Healthcare organizations and providers are urging the Drug Enforcement Administration (DEA) to modify its proposed rules for telehealth-based prescribing, expressing concerns about reduced access to care for marginalized groups, limited access to legitimate healthcare, and a potential increase in illegal online drug sellers. The DEA is currently considering comments from the healthcare industry before drafting the final rule.
Healthcare organizations and providers are expressing concerns about the Drug Enforcement Administration’s (DEA) proposed rules governing telehealth-based prescribing, calling for modifications that extend the prescribing flexibilities enacted during the COVID-19 pandemic. The proposed rules extend some virtual prescribing flexibilities and limit others. Healthcare providers can virtually prescribe a 30-day supply of Schedule III-V non-narcotic controlled medications and buprenorphine without a prior in-person evaluation. However, healthcare providers will not be able to do the same for certain controlled substances, like Adderall, Oxycodone, Vicodin, and Ritalin, after the public health emergency ends.
Trade associations and mental healthcare organizations submitted comment letters to the DEA, expressing their concerns and largely denouncing the move. ATA Action, the advocacy arm of the American Telemedicine Association, submitted two letters to the DEA with recommendations to adjust the proposed rules to prevent drug diversion while ensuring access for patients who require controlled substances for medical treatment.
The proposed rules could harm patients, mainly by reducing access to care for marginalized groups who face various socioeconomic barriers. The rules may create a significant and avoidable public health crisis by limiting access to legitimate health care. Additionally, the proposed rules may not be effective in curbing drug diversion, and illegal online drug sellers may fill the void. The 30-day limit on supplies of buprenorphine for opioid use disorder treatment and Schedule III-V non-narcotic substances is arbitrary and may do more harm than good, as patients who cannot continue with OUD treatment generally begin to misuse opioids again.
To minimize the potential negative effects of the rules, ATA Action recommends extending virtual prescriptions from 30-day supplies to 180-day supplies to give patients enough time to see a provider in person, if the in-person requirements cannot be eliminated. They also suggest allowing short-term virtual prescriptions of Schedule II stimulants. To ease the registration process implemented by the DEA, ATA Action recommends that the DEA extend the registration flexibility for 180 days post-PHE and require prescribers to register with DEA only once.
The American Hospital Association (AHA) and Alliance for Connected Care similarly weighed in on the proposed virtual prescribing rules. The AHA noted that the proposed rules would impose burdensome restrictions and additional administrative requirements on providers and patients, which may adversely impact patient access to medically necessary treatment. The association suggested that the DEA institute a special registration process to enable practitioners who register with the DEA to virtually prescribe controlled substances without an in-person evaluation.
The comment letter submitted by the Alliance for Connected Care also highlights the benefits that expanded telehealth prescribing provided patients during the COVID-19 PHE. Like the AHA, the group suggests that the DEA create a special telemedicine registration process, stating that the process “should be an opportunity for health care providers or provider organizations to subject themselves to a higher level of scrutiny by DEA, and in exchange have greater flexibility to prescribe without in-person referral requirements, prescribing time-limits, and the ability to prescribe a wider range of substances.”
The proposed DEA rules may curb access to controlled substances via telehealth, negatively impacting patient care. To address this concern, several organizations, such as the American Psychiatric Association, Mental Health America, the Medical University of South Carolina, and Stanford Health Care, sent a letter to the DEA requesting modifications to the proposed rule to ensure more flexible prescribing limitations for providers when a controlled substance is offered by a highly trained clinician in conjunction with an ongoing mental health treatment plan.
The DEA provided a 30-day comment period for the proposed rules, which ended on March 31. The agency will then consider the comments before drafting the final rule.
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