Hospitals push for extension of telehealth prescriptions

Health systems are pushing the federal government to extend telehealth waivers, which are slated to expire at the end of the year.

The American Hospital Association is pushing for federal approval to continue remote prescription of some controlled substances, as telehealth waivers are slated to lapse at the end of the year.

Telehealth advocates are encouraged by strong bipartisan support for legislation that would allow hospitals, health systems and other providers to continue providing telehealth services. But hospitals are also drawing attention to a key provision on prescribing drugs in virtual appointments.

The American Hospital Association is pushing for federal approval to continue remote prescription of some controlled substances, such as Oxycontin and Xanax.

The association notes that the Department of Health and Human Services and the Drug Enforcement Administration have been working to develop rules regarding remote prescriptions.

But in a letter to the Centers for Medicare and Medicaid Services, the association says, “We are concerned that DEA in conjunction with HHS has not yet issued rules to either extend the current waiver or provide a permanent pathway to telemedicine prescribing of controlled substances as mandated by Congress.”

“The current waivers will expire at the end of the year, and, without an extension of the current waiver or rules implementing a special registration for telemedicine prescribing, patients and their providers will experience profound negative impacts,” the AHA said.

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With less than three months left in 2024, when telehealth waivers are scheduled to expire, the hospital association is asking the federal government for a two-year extension, at minimum, for provisions for remote prescriptions.

The hospital association says that providers should be able to prescribe controlled substances via telehealth appointments because some patients don’t have easy access to a clinic.

“In many cases, seeing a provider in person is simply not an option for some patients whether due to physician shortages, mobility issues, or transportation challenges,” the AHA said in its letter.

The American Telemedicine Association has also been urging Congress to push the DEA and health department for an additional two-year extension of remote prescriptions.

Kyle Zebley, senior vice president of public policy for the American Telemedicine Association, has said the resolution of the remote prescriptions is an important issue that shouldn’t be forgotten in the extension of telehealth waivers.

“If left unaddressed, this issue could create dire consequences,” Zebley said in a statement last month.

The DEA has previously said that it wants to strike a balance between access and safety when it comes to the remote prescription of controlled substances.

Anne Milgram, the DEA administrator, said in February 2023 that the agency is committed to “the expansion of telemedicine with guardrails that prevent the online overprescribing of controlled medications that can cause harm.”

The DEA has been working for years on regulations governing the prescription of controlled substances remotely. The agency proposed some regulations that rankled healthcare providers, who described the rules as too restrictive. After the agency received “a record 38,000 comments” on its proposal, the DEA agreed to a two-year extension on remote prescriptions.

Since permanent regulations have yet to be crafted, hospitals are hoping for a similar extension through 2026.

“We strongly urge the DEA in coordination with HHS to extend the waivers for the in-person visit requirement for prescribing controlled substances until it can, with appropriate stakeholder input, develop and propose a framework for a special registration process for prescribing controlled substances via telemedicine that fully addresses the comment letters it received,” the AHA wrote.

Telehealth advocates have expressed optimism that lawmakers and President Biden’s administration will approve the extension of telehealth programs. Last month, the House & Energy Commerce Committee passed the Telehealth Modernization Act unanimously with a 41-0 vote.

The bill (H.R. 7263) continues many telehealth flexibilities for an additional two years, through the end of 2026. The legislation would also provide a five-year extension for hospital-at-home programs.

While telehealth supporters expect the waivers will be passed, they also predicted that lawmakers may not move the legislation toward the end of the year, when Congress incorporates the legislation with broader spending bills.

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