Telehealth prescribing flexibility extended through 2025

The U.S. DEA and HHS have extended a critical telehealth prescribing flexibility for controlled substances, such as Adderall and Vicodin, through Dec. 31, 2025.

The long-awaited extension follows nearly a year of healthcare stakeholder-led requests urging the agencies to make the flexibility permanent. The flexibility waives a requirement of the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, stating that healthcare practitioners providing virtual prescriptions for controlled substances must have previously conducted at least one in-person medical evaluation of the patient.

The DEA initially waived this requirement during the COVID-19 pandemic to ease access to medications amid in-person care restrictions. In February 2023, the agency released a proposed rule that would allow healthcare practitioners to continue to provide virtual prescriptions for Schedule III-V non-narcotic controlled medications without a prior in-person exam; however, the in-person exam requirement would be reinstated for Schedule II controlled substances, such as Adderall, Oxycodone, Vicodin and Ritalin.

The healthcare industry resisted this proposal, posting a record 38,000 comments on the proposed rule in the Federal Register. A few months later, the DEA held listening sessions to inform its virtual prescribing regulations. During the sessions, numerous healthcare providers and administrators voiced support for permanently extending the pandemic-era flexibility.

The DEA and HHS eventually extended the flexibility through the end of 2024. Since then, healthcare stakeholders and industry groups have advocated strongly for another extension.

"We continue to carefully consider the input received and are working to promulgate a final set of telemedicine regulations," the DEA wrote on its website. "However, with the end of 2024 quickly approaching, DEA, jointly with HHS, has extended current telemedicine flexibilities through December 31, 2025."

Though it is not the permanent extension many stakeholders asked for, healthcare industry associations celebrated it.

"MGMA is pleased that the DEA and HHS heeded our call, once again extending the flexibilities for prescribing medications via telehealth through the end of 2025 while they promulgate a sustainable, long-term solution," said Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association, in a statement. "This extension is critical to avoid upending patients and medical groups that have come to rely on telemedicine for access to their medications."

While applauding the extension, the American Telemedicine Association (ATA) noted their intention to continue advocating for the flexibility to be made permanent.

"As we close out this year and prepare for 2025, we will remain actively engaged with the incoming Trump administration, the DEA, the Department of Health and Human Services (HHS), interagency partners, and other key stakeholders to establish a permanent framework that ensures appropriate and necessary access to care for millions of Americans," said Kyle Zebley, senior vice president of public policy at the ATA and executive director of its advocacy arm, ATA Action, in a statement.

Though support for solidifying the telehealth prescribing flexibility is widespread, instances of fraud, waste and abuse have raised concerns that bad actors will misuse it.

Recently, telemental healthcare provider Cerebral entered into a non-prosecution agreement with the U.S. Attorney's Office for the Eastern District of New York, agreeing to pay $3.6 million for encouraging the unauthorized distribution of controlled substances.

The company provides telehealth consultations for mental health conditions and virtual prescriptions for various medications, including controlled substances like Adderall. According to the U.S. Attorney's Office, Cerebral employed various business practices between February 2021 and October 2022 to increase medication prescriptions and boost patient retention and revenue.

The company received an additional fine of $2.92 million, which it cannot currently pay.

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