Stakeholders plead for telehealth prescribing extension

Following reports that the DEA plans to limit telehealth prescriptions for controlled substances, hundreds of healthcare stakeholders are urging lawmakers to intervene.

More than 330 organizations signed letters to both branches of Congress and the White House asking lawmakers to extend telehealth prescribing flexibilities for controlled substances that were enacted during the COVID-19 pandemic. Prior to the pandemic, the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 required healthcare practitioners to conduct in-person medical evaluations before prescribing controlled substances through telehealth. This requirement was waived during the pandemic.

In February 2023, the DEA issued a proposal, which included plans to reinstate the in-person medical exam requirement before providing telehealth prescriptions for Schedule II controlled substances like Adderall, Oxycodone, Vicodin, and Ritalin. The proposal met swift and strong opposition from the healthcare industry, with the DEA receiving 38,000 comments on its proposed rule, many of which voiced provider concerns about limiting patient access to needed medications.

Last October, the DEA extended the pandemic-era flexibility through the end of 2024.

However, according to a Fierce Healthcare report, leaked plans reveal that the DEA will eliminate healthcare providers' ability to prescribe Schedule II controlled substances via telehealth without a prior in-person appointment. This will occur either through new regulations or allowing the flexibility to expire at the end of the year.

Numerous organizations -- including Amazon, Mass General Brigham, Cleveland Clinic, Hims & Hers Health, Bicycle Health and the College of Healthcare Information Management Executives -- have now signed letters asking for the telehealth prescribing flexibility to be extended.

In the letter to Congress, stakeholders asked for a two-year extension of the prescribing flexibility to be included in a year-end legislative package.

"Given the widespread provider shortage across medical professions and specialties, this flexibility has been essential in ensuring that patients receive timely and necessary care," the letter states. "Continuing these practices is vital to sustaining access to treatment and addressing the ongoing healthcare challenges in underserved areas."

Further, the letter notes that a two-year extension would give the DEA time to create a special registration pathway that continues access to care via virtual prescriptions of controlled substances.

The letter to the White House also urges the Biden Administration to work with the DEA to extend the telehealth prescribing flexibility for two years, giving the DEA additional time to establish a special registration pathway.

"An extension would avert patient harm from abruptly cut off care, while giving us all more time to come to consensus about the best way to balance access and enforcement," the letter states.

The letters are the latest in several efforts to safeguard telehealth prescribing flexibility, with some stakeholders arguing that the flexibility should be extended permanently.

In September 2023, the DEA conducted listening sessions to inform its decisions around virtual prescribing regulations. Healthcare providers and researchers outlined the need for virtual prescribing and its potential adverse effects, offering insights into how the latter can be mitigated.

For instance, Jesse M. Ehrenfeld, MD, immediate past president of the American Medical Association, stated during last year's listening session that, "Telemedicine can allow a physician to conduct pill counts, monitor toxicology screens, and ensure medication adherence or identify adverse behaviors requiring a change of therapy for situations …" while, on the other hand, "an in-person evaluation would result in a delay in care that could lead to patient harm."

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.