Are new controlled substance telehealth guidelines final? Trade group hopes not
Prescribing rules promise flexibility but leave room for improvement, industry experts say.
Francis Scialabba
Prescribing rules promise flexibility but leave room for improvement, industry experts say.
Francis Scialabba
New year, new rules!
In the final days of President Joe Biden’s tenure, the Drug Enforcement Administration (DEA) announced three new rules to allow medical providers to prescribe controlled substances via telehealth.
These rules would make temporary flexibilities—enacted in 2020 following difficulties getting prescriptions during the Covid-19 pandemic—permanent.
Telehealth companies have long pushed for a permanent extension, but there are still a few hiccups in the fine print of this proposal that need to be addressed, Christopher Adamec, executive director of industry group Alliance for Connected Care, told Healthcare Brew.
He hopes the Trump administration will make some tweaks. The White House didn’t provide an answer on that by deadline.
“The Biden administration put forward a great framework, but there are some pretty serious issues with it that would aggressively curtail the way telehealth is used today,” Adamec said.
Tell me more. The DEA’s new rules include one that allows telehealth providers to prescribe buprenorphine—a medication used to help treat opioid dependence—for six months. Previously, a patient needed to have an in-person medical evaluation to get more than 30 days of buprenorphine.
This rule is finalized and set to take effect February 18, though the Trump administration could nix those plans.
The problem here: the six-month limit, Adamec lamented. Not all patients will be able to secure an in-person appointment after six months.
“[A clinician may] have to cut off treatment in a potentially harmful way when the patient may need it most,” he said.
Another proposed rule allows providers to get a special registration to prescribe Schedule III–V controlled substances without an in-person visit, as well as an advanced telemedicine prescribing registration to prescribe Schedule II–V controlled substances without an in-person visit.
However, the new proposed rules say that even if providers sometimes prescribe Schedule II drugs via telehealth, at least 50% of their Schedule II prescriptions need to be done after an in-person visit. This makes it impossible to prescribe Schedule II drugs—such as hydrocodone, oxycodone, Adderall, or Ritalin—as a telehealth-only practice, Ademac said.
Telehealth providers would also be required to be in the same state as the person they’re remotely prescribing a Schedule II controlled substance to, with the rationale that it’s easier for state agencies to monitor prescribing practices.
“That’s a challenge for expanding access to treatment for patients that may be in an area where there are clinician shortages,” Adamec said.
Not everyone found issues with the rules, however.
“The DEA’s new rules and registration requirements demonstrate a much-needed, mindful approach to balancing telehealth access with patient safety,” Hari Prasad, co-founder and CEO of mobile patient intake management system Yosi Health, told Healthcare Brew via email.
