Trump administration set to extend COVID telehealth rules for ADHD medications

Without telehealth, Annie,* a 26-year-old student who lives in Tennessee, would need to travel about an hour to see her psychiatrist in person to get her monthly ADHD medications. Annie doesn’t have a car. She’d have to spend a lot of time on the bus or pay for a taxi or Uber. Plus she’d have to take time off work to make the trip. 

But thanks to continuing COVID-19-era telehealth flexibilities, Annie doesn’t need to see her provider in person to get her stimulant prescription. Telehealth removes a big barrier to getting care.

“These medications have really helped me a lot,” said Annie. “I’ve gotten fired, unfortunately, from some jobs in the past because I wasn’t able to do what I needed to do, and I was unmedicated at those times. But since getting on medication, my life has gotten a lot better.” 

Current telehealth flexibilities, which allow for easier access to ADHD medications, were set to expire at the end of 2025. If that happened, regulations would roll back to pre-pandemic laws that limit telehealth for controlled substance prescribing. That would make it harder for people like Annie to get their medications.

But in November, the Trump administration signaled it would again extend COVID-19 telehealth prescribing rules. These rules dictate how and whether controlled medications — including ADHD stimulants — can be prescribed via telehealth.

The new rule is titled “Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications.” It extends through December 31, 2026, the current rules for telehealth that don’t require an in-person visit before getting a prescription for controlled medications.

So what are the current telehealth rules? How have other administrations tried to change them? And how do these rules affect people with ADHD? 

History of telehealth regulations for ADHD medications

It’s hard to remember now. But before the COVID-19 pandemic, health care providers weren’t allowed to prescribe stimulants for ADHD without an in-person visit first. 

Stimulants, such as Adderall, Ritalin, and Vyvanse, are Schedule II controlled substances. The Drug Enforcement Agency (DEA) considers Schedule II medications to have a high potential for misuse. So doctors have to follow more laws and regulations when prescribing them. The Ryan Haight Act of 2008 sets the rules for prescribing Schedule II medications via telehealth.

The Ryan Haight Act was named in memory of a teenager who overdosed on Vicodin. The medication was prescribed to him by an online doctor. 

The law requires that doctors see patients in person before prescribing a controlled substance. Doctors must also see patients in person at least once every 24 months to keep prescribing these medications. 

Pandemic telehealth flexibilities

During the pandemic, the DEA relaxed the rules of the Ryan Haight Act. Starting in March 2020, clinicians could prescribe controlled substances without seeing patients in person first. The relaxed rules also let providers see people via telehealth in their homes. This previously wasn’t allowed.

In addition, health insurers started paying doctors the same amount for a telehealth visit as for in-person visits.¹ This payment parity wasn’t standard before the pandemic. With payment parity, doctors faced fewer barriers to using telehealth during the pandemic. And as a result, it became easier for patients to get ADHD treatment. 

The COVID-19 telehealth rules also let providers use audio-only phone calls for telehealth appointments.¹ Before, insurance companies didn’t reimburse for phone calls. Doctors needed to use video calls to get paid. People with low incomes or in remote areas may not have access to reliable internet or a smart phone for video calls. Making video calls privately can also be more challenging. Audio-only telehealth made it easier for people in these situations to get the care they need.

Biden’s 2023 telehealth proposal

The pandemic public health emergency began to wind down in 2023. So the Biden administration proposed new telehealth rules. These rules would have rolled back many of the pandemic’s flexibilities. 

The proposal, issued in February 2023, would have required an in-person visit before doctors could prescribe a Schedule II stimulant. Those who started taking stimulants without an in-person evaluation would now need to see their doctor in person within 180 days. The proposal also required doctors to note on the prescription if a controlled substance was prescribed via telehealth.²

The proposal received over 35,000 public comments. Some wrote in support of the proposal. But the new rules proved to be unpopular among patients and providers.

“My sister already has many challenges thanks to her ADHD,” wrote one commenter. “Please don't give her another challenge by no longer allowing her to get her medications from a telehealth prescription.”

“Telehealth is incredibly important for folks who are marginalized, live in rural areas, or who fear or face harassment,” wrote another commenter. “This restriction is unnecessary and exceedingly harmful for many in our society.”

Ultimately, the Biden administration never passed the proposed 2023 changes. Instead, the COVID-19 telehealth rules were extended three times. The last extension was set to expire December 31, 2025.

Biden’s 2025 telehealth proposal

On January 17, 2025, the Biden administration made one more attempt to propose telehealth regulations. The proposed rules would require doctors and telehealth companies to get a special registration from the government to prescribe Schedule II substances using telehealth. 

Health care providers already have to register with the DEA to prescribe controlled substances. Under the new proposal, they’d need an additional state telemedicine registration for every state where they see patients.

A special registration for controlled substance prescribing isn’t a new idea. In 2018, Congress passed the Special Registration for Telemedicine Act. This law authorized the DEA to create a special registration process. But it was never implemented. The January 17 proposed rule was the first time an administration attempted to create the registry. 

The proposed regulations would also limit how often providers could use telehealth to prescribe Schedule II medications. No more than half of these prescriptions could be made through telehealth. They’d have to write the other half during an in-person appointment. So if a doctor writes 100 telehealth prescriptions per month, either 50 of those patients would now need to come into the office, or the doctor would need to find 100 new in-office patients.

These suggested rules concerned people with ADHD and their providers. Many expressed their worry in the comments section of the proposal, which closed March 18.

“ADHD medications are essential for many individuals to manage daily functioning, and requiring in-person visits will be a significant hardship for those who rely on telehealth,” commented one physician.

“Telehealth has been a huge help, offering more flexible care for those of us who need it most,” wrote another commenter. “For many of us, ADHD medication isn’t just a convenience — it’s a lifeline. … Let’s make sure we don’t make it harder to get the treatment we need. We need better access, not more barriers.”

In the end, the Biden administration’s rule was not implemented. Now the Trump administration will extend the COVID-19 telehealth rules for the fourth time.

Benefits of telehealth for ADHD medications

Telehealth was a critical tool to access ADHD treatment during the pandemic. According to the CDC, 30 percent of people with ADHD used telehealth to get their prescriptions. About 9 percent got their ADHD diagnosis using telehealth alone. And 46 percent of adults with ADHD used telehealth at some point.³ ADHD diagnoses also increased during the pandemic. This increased the number of people taking stimulant medications.⁴ Telehealth helped make this possible.

After the pandemic, people still rely on telehealth to get the treatment they need. For people with ADHD, telehealth reduces the time, effort, and executive function needed to get to an in-person visit.³ These logistics can be difficult for people with ADHD.

“[Telehealth] makes life significantly easier,” said Kimberlee Rowett, a Utah resident who sees her doctor about once a month for follow-up appointments. “It's really nice to just be able to pause my day, whatever I’m doing, jump on essentially a FaceTime, talk with my provider and let them know where I’m at, and go about my day after.

Camara Rauen, who lives in Los Angeles, would have loved to see a psychiatrist in person for her ADHD. But she couldn’t find one she could afford, or who was covered by her insurance. Eventually, she found a telehealth psychiatrist. And she’s also had a great experience.

“Telehealth has been a pro for me because it’s very convenient,” Rauen said. “I enjoy my psychiatrist. I feel like they really have gotten to know me … and they really care about how I’m being affected.”

Telehealth access in underserved areas

Telehealth makes it easier for people in rural areas and with low incomes to get care that would otherwise be inaccessible.⁵ An estimated 1 in 5 people in the U.S. live in a rural area. Telehealth reduces the cost and burden of traveling to see providers in person.

“Living in rural Montana, my nearest ADHD specialist is 248 miles away, and others like me have just begun to rely on the convenience and accessibility of telehealth,” wrote one commenter on the January 17 telehealth proposal.

“With my current insurance, there are no in-network psychiatry options within 50 miles of where I live, and appointments are backed up at the nearest in-person options for months,” wrote another commenter. “Telehealth makes this treatment possible with my insurance and feasible with my schedule.”

How clinicians view telehealth

Many providers also support telehealth for people with ADHD.

“Telemedicine has been a real game-changer for both me and my patients,” wrote one health care provider on the January 17 telehealth proposal. “The switch has allowed me to reach and help way more people, and my patients have been extremely grateful for the convenience.”

“A large number of my ADHD patients live in areas far from specialized care or have difficulty accessing in-person appointments,” wrote another clinician. “Telemedicine has been a critical tool in providing timely and effective care to these individuals.”

Other providers have mixed opinions about using telehealth for stimulant prescriptions. They agree that telehealth can be helpful. But they’re a little more cautious.

“Telehealth has been a great tool in managing ADHD, but I use it selectively,” said Geny Augustine, MD, a family medicine physician at Solace Health. “I do prescribe ADHD medications via telehealth in some instances — mostly for patients I have already treated over extended periods.”

But Augustine still prefers an in-person appointment sometimes.

“For either initial diagnoses or cases with more complicated medical history, I also still favor the in-person evaluation as it can provide a more complete clinical picture,” Augustine said.

Concerns about telehealth prescribing

Not everyone agrees Schedule II medications should be prescribed via telehealth. 

“Telehealth rules for stimulant restrictions existed for a reason,” said Ryan S. Sultan, MD, a psychiatrist at Integrative Psych. “The government has deemed that these drugs are too high-risk for nefarious and hurtful outcomes and need to be restricted.”

The DEA sets regulations on Schedule II drugs to prevent misuse and to prevent drugs from going to the illegal market where they’re used for nonmedical purposes. In 2022, about 4.3 million people misused stimulants. Another 1.8 million people had a stimulant use disorder.⁶ 

Critics fear that telehealth makes it easier to get stimulants for misuse or nonmedical purposes. They’ve also raised concerns about telehealth becoming a tool to make a profit at the cost of patient care and safety.

“I’ve observed hundreds of nurse practitioners rushing to obtain licenses across multiple states. Not out of a desire to serve patients, but to maximize their patient load and income through private telehealth services,” commented a nurse practitioner on the January 17 proposal. 

Misuse of telemedicine regulations

Two high-profile cases involving the telehealth companies Cerebral and Done Health further highlighted these concerns. Both companies started offering ADHD evaluations and prescriptions during the pandemic. 

According to a Wall Street Journal investigation, both companies set initial evaluations to diagnose ADHD at 30 minutes. Providers said this wasn’t enough time to effectively diagnose ADHD. Providers also felt pressure to prescribe stimulant medications — even when they were concerned that patients might not qualify for a prescription.

Cerebral and Done earned money by charging a monthly fee for services in addition to the cost of a user’s monthly medication.

By 2022, Cerebral came under federal scrutiny and stopped prescribing ADHD medications. In 2024, the company agreed to pay $3.6 million to the U.S. government in exchange for a non-prosecution agreement. 

Done, on the other hand, faced criminal charges for its prescribing practices. In November 2025, the company’s CEO Ruthia He and its top doctor David Brody were convicted for their role in inappropriately distributing stimulant medications. They could face up to 20 years in jail when sentenced.

Telehealth benefits outweigh the risks

Despite the fears associated with telehealth, experts at the CDC have said “the benefits of increased access to diagnosis and treatment via telehealth outweigh the risks of undiagnosed and untreated ADHD.”³

Untreated ADHD is associated with negative consequences such as:^3,7

• Increased social and emotional challenges

• Worse work and school performance

• Higher risk of unintentional injuries

• Higher risk of substance use disorders

• Increased likelihood of car accidents

• Higher risk of suicidal behaviors

• More risk of engaging in criminal behavior

Telehealth helps people get treatment. And that can help prevent these negative consequences.

Research also shows that getting stimulant medications through telehealth doesn’t increase the risk of substance use disorders compared to in-person care for people with ADHD.^8,9 Additionally, treating ADHD with stimulant medications lowers the risk of substance use disorders in the first place.¹⁰

When people can’t access their ADHD medications, they’re more likely to turn to potentially harmful coping strategies.¹¹ This could include self-medicating with energy drinks or alcohol. But some people try to get ADHD medications on the illegal market, which can be dangerous.

What this means for you 

The Trump administration has extended COVID-19 rules for telehealth a fourth time. This means nothing will change for another year. 

There’s still uncertainty about what will happen beyond the Trump administration’s latest telehealth extension, so stay tuned for what’s next. It’s unclear what kind of rules the DEA might suggest next. But for now, you’ll still be able to see your provider and get your stimulant medications via telehealth.

Talk to your health care provider if you have concerns about using telehealth to get your medications. They can help you understand the regulations and what they might mean for you in the future. We’ll keep you up to date if anything changes. So keep following for the latest news.

(*Name changed to protect patient privacy.)

Summary

• The Trump administration extended COVID-era telehealth rules for prescribing controlled medications. The extension will last for another year. 

• These rules have been in place since 2020. They let people with ADHD get prescriptions for stimulant medications through telehealth. The rules were set to expire at the end of 2025. 

• Before the pandemic, ADHD patients had to see a doctor in person first. This made access harder, especially for people in rural areas or with limited resources. 

• The Biden administration tried to tighten telehealth rules after the pandemic. But these changes were never implemented. 

• For now, nothing changes. People can keep getting ADHD evaluations and prescriptions through telehealth.

Thumbnail image credit: Viktor Cvetkovic via Getty Images