Telehealth gets extension, but ‘Super Bowl’ for virtual care is coming next year

Telehealth advocates say they are glad some flexibilities will continue throughout 2024, but they are hoping to make those provisions permanent. (Image credit: ©rh2010 - stock.adobe.com)

Federal agencies delivered the news telehealth advocates had been seeking.

Actually, they may have exceeded expectations.

The Drug Enforcement Administration and the Department of Health & Human Services have agreed to allow the remote prescription of some controlled substances through the end of 2024.

Federal agencies had earlier agreed to allow virtual providers to write prescriptions for drugs such as Oxycontin and Xanax until Nov. 11, 2023, and into 2024 for some patients. Last week, the DEA and health department said last week all prescriptions via telehealth would be allowed until the end of next year.

The American Telemedicine Association had been pushing for an extension, arguing that it’s better for patients. Kyle Zebley, the senior vice president of public policy for the American Telemedicine Association, said he hoped for an extension but didn’t necessarily expect it to run through 2024.

“I was a little surprised,” Zebley tells Chief Healthcare Executive®. “I think it's fair to say, and just about everybody else I know that follows this closely, was surprised by the length of the extension. The fact that we've got 15 full months to maintain the access to care that's been achieved over the last three-and-a-half years is undoubtedly a very good thing.”

Now, Zebley says telehealth advocates need to be ready to win support in Washington, from lawmakers and regulators, to ensure telehealth provisions can continue beyond 2024. Advocates are hoping to see permanent reforms.

The telemedicine association is telling partners, providers, and payers to gear up for the Super Bowl next year.

“The American people are very clear they want this to continue,” Zebley says. “They want the access to continue.”

• Read more: How hospitals and health systems could do more with telehealth

‘Coming to a head’

The DEA said it wanted to give patients access to necessary medications, but to ensure there were sufficient safety measures to prevent overprescribing. Regulators weighed requirements for in-person appointments for initial prescriptions or refills of some controlled substances.

The debate largely centered on pain medication such as Oxycontin and Vicodin, and treatments for behavioral health and substance abuse, such as Xanax, Valium, and buprenorphine. Some of those provisions regarding controlled substances had been initially set to lapse at the end of the federal designation of the COVID-19 public health emergency.

Healthcare groups pushed Washington to continue those flexibilities, and they elicited strong public support. The DEA said the agency received a record 38,000 letters on the issue of continuing remote prescriptions.

Zebley says that the public response made a difference.

“Huge,” he says. “Huge. And it showed tremendous goodwill and humility and again, thoughtfulness, that the DEA didn't just move forward with the rules as drafted, as was their right to do.”

With the extension for remote prescription of controlled substances in place, providers now have assurance that a wide variety of telehealth services will be allowed to continue through 2024. Last December, lawmakers and President Biden administration’s agreed to keep waivers in place for telehealth services through 2024. Those waivers cover virtual appointments with providers of primary and specialty care as well as hospital-at-home programs.

“Next year seems to be where it's all coming to a head,” Zebley says. “All of these dangling deadlines, be it legislative or regulatory, are all coming to a head on New Year's Eve 2024. And so it'll be a lot of work from then to make sure they don't go away come New Year's Day 2025.”

Coaxing supporters off the sidelines

While telehealth usage has dipped from the peak of the pandemic, patients are utilizing virtual care much more regularly than they did before the COVID-19 pandemic. Analysts expect to see continued growth in telehealth for patients with behavioral health, given the shortage of mental health clinicians nationwide. Some behavioral health patients are more comfortable seeing providers remotely as opposed to going in person.

Zebley says it’s going to take a concentrated effort to persuade policymakers.

“We can't be asleep at the switch and assume good things just to happen to us, without a lot of effort, without putting in the hard work and the elbow grease to have minds changed and cases made, one conversation at a time, one letter at a time,” Zebley says.

The telehealth association is asking healthcare leaders, hospitals and payers to make the case to lawmakers, Zebley says. Patients will also need to share how telehealth is helping them.

“You can't expect to just sit on the sidelines and watch other people play the game,” Zebley says. “Everybody's got to be a player in this. Politics and public policy is not a spectator sport. It requires active participation.”

Now, with telehealth flexibilities lasting through 2024, telehealth advocates are looking to lock those in beyond temporary extensions.

By the end of next year, Zebley says, “We'll have lived under a paradigm and a world where people have access to these clinically appropriate controlled substances as prescribed by a licensed medical professional for just shy of five years.

“And so I feel like we should be in a pretty good place with our very modest request that we maintain what has been the status quo … rather than going backwards to regressive old policies that limit access.”