Telehealth advocates say DEA plan could limit access to certain drugs

Advocates for telehealth are increasingly concerned about changes in prescribing some medication when the federal COVID-19 Public Health Emergency ends in May.

Specifically, telehealth groups say they are concerned because the Drug Enforcement Administration has proposed tighter regulations on the remote prescription of some drugs for mental health and substance use disorder.

The DEA proposed rules that would limit the amount of medications prescribed by some providers. Doctors could remotely prescribe a 30-day supply of Schedule III-V non-narcotic controlled medications, such as Xanax or Valium, as well as a 30-day supply of buprenorphine for the treatment of opioid use disorder.

After that 30-day period, patients would need an in-person evaluation for another prescription, under the DEA guidelines. The rules would take effect when the public health emergency ends May 11.

Kyle Zebley, senior vice president for public policy of the American Telemedicine Association, said the DEA rules could make it harder for patients to get the medications they need.

“The proposed rules from the DEA are significantly more restrictive than is warranted,” Zebley said in a statement.

“Our concern lies with the potential public health crisis this could cause for individuals needing access to clinically appropriate prescriptions of controlled substances for a wide variety of medical circumstances, including for mental health and substance use disorders,” he said.

• Read more: Where telehealth can help patients, and providers, avoid in-person care

The DEA said it is trying to ensure patients have access to medication while also reducing the potential harm for patients getting more than they need.

“DEA is committed to ensuring that all Americans can access needed medications,” DEA Administrator Anne Milgram said in a statement.

“The permanent expansion of telemedicine flexibilities would continue greater access to care for patients across the country, while ensuring the safety of patients. DEA is committed to the expansion of telemedicine with guardrails that prevent the online overprescribing of controlled medications that can cause harm.”

The DEA says the rules do not affect telemedicine consultations that do not involve the prescribing of controlled medications. The DEA’s proposal would not affect remote prescriptions of non-controlled substances such as antibiotics, birth control, blood pressure medicine and insulin, CBS News reports.

Telemedicine consultations by a medical practitioner that has previously conducted an in-person examination of a patient would also not be affected, the agency says.

As part of the proposal, the DEA would allow care to continue uninterrupted for 180 days after the end of the public health emergency, which Zebley said is a positive step. But telemedicine groups still want to see changes in the DEA’s plan. The American Telemedicine Association and ATA Action, its trade group, plan to continue making the case to the agency.

“Our hope is that the DEA works with us to avoid unnecessary and inappropriate restrictions on the prescription of essential medications for these vulnerable and underserved populations,” Zebley said in a statement.

Telehealth advocates had hoped lawmakers would include a provision covering those remote prescriptions in the $1.7 trillion spending bill approved in late December in the waning days of the last congressional session. But that language didn’t make it into the final bill.

• Read more: Telehealth diagnosis shows high level of accuracy, study finds

Congress did approve a two-year extension for telehealth waivers in the spending package, ensuring healthcare providers could continue telehealth services through the end of 2024. The extension also covered hospital-at-home programs. Healthcare advocates are pushing for permanent telehealth reforms.

Healthcare leaders have said telehealth can be an important tool in expanding access to mental health care. Researchers found the expanded use of telehealth helped reduce the risk of overdose among some patients.

The DEA is still gathering public comment on the proposal through late March. Here’s more from the DEA on its proposal.