DEA Extends Virtual Prescribing Flexibilities Through 2024

In the face of unflagging resistance from the healthcare industry, the Drug Enforcement Administration (DEA) and the Department of Health and Human Services (HHS) said they will lift proposed restrictions on the virtual prescription of controlled substances through the end of 2024.

By lifting the proposed restrictions, the DEA is extending flexibilities that allow providers to prescribe controlled medications via telehealth for new patients without previously examining them in person. This is the second extension provided by agencies after the first was slated to end this November.

The extensions follow vehement pushback from healthcare organizations, trade associations, telehealth providers, and other stakeholders to the DEA’s plans to limit the scope of virtual prescriptions of controlled substances after the end of the public health emergency (PHE) declaration.

During the COVID-19 pandemic, the DEA lifted in-person examination requirements prior to telehealth prescribing of controlled substances to streamline the process and extend needed access to medications.

But in February, the DEA issued a proposal to permanently extend some pandemic-era telehealth rules governing virtual prescribing while ending others. The agency stated that it would safeguard providers’ ability to remotely prescribe a 30-day supply of Schedule III-V non-narcotic controlled medications and a 30-day supply of buprenorphine for treating opioid use disorder (OUD) with a prior in-person examination.

This flexibility would not extend to Schedule II controlled substances, like Adderall, Oxycodone, Vicodin, and Ritalin, the agency stated.

The agency received nearly 38,000 comments on its proposed rule, with numerous organizations voicing concerns.

For instance, the American Hospital Association stated in a letter that the proposed rules would "impose burdensome restrictions and additional administrative requirements on providers and patients, which we are concerned will adversely impact patient access to medically necessary treatment."

The DEA then extended the virtual prescribing flexibilities through November and conducted listening sessions last month.

At the listening sessions, stakeholders from across the industry urged the DEA to permanently allow the virtual prescription of controlled substances without requiring an in-person exam beforehand.

"The ability for these providers to prescribe controlled substances and use their medical judgment over telemedicine without a prior in-person visit allows patients to receive clinically appropriate essential care via a convenient patient-centered modality," said Helen Hughes, MD, medical director of the Office of Telemedicine at Johns Hopkins Medicine, during the sessions.

Healthcare providers also urged the DEA to set up a telemedicine special registration process to ensure that virtual prescriptions without a prior in-person exam do not adversely impact patients.

Shabana Khan, MD, chair of the American Psychiatric Association's telepsychiatry committee and co-chair of the American Academy of Child and Adolescent Psychiatry's telepsychiatry committee, stated that a telemedicine special registration process would allow practitioners to affirm their adherence to patient safety processes, such as having a plan in place if a patient needs to be assessed in person.

Thus, telehealth proponents have applauded the latest extension.

“We are thrilled that the DEA is taking such a thoughtful and thorough approach to creating the right rules around prescribing controlled substances. This is a critical issue for millions of individuals and their families, as well as clinicians wanting to provide care to their patients, wherever and whenever they need it,” said Kyle Zebley, senior vice president of public policy at the American Telemedicine Association (ATA) and executive director of ATA Action, its advocacy arm, in a statement.

But Zebley also noted that the new 2024 deadline for the virtual prescribing flexibility means “that next year is shaping up to be the Super Bowl for telehealth.”

Numerous other telehealth flexibilities enacted during the pandemic have also been extended through the end of 2024. These include eliminating geographic restrictions on originating sites for telehealth services and allowing for continued coverage of audio-only telehealth services under the Medicare program.