DEA Telemedicine Deadline Dec. 31, 2026: GLP-1s vs. Phentermine
The federal telemedicine rule that expires on December 31, 2026 covers controlled substances, and semaglutide and tirzepatide are not controlled substances. If your telehealth program prescribes only a GLP-1 like Wegovy, Zepbound, Ozempic or Mounjaro, the DEA deadline does not change how you get it. It matters if your program also prescribes phentermine or Qsymia, both of which contain a Schedule IV drug.
Key takeaways
- DEA and HHS extended the COVID-era telemedicine flexibilities for controlled medications a fourth time, through December 31, 2026.
- Semaglutide, tirzepatide and liraglutide do not appear on DEA's list of controlled substances, so the federal in-person evaluation rule for controlled drugs does not apply to them.
- Phentermine is Schedule IV. Qsymia contains phentermine, so a program that adds either one is affected if the flexibilities lapse.
- As of October 19, 2026, DEA's special registration rule for telemedicine is still only a proposal.
- State telehealth laws apply either way, including to GLP-1 prescribing.
What actually expires on December 31
A federal law, the Ryan Haight Online Pharmacy Consumer Protection Act, generally requires at least one in-person medical evaluation before a practitioner prescribes a controlled substance over the internet. During the COVID-19 public health emergency, DEA waived that requirement. The waiver has since been extended in a series of temporary rules.
The most recent one, the Fourth Temporary Extension, was published in the Federal Register on December 31, 2025 (90 FR 61301). DEA and HHS issued it jointly. It is effective January 1, 2026 through December 31, 2026.
Under that rule, a DEA-registered practitioner may prescribe Schedule II through V controlled substances by telemedicine without a prior in-person evaluation, as long as the prescription is for a legitimate medical purpose in the usual course of practice, is issued using an interactive telecommunications system as defined in Medicare regulations, and meets DEA's other prescription rules. The rule says the extension is meant to prevent a "telemedicine cliff" and give DEA time to finish permanent regulations.
The rule contains no grace period for patient relationships started during the flexibility period. When it expires, it expires for everyone, unless DEA acts again.
Why your GLP-1 is outside this rule
The Ryan Haight Act and the DEA flexibilities apply only to drugs on the federal controlled substance schedules. DEA's alphabetical list of controlled substances (dated August 27, 2026) does not include semaglutide, tirzepatide or liraglutide. It also does not list topiramate or the naltrexone/bupropion combination.
That means a telehealth clinician can lawfully prescribe a GLP-1 without ever seeing you in person, as far as federal controlled-substance law goes, and that will be true on January 1, 2027 whatever DEA decides. Whether a clinician should prescribe without an exam, and what counts as a valid relationship, is governed by state law and professional standards, covered below.
| Drug often used for weight management | Federal schedule | Affected by DEA telemedicine deadline? |
|---|---|---|
| Semaglutide (Wegovy, Ozempic, Rybelsus) | Not controlled | No |
| Tirzepatide (Zepbound, Mounjaro) | Not controlled | No |
| Liraglutide (Saxenda, Victoza) | Not controlled | No |
| Phentermine | Schedule IV | Yes |
| Phentermine/topiramate ER (Qsymia) | Schedule IV (phentermine component) | Yes |
| Diethylpropion | Schedule IV | Yes |
| Phendimetrazine, benzphetamine | Schedule III | Yes |
Source: DEA Controlled Substances, Alphabetical Order (Aug. 27, 2026); 21 CFR 1308.14(f); Qsymia PI (rev. 03/2026).
Where phentermine enters the picture
Some weight programs offer older oral medications alongside or instead of GLP-1s. Those are the prescriptions the deadline touches.
Phentermine is listed in Schedule IV under 21 CFR 1308.14(f). A current phentermine tablet label on DailyMed describes it as a "short-term (a few weeks) adjunct" for weight reduction. The same label says safety and efficacy of combining phentermine with other weight-loss products have not been established and that coadministration is not recommended.
Qsymia (phentermine and topiramate extended-release) carries a CIV designation. Its prescribing information, revised March 2026, says it "contains phentermine, a Schedule IV controlled substance, and topiramate, which is not a controlled substance." It is distributed under a REMS program through certified pharmacies, is indicated for certain adults and for patients 12 and older with obesity, and is contraindicated in pregnancy.
If a telehealth program prescribes either drug to you without an in-person visit, it is currently relying on the DEA flexibilities. Unless something changes, that path closes for new patients after December 31, 2026.
Weighing telehealth weight programs?
Compare current GLP-1 options, then confirm each provider's licensing, pharmacy and prescribing terms directly.
Paid links. We may earn a commission; it never changes what we write. See all options. Compounded medications are not FDA-approved.
The permanent rule that is not final yet
DEA proposed a permanent framework, Special Registrations for Telemedicine and Limited State Telemedicine Registrations, on January 17, 2025. Comments closed March 18, 2025. The proposal would create three registrations:
- A Telemedicine Prescribing Registration letting qualified clinicians prescribe Schedule III through V drugs by telemedicine. Phentermine and Qsymia would fall in that range.
- An Advanced Telemedicine Prescribing Registration adding Schedule II for certain specialists.
- A Telemedicine Platform Registration for online platforms that dispense Schedule II through V drugs.
The proposal would also require clinicians to hold a DEA-issued state telemedicine registration for each state where they prescribe, at a proposed $50 per state, and eventually a prescription drug monitoring program check across all 50 states.
As of October 19, 2026, DEA had not published a final special registration rule or a fifth extension in the Federal Register. A December 2025 McDermott Will & Schulte analysis noted that the administration had not finalized the proposal and that it was unclear whether it would move forward. DEA could still extend the flexibilities again, finalize a rule, or let them lapse. This article does not predict which.
If the flexibilities lapse: what changes for you
Here is how the outcome would differ by situation, based on how the current rule and the Ryan Haight Act work.
| Your situation | What the rules indicate | What to do now |
|---|---|---|
| GLP-1 only, prescribed online | Not a controlled substance; federal deadline does not apply. | Nothing DEA-related. Keep an eye on your state's telehealth rules. |
| GLP-1 plus phentermine or Qsymia, never seen in person by that prescriber | The current rule's authority for remote controlled-substance prescribing ends December 31, 2026, with no built-in grace period. | Ask the program in writing how it will handle the controlled-drug part of your plan in January. |
| Phentermine or Qsymia from a prescriber who has examined you in person | The federal rule describes the Act's remote-prescribing requirements as no longer applying to a relationship once an in-person evaluation has occurred. Other DEA and state rules still apply. | Confirm with your prescriber that the in-person visit is documented. |
| Starting phentermine or Qsymia after January 1, 2027 | Depends on whether DEA extends the flexibilities or finalizes a new rule before then. | Check DEA's announcements in December before enrolling. |
Source: Fourth Temporary Extension, 90 FR 61301.
Hypothetical scenario (illustrative only)
Someone enrolls in an online program in 2026 and receives tirzepatide plus a phentermine prescription after a video visit. In January 2027, with no new DEA action, the tirzepatide refills could continue as before. The phentermine refills could not continue under the expired flexibilities, and the program would need either an in-person evaluation or a different legal pathway, or would need to stop that drug. The person should hear about this from the program before January, not at the pharmacy counter.
State law applies either way
The DEA rule sets a federal floor for controlled substances only. States separately decide what counts as a valid patient relationship for any prescription, including a GLP-1. According to the Center for Connected Health Policy's state online prescribing tracker, most states do not consider an online questionnaire alone enough to establish that relationship.
Some states also add their own controlled-substance rules. As summarized by CCHP (updates dated mid-2026), Alabama requires synchronous audio or audio-video communication and at least one in-person encounter in the previous 12 months for controlled substances via telehealth. Arkansas generally bars physicians from prescribing Schedule II through V drugs by telemedicine without an in-person exam, with listed exceptions. So even if DEA extends the federal flexibilities again, your state may already require a visit for phentermine.
Questions to ask your program before January
- Is anything in my plan a controlled substance? Which drug, and which schedule?
- Is the prescriber licensed in my state, and DEA-registered in my state if they prescribe a controlled drug?
- If the DEA flexibilities lapse, what happens to my next refill of that drug? Will you require an in-person visit, and where?
- Does my state require an in-person exam for this drug regardless of federal rules?
- If the controlled drug stops, does my GLP-1 prescription continue unchanged?
A program that cannot answer the first question clearly is telling you something about how carefully it tracks your prescriptions.
Reviewing your options for 2027?
See participating providers' current pricing and terms, and verify licensing and pharmacy details with each one before you switch.
Paid links. We may earn a commission; it never changes what we write. See all options. Compounded medications are not FDA-approved.
Where this guide stops
This is a plain-language summary of federal rules as of October 19, 2026, not legal or medical advice. DEA can publish a new rule or extension at any time, and state laws change often. Do not stop a controlled medication abruptly without talking to a prescriber; the Qsymia label, for example, addresses tapering in its dependence section. For your specific plan, ask your prescriber, and for the law in your state, check your state medical board.
Frequently asked questions
Does the DEA telemedicine deadline affect Wegovy, Zepbound, Ozempic or Mounjaro?
No. The DEA flexibilities cover controlled substances, and semaglutide and tirzepatide do not appear on DEA's list of controlled substances. State telehealth laws still apply to how they are prescribed.
When do the DEA telemedicine flexibilities expire?
The fourth temporary extension, published December 31, 2025, runs from January 1, 2026 through December 31, 2026. As of October 19, 2026, no further extension or final special registration rule had been published.
Is phentermine a controlled substance?
Yes. Phentermine is Schedule IV under federal law, and Qsymia contains phentermine. Prescribing them by telemedicine without an in-person evaluation currently relies on the DEA flexibilities.
What happens to my phentermine prescription if the flexibilities lapse?
If DEA takes no further action, the federal authority for prescribing controlled drugs remotely without an in-person evaluation ends after December 31, 2026, with no grace period in the current rule. Ask your program in writing how it will handle your next refill.
Sources
- DEA/HHS, Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications, 90 FR 61301 (Dec. 31, 2025)
- DEA, Special Registrations for Telemedicine and Limited State Telemedicine Registrations, proposed rule (Jan. 17, 2025)
- DEA Diversion Control Division, Controlled Substances: Alphabetical Order (Aug. 27, 2026)
- eCFR, 21 CFR 1308.14, Schedule IV
- Qsymia (phentermine and topiramate extended-release) prescribing information (rev. 03/2026)
- DailyMed, phentermine hydrochloride tablet label
- Center for Connected Health Policy, State Telehealth Policies for Online Prescribing
- McDermott Will & Schulte, DEA extends telemedicine flexibilities for controlled substance prescribing for 2026 (Dec. 30, 2025)
Medical disclaimer: This article is general information, not medical advice, and does not replace a licensed clinician who knows your history. Approvals, labels, coverage and prices change; check the linked sources and talk with your prescriber or pharmacist before making decisions about any medication.