Telehealth groups urge DEA to release controlled substance prescribing proposal

Dive Brief:

Telehealth groups are urging the Drug Enforcement Administration to speed up a proposed rule that would allow and regulate the prescription of controlled substances through virtual care.
In a letter sent Tuesday to DEA Administrator Anne Milgram, more than 200 telehealth advocacy groups, providers and virtual care companies asked the agency to quickly release the regulation, as clinicians and pharmacies would need time to comment and prepare for implementation.
In October, the DEA and the HHS temporarily extended pandemic-era prescribing flexibilities for controlled substances through this year. The agency said it would work to create new standards or safeguards by the fall.

Dive Insight:

During the COVID-19 public health emergency, regulators granted exceptions to the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, which required most practitioners to have at least one in-person evaluation before prescribing controlled substances. The goal was to ensure patients could still access care during the pandemic.

Last summer, the DEA said it was “open to considering” a special registration process for telemedicine prescribing for some controlled substances.

The agency had previously received tens of thousands of comments expressing concern about a proposal that would have added a 30-day supply limit for virtual prescriptions of some controlled substances, including for opioid use disorder treatment buprenorphine.

Telehealth and provider groups have argued virtual care helps patients receive care where they might otherwise go without, including for substance use disorders — an escalating public health challenge in the U.S.

Research has also shown that telehealth expansion during COVID-19 increased the number of people who receive care for common mental health disorders and lowered the odds of medically treated opioid overdoses among Medicare patients.

The letter published this week said a rule to allow telehealth prescribing for controlled substances is “crucial” to ensuring continued access to telehealth care, including for mental health and substance use treatment.

But the groups argued a proposal should be released immediately to give stakeholders adequate time to comment on the rule and prepare. If the DEA implements a special registration process, it would take “significant operational lead time” to put in place. Pharmacies and other parts of the healthcare delivery system would need time to train staff.

A significant policy change later in the year could also affect clinicians’ ability to make appointments with patients to ensure continuity of care.

“While we hope the final rulemaking preserves patient access, any policy change that requires patients to seek in-person care would be extremely disruptive due to long scheduling lead times and in-office wait times,” the groups wrote.