Industry rebuffs special registrations for telehealth prescribing

Healthcare provider groups are voicing their concerns and requesting amendments to the DEA's proposed special registration framework that will govern telehealth prescribing of controlled substances.

In the last two weeks, the American Hospital Association and the Association of American Medical Colleges (AAMC) have submitted comments on the agency's proposal to create three types of registrations through which clinicians can prescribe Schedule II-V controlled substances via telehealth.

Though the Ryan Haight Act of 2008 directed the DEA to create a special registration framework, this is the first time the DEA has proposed a plan. However, since the proposal was released in January, it has been met with pushback from the healthcare industry.

In comments published on March 17, AAMC leaders asked the agency to amend several of its proposed policies, including eliminating the 50% threshold for telehealth prescriptions of Schedule II controlled substances, such as Adderall and Ritalin. The proposed framework would limit the average number of telehealth-based Schedule II prescriptions to less than 50% of the total number of Schedule II prescriptions issued by the clinician.

AAMC leaders wrote that this "overly burdensome, infeasible, arbitrary" policy "will jeopardize patient care and will not assist the DEA in its anti-diversion goals."

The healthcare provider group also asked the DEA to remove certain Prescription Drug Monitoring Program (PDMP) check requirements. In the current proposal, the DEA requires telehealth prescribers to conduct a nationwide PDMP check. However, this requirement will go into effect in three years after a nationwide PDMP is created. Until then, registrants must conduct a PDMP check of the state/territory where the patient and prescriber are located,  and any state/territory with a PDMP reciprocity agreement with the states where the patient and prescriber are located.

AAMC leaders wrote that while they support the nationwide PDMP check and PDMP check for the state or territory where the patient and prescriber are located, they asked the DEA to remove the requirement regarding states with PDMP reciprocity agreements.

The AHA's comments closely align with AAMC's, with the hospital group also asking the DEA to remove the 50% limit on telehealth prescribing for Schedule II controlled substances and PDMP check requirements.

In addition, the group's leaders voiced concerns regarding the DEA's proposed policy requiring healthcare practitioners to complete a state registration for every state where they treat a patient. Instead, AHA leaders suggest adding a question to the general registration form asking practitioners to indicate the states in which patients receiving telehealth-based prescriptions are located.

Finally, the AHA requested a yearlong pre-implementation period to adopt the rules once they are finalized.

The comments follow other groups, like ATA Action, detailing their concerns regarding the proposed special registration framework.

As the DEA contends with comments and concerns from stakeholders regarding the special registrations, it must also decide whether to continue allowing healthcare practitioners to provide telehealth prescriptions for controlled substances without first conducting an in-person medical evaluation. The pandemic-era flexibility, which is widely popular among practitioners, is set to expire on Dec. 31, 2025.

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