After pressing from healthcare advocates, the federal government continues some flexibilities that had been set to expire. Now the press is to make reforms permanent.
Advocates for telehealth are breathing a sigh of relief.
The Drug Enforcement Administration and the Department of Health & Human Services have agreed to extend telehealth provisions for some controlled substances through the end of 2024. The agencies made the announcement last week.
Some flexibilities had been slated to end in November 2023, although some exceptions were allowed.
Federal officials had wrestled with continuing remote prescriptions for some medications, including drugs used by those with behavioral health needs and substance use issues.
The American Telemedicine Association welcomed the government’s move to extend flexibilities involving virtual care, and the group says the goal is to make those reforms permanent.
“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,” says Kyle Zebley, senior vice president of public policy for the American Telemedicine Association.
Background: The federal government relaxed rules on allowing the prescription of controlled substances via telehealth throughout much of the COVID-19 pandemic. Some provisions were set to lapse with the end of the federal designation of COVID-19 as a public health emergency in May.
Telehealth advocates have urged the government to allow providers to continue ordering prescriptions virtually. The government was considering some requirement for in-person appointments before getting prescriptions or refills. Federal officials have said they sought to balance public access while putting in guardrails to prevent overprescribing.
Public pressure: The issue has gained significant public attention. The DEA said it received 38,000 letters earlier this year about rules governing remote prescriptions, with many calling for the government to continue to allow doctors to issue prescriptions after seeing patients virtually.
After the public response, federal officials said in May that they would allow the current roles on remote prescriptions to continue until Nov. 11. If a patient and a practitioner have established a telemedicine relationship on or before Nov. 11, 2023, the flexibilities would be permitted to continue until November 11, 2024, the federal agencies say.
Now, the DEA and HHS have taken another step. They said remote prescriptions can continue throughout 2024.
The drugs: The debate has surrounded some controlled substances such as Vicodin, OxyContin and Adderall, listed as “Schedule II” medications by the DEA. The DEA initially sought a requirement to have doctors see a patient in person in order to prescribe those drugs.
The DEA also initially sought to allow doctors to 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, the DEA had sought an in-person evaluation for another prescription.
Looking ahead: Telehealth advocates, including the American Telemedicine Association, say that they will need to engage in a full court press with Congress and the federal government to extend remote prescriptions beyond 2024. They are hoping to see permanent reforms.
Supporters of continuing the remote prescription of controlled substances say it’s critical to providing care to those in areas without easy access to mental health professionals. The ATA has argued that restricting access to telemedicine could hurt patients.
Bipartisan backing: Telehealth advocates have enjoyed bipartisan support in Congress, but Zebley says the association isn’t taking anything for granted in the push for permanent reforms.
“We know that getting Congress to act, getting the administration and regulatory agencies to act, is no small feat,” Zebley says.
He says advocates are committed to ensuring patients can retain the option to see providers virtually.
"Telehealth was that silver lining during the pandemic, but now it comes to whether or not this is going to be a permanent part of our healthcare system," Zebley says. "We think it should be, we think it can be, but it's going to require a team effort."