Expiration of Telehealth Flexibilities for Schedule II Prescribing in New Jersey
Effective February 16, 2026, in New Jersey, prescribing of Schedule II controlled substances must comply with the statute which permits telemedicine prescribing of Schedule II medications only after an initial in-person examination and requires an in-person visit at least once every three months thereafter. A limited exception remains: Schedule II stimulant medications prescribed to minors under age 18 using real-time, interactive audio-visual technology and obtains prior written parental or guardian consent to waive the in-person examination requirement.
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Telemedicine Prescribing Flexibilities Extended Through 2026
The DEA and HHS have issued a fourth temporary rule extending COVID-era telemedicine flexibilities for prescribing controlled substances through December 31, 2026. This extension allows DEA-registered clinicians to continue prescribing Schedule II–V medications via telemedicine without an initial in-person visit, helping prevent disruptions in care.
The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 governs online prescribing of controlled substances in the US. This law was created to regulate online internet prescriptions, is enforced by the DEA (Drug Enforcement Agency) and also imposes rules around the prescription of controlled substances through telepsychiatry.
- The Act requires any practitioner issuing a prescription for a controlled substance to conduct an in-person medical evaluation (with certain specified exemptions) prior to prescribing controlled substances. Per the Act, the prescribing practitioner is required to have conducted one in-person medical evaluation with the patient and may prescribe via telemedicine thereafter. The occurrence or frequency of additional in-person visits is not mandated under the Ryan Haight Act.
- The Act also describes special circumstances such as “covering practitioners” – “a practitioner who conducts a medical evaluation [by telemedicine] at the request of a practitioner who … has conducted at least 1 in-person medical evaluation of the patient or an evaluation of the patient through the practice of telemedicine within the previous 24 months" – and prescribing within a federal health care system (e.g. Indian Health System; Department of Veteran’s Affairs). Psychiatrists working in federal health care systems should be familiar with their organization’s policy around the telepsychiatric prescribing of controlled substances.
- In addition to complying with the Ryan Haight Act, psychiatrists need to make sure they comply with other federal, state and organizational rules and policies around the prescription of controlled substances. Prior to the temporary flexibilities around these rules, the Centers for Medicare & Medicaid Services (CMS) required annual in-person visits for mental health, subject to exceptions if the risk of in-person care outweighs the clinical benefit, for Medicare patients. CMS also required in-person establishment of Medicare patients prior to providing telemental health, which was not eligible for exceptions.
Additional in-person evaluations, beyond the minimum required by relevant facility, state, and federal policy, was up to clinical discretion. For example, if the practitioner was unable to obtain the data they need for clinical decision-making through telehealth, the practitioner could recommend that a patient be seen in-person.