Alliance News

Last week, we finally saw a proposed rule – “Telemedicine Prescribing of Controlled Substances When the Practitioner and the Patient Have not had a Prior In-Person Medical Evaluation” arrive at OMB.  We expect that this proposed rule will avert the current end of telehealth prescribing flexibility on December 31, 2024.  However, there remains significant risk of patients losing access to care due to the rulemaking.

We also saw two major policy developments in this space last week, outlining the opportunities and risks for telehealth access.

• First – our nation’s foremost medical societies and behavioral health voices called on the Administration to ensure that patients – both child and adult – are able to receive prescriptions to non-narcotic stimulants necessary for care through telehealth.
• Second, the Department of Justice made a major arrest related to the prescribing of Adderall over the internet.

So, what does this mean?

The letter to Drug Enforcement Administration (DEA) demonstrated the widespread agreement that telehealth is absolutely crucial for the ability of psychiatrists, pediatricians, mental health professionals, and patients to offer and receive treatment.  They make it clear that there is no option to go back to a world in which these providers and patients have additional barriers to health care access.

The enforcement actions by DEA put an exclamation point on their previously shared concerns with stimulant prescribing.   In our view, these actions demonstrate that “wild west” period of virtual care spawned in 2020 has come to a close.  The actions show that regulators are closely scrutinizing the practices of organizations that stretched the traditional boundaries of health care and are now taking important steps to rein in those who may have overstepped.

Moving forward, we hope to see a rulemaking that focuses on the special registration process for telemedicine that is required by statute, but without the significant and burdensome in-person visit requirements that were featured in the previous proposed rule – and which would have cut many patients off from access to care.

As you might expect from the updates above, a major area of debate for this rulemaking will be around non-narcotic stimulants – which were heavily restricted by the previous proposed rule.  It’s clear that access to these treatments through telehealth are needed by patients and medical providers.  Its also now clear that the DEA has the will and enforcement capability to monitor this space and protect patients.  With a special registration process in place, the DEA would have even more tools and capability to monitor prescribing and intervene when needed.

Will an answer as simple as registration and enforcement emerge in the proposed rule?  It’s unlikely.  We are eagerly awaiting the details of the proposal from DEA.  Ideally one that listens to clinical voices, continues investigating potential bad actors, and – most importantly – ensures the lifeline of telehealth is not severed.