Buprenorphine Telemedicine Prescribing

Buprenorphine Telemedicine Prescribing is sponsored by Substance Abuse and Mental Health Services Administration (SAMHSA). This is a forecasted funding opportunity for Fiscal Year 2026 related to buprenorphine telemedicine prescribing.

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Your browser is not supported Switch to Chrome, Edge, Firefox or Safari Buprenorphine Telemedicine Prescribing: Questions and Answers SAMHSA, on behalf of HHS, and the DEA have published a final rule that provides patients with the ability to remotely access to buprenorphine.

This change allows a patient to start and receive up to a total of a 6-month supply of buprenorphine through a telephone consultation, or audio-visual telehealth, with a provider. Further prescriptions of buprenorphine will require an in-person visit to a medical provider or through another mechanism as determined by the DEA. Expand All | Collapse All As a practitioner, what do I need to know about this new rule?

This rule creates an important pathway for practitioners to initiate buprenorphine via telemedicine, including audio-only and audio-visual appointments, to treat opioid use disorder (OUD).

If you have never conducted an in-person visit with your patient, there are a few key requirements: check the state’s prescription drug monitoring system where the patient is located prior to prescribing, document the date and time when you checked it, and prescribe for no more than a total of 6 months of medication supply using this method.

As best practice, you may want to ensure your patients have acceptable ID before they head to the pharmacy, so they don’t run into problems picking up their filled prescription. But most importantly - if you've already evaluated the patient in person at any point, these special requirements don’t apply to you. Does this rule apply if I’ve evaluated the patient in person my patient in person before?

No - If you have previously conducted an in-person medical evaluation of your patient, this rule does not apply. It only applies to situations where you’ve never seen the patient for an in-person medical evaluation. Once you've had an in-person visit with a patient, you can provide evidence-based and person-centered care according to practice standards and your respective state’s laws.

Expand All | Collapse All For how long can I prescribe buprenorphine via telemedicine under this rule? The rule allows you to initiate buprenorphine and prescribe it for up to a total of a six month supply from the date of your first prescription.

As a practitioner, you can split this up however it makes sense for your patient– it may be necessary to see the patient regularly via telemedicine and to titrate the dose as the individual stabilizes on buprenorphine, but then once the patient finds a stable dose, longer prescriptions could be written. In other words, you don't have to write all 6 months at once.

After the 6-month supply ends, you will need to either conduct an in-person medical evaluation or continue care through other forms of telemedicine that are specifically authorized under federal law (21 U.S.C. 802(54)). Practitioners should consult with DEA and their state medical boards about what specific telemedicine practices are currently authorized for prescribing controlled medications after this six-month period.

Can I start another six-month supply after the previous six-month supply period ends? No. The rule allows just one six-month period of audio-only or audio-visual prescribing per patient that you have never evaluated in person. This is not intended to be used repeatedly with breaks in between.

This means, for example, that if a patient for whom you have prescribed three months of buprenorphine via telemedicine is lost to your practice for six months and then returns, the most you could prescribe by telemedicine before needing to see the patient in-person is three months. The six month period is intended to be a total six month supply.

Prescription Drug Monitoring Program (PDMP) Requirements Expand All | Collapse All What are the PDMP checking requirements? Before writing each prescription, you must check the PDMP for the state where your patient is located during the telemedicine visit. Pursuant to the rule, look at the patient’s-controlled medication prescription history for the past year (or whatever history is available if less than a year).

Make sure to document in their medical record the date and time you checked the PDMP. What if I can’t access the PDMP? If you can't access the PDMP, you can still help your patient.

Document in the patient’s medical record, whether paper or EHR, when you tried to check it and why you couldn't access it. You can then prescribe up to a seven-day supply. Before writing another seven-day prescription, you will need to try checking the PDMP again.

Remember that these seven-day prescriptions count toward the six-month total supply limit. What should I do if my state doesn’t have a PDMP or if my patient lives in a different state? The rule requires checking the PDMP of the state where the patient is located at the time of the telemedicine encounter.

If you cannot access that state’s PDMP, you must document your attempt to access it and can then prescribe up to up to seven-day supply, attempting to check the PDMP before each new seven-day prescription. Identity Verification Requirements Expand All | Collapse All What kinds of ID can patients use at the pharmacy? The rule recognizes that patients need flexible ID options.

While a state or federal government photo ID works best, a pharmacist can also accept other forms of identification. This includes school documents for minors, letters from homeless shelter staff, tribal government letters, utility bills, bank statements, voter registration cards, or pay stubs. The key is ensuring the patient can be properly identified.

How can I help patients who might have trouble with ID requirements? As a practitioner, you can help by providing a letter verifying your patient’s identity. This can be especially helpful for patients experiencing homelessness, those who lack access to standard ID, or other vulnerable populations.

Your letter should clearly identify the patient, explain that you are their treating practitioner, and include your contact information. After the Initial Six-Month Supply Period What are my options after the six-month telemedicine prescribing period ends? You have two main options: See the patient for an in-person visit.

Once you do this, you can continue care without the requirements of this rule. Continue treatment through other forms of telemedicine that are specifically authorized under federal law. You should consult DEA and your state medical board about which telemedicine practices are currently authorized for prescribing controlled medications.

Pharmacy-Related Questions Can someone else pick up a patient’s prescription? Yes, the pharmacy can verify the identity of the patient by accepting identification from any individual who falls under the definition of “ultimate user” as defined in 21 U.S.C. 802(27).

That includes individuals who are members of the household of the patient to whom the medicine is prescribed. They'll need to provide acceptable identification too when they pick up the medication on behalf of the patient. General Practice Questions Expand All | Collapse All Do I need any additional registration to initiate buprenorphine via telemedicine?

No additional registration beyond your current DEA registration that allows Schedule III-V prescribing is needed. You must also ensure that you comply with all state laws about telemedicine practice in both your location and your patient’s location. What extra documentation do I need to maintain?

Under this rule, you are required to document when you checked the PDMP (or tried to check it) for each prescription. Beyond that, maintain your usual medical records according to standards of practice. Can I use audio-only telemedicine even if video is available?

Yes. You can use audio-only telemedicine even if video capability exists but document in the medical record the reason for choosing audio only. The choice of communication method should be based on what works best for you and your patient while meeting the rule’s requirements.

What if my state has stricter telemedicine prescribing rules? Follow the stricter requirements. This federal rule sets minimum standards, but if your state has additional requirements, you need to meet those too.

Are there resources on buprenorphine prescribing? The Substance Abuse and Mental Health Services Administration (SAMHSA) has published many resources on this topic. SAMHSA’s Treatment Improvement Protocol on Medications for Opioid Use Disorder (MOUD) provides evidence and practice-based information regarding buprenorphine, methadone and naltrexone.

SAMHSA’s Buprenorphine Quick Start Guide is a short guide designed to help practitioners start and maintain patients on buprenorphine. Other guides, such as Practical Tools for Prescribing and Promoting Buprenorphine in Primary Care Settings , provide information applicable to specific settings. In December 2022, the requirement to obtain a special waiver to prescribe buprenorphine for OUD was lifted.

Now, where state law allows, any practitioner with a valid state license and DEA registration to prescribe Schedule III medications may prescribe buprenorphine for OUD. This expands opportunities to provide care and the ability to provide treatment to those with OUD across different settings. For more information on removal of the Data-Waiver, see Substance Use Disorder Treatment Options .

View the final rule (PDF | 462 KB) . Source: https://www. samhsa.

gov/substance-use/treatment/statutes-regulations-guidelines/buprenorphine-telemedicine-prescribing