Telehealth Prescribing Flexibility Ensures a Positive Future for Patients
As the end of 2024 approaches, numerous healthcare organizations are urging Congress and the White House to extend telehealth prescribing flexibilities for controlled substances. These flexibilities, introduced during the COVID-19 pandemic, allowed providers to prescribe controlled substances via telehealth without requiring an in-person consultation. With the possibility of these flexibilities expiring, stakeholders are concerned about the impact on patient care, especially in underserved areas.
Background of Telehealth Prescribing Flexibility
Ryan Haight Act and COVID-19 Waivers
Before the pandemic, the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 required healthcare practitioners to perform in-person medical evaluations before prescribing controlled substances through telehealth. However, during the pandemic, the U.S. government waived this requirement to ensure patients continued to receive care, even when in-person visits were not feasible. This led to the widespread adoption of telehealth for various medical services, including the prescription of controlled substances.
As part of the pandemic response, telehealth prescribing became an essential tool for providing timely treatment, particularly for patients in rural or underserved areas.
DEA’s Proposal to Reinstate In-Person Evaluation
In February 2023, the Drug Enforcement Administration (DEA) issued a proposal aimed at reinstating the pre-pandemic rule requiring in-person consultations before issuing prescriptions for Schedule II controlled substances, such as Adderall, Oxycodone, Vicodin, and Ritalin. The proposed rule sparked widespread opposition from healthcare providers and organizations. The DEA received over 38,000 comments, many expressing concern about how this limitation could reduce access to necessary medications for patients who rely on virtual care.
In response to the backlash, the DEA temporarily extended the flexibility through the end of 2024. However, leaked information suggests that the DEA may soon eliminate the option to prescribe Schedule II controlled substances through telehealth without a prior in-person appointment.
Healthcare Stakeholders Urge for Extension
The Letters to Congress and the White House
More than 330 healthcare organizations, including major institutions like Amazon, Mass General Brigham, Cleveland Clinic, Hims & Hers Health, and Bicycle Health, have come together to sign letters addressed to both Congress and the White House. These letters strongly advocate for the extension of telehealth prescribing flexibility for at least two more years.
The stakeholders have requested lawmakers to include this extension in a year-end legislative package, emphasizing the importance of telehealth in maintaining access to healthcare for millions of Americans, particularly those in rural or medically underserved communities.
Reasons for Urging the Extension
In their letters, stakeholders argue that the ongoing provider shortages across medical professions make telehealth a crucial tool in ensuring patients receive necessary care in a timely manner. Telehealth has helped close gaps in access to healthcare, especially in areas with limited availability of healthcare professionals. Extending the flexibility for two more years would also allow the DEA more time to develop a “special registration pathway,” which could allow telehealth prescriptions for controlled substances to continue safely and effectively.
The letter addressed to the White House further urged the Biden Administration to collaborate with the DEA in extending the flexibility, emphasizing that immediate restrictions could abruptly disrupt care for vulnerable patients.
Potential Impact of Expiration on Patient Care
If the telehealth prescribing flexibility is not extended, it could create significant challenges for patients who have come to rely on virtual care, particularly those in rural areas or those with mobility issues. Without the ability to access prescriptions via telehealth, patients might face delayed care or be forced to travel long distances for an in-person consultation. This could result in untreated conditions, including chronic pain, mental health disorders, and addiction treatment, which rely on timely access to medications like Adderall or Oxycodone.
The expiration of the flexibility could also disproportionately affect patients with limited transportation or financial means, further exacerbating existing healthcare inequities.
Listening Sessions and Stakeholder Feedback
In September 2023, the DEA held listening sessions to gather input from healthcare providers, researchers, and other stakeholders. These sessions provided valuable insights into the benefits of telehealth prescribing and the potential negative impact of ending the flexibility.
Dr. Jesse M. Ehrenfeld, past president of the American Medical Association, emphasized that telemedicine offers several benefits, such as allowing physicians to conduct pill counts, monitor toxicology screens, and ensure medication adherence. He argued that these tasks could be effectively managed via telehealth, while an in-person evaluation might delay care, potentially causing harm to patients.
The listening sessions highlighted the widespread support for continuing virtual prescribing, with many participants suggesting that a permanent solution should be considered.
Conclusion
The debate over telehealth prescribing flexibility has underscored the critical role virtual care has played in maintaining access to healthcare during the pandemic. As the end-of-year expiration date for these flexibilities draws closer, healthcare organizations, providers, and patients are urging Congress and the White House to act. Extending the flexibility would not only ensure continued access to vital medications but also give the DEA more time to develop a long-term solution.
With widespread support for virtual care and the potential harm from cutting off access, it is essential that lawmakers prioritize patient needs and ensure that telehealth remains a viable option for those in need of controlled substances.
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FAQs
1. What is the Ryan Haight Act?
A. The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 requires healthcare providers to conduct in-person medical evaluations before prescribing controlled substances via telehealth. This requirement was waived during the COVID-19 pandemic to improve access to care.
2. Why is telehealth prescribing flexibility important?
A. Telehealth prescribing flexibility allows healthcare providers to prescribe controlled substances remotely, increasing access to care for patients in underserved or rural areas.
3. What is the DEA’s stance on telehealth prescribing?
A. The DEA has proposed reinstating the requirement for in-person evaluations before issuing telehealth prescriptions for controlled substances, which has sparked opposition from healthcare providers.
4. What impact could the expiration of telehealth prescribing flexibility have?
A. If the flexibility expires, patients may face delays in care, reduced access to medications, and potential harm, especially those in underserved areas.
