Built for This Moment
Medstra's infrastructure was designed from day one to comply with federal telemedicine regulations. Everything the DEA requires, Medstra provides.
Audio-Video Platform
- •HIPAA-compliant platform
- •Real-time consultations
- •Encrypted communications
- •Documented records
Physician Network
- •DEA-registered physicians
- •Licensed in 50 states
- •Credentialed and verified
- •Schedule III authorization
Medical Purpose Framework
- •Medical history collection
- •Laboratory work requirements
- •Physician independent judgment
- •Clinical guidelines
Compliance Infrastructure
- •Three-entity CPOM structure
- •Safe harbor AKS payments
- •HIPAA compliance
- •Ongoing monitoring
09What This Means for Your Business in 2026
Certainty Through Year-End 2026
You have regulatory certainty for the next 12 months. This allows for strategic planning, patient promises, competitive positioning, and financial forecasting.
What You Should Do
Current Brand Partners
- Continue operations as normal
- Scale patient acquisition with confidence
- Focus on growth (framework is stable through 2026)
- Monitor updates from Medstra on final regulations
Prospective Brand Partners
- Launch with confidence (12 months certainty)
- Build your brand on proven infrastructure
- Acquire patients nationally via telemedicine
- Trust Medstra to handle regulatory transitions
10The Bottom Line: This Is Good News
The DEA's fourth extension of telemedicine flexibilities is overwhelmingly positive for Medstra Brand Partners.
What It Confirms
- ✓Telemedicine prescribing is here to stay
- ✓Federal government recognizes telehealth value
- ✓Permanent regulations will preserve access
- ✓Your business model is protected through 2026
What It Prevents
- ✗Telemedicine cliff (abrupt loss of prescribing)
- ✗Patient care disruption (millions losing access)
- ✗Forced pivot to in-person requirements
- ✗Loss of national reach
Your business is protected. Your patients are protected.
Your future is secure.
Ready to Launch?
Build your TRT brand with 12 months of regulatory certainty
Visit medstra.com to learn how to become a Brand Partner and build your telehealth business on federally compliant infrastructure.
Schedule a Call11Frequently Asked Questions
Frequently Asked Questions
Yes. Through December 31, 2026, you can onboard new patients via audio-video telemedicine without any in-person visit requirement.
Conclusion: Regulatory Certainty for Growth
The DEA's fourth extension provides exactly what Medstra Brand Partners need: regulatory certainty. Through December 31, 2026, audio-video telemedicine prescribing of controlled substances (including testosterone) is authorized, no in-person visit requirement for new or existing patients, operations continue uninterrupted, and your business model remains viable and competitive.
Medstra's infrastructure is compliant today and will remain compliant tomorrow. The three-entity CPOM structure is permanent. The safe harbor-compliant AKS payment framework is permanent. The audio-video telemedicine platform is permanent. The DEA-registered physician network is permanent.
The foundation is built. You focus on acquiring patients and building your brand. Medstra handles regulatory compliance.
Regulatory Disclaimer
This article is for informational purposes only and does not constitute legal or medical advice. The DEA's Fourth Temporary Rule extends existing telemedicine flexibilities through December 31, 2026. All Medstra Brand Partners must continue to comply with applicable federal and state laws, including but not limited to Corporate Practice of Medicine statutes, the Federal Anti-Kickback Statute, HIPAA, and all DEA regulations. Medstra provides compliant infrastructure but each Brand Partner is responsible for ensuring their specific operations comply with all applicable laws. Consult with qualified healthcare attorneys for specific legal guidance.
About Medstra
Medstra provides compliant MSO infrastructure for telehealth operators, including three-entity CPOM-compliant structure, safe harbor-compliant AKS payment framework, and DEA-registered physician networks operating via audio-video telemedicine platforms. Our infrastructure is designed to comply with current DEA telemedicine flexibilities and will be updated to satisfy eventual final regulations when published.
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