In response to persistent resistance from the healthcare industry, the Drug Enforcement Administration (DEA) and the Department of Health and Human Services (HHS) have announced an extension of proposed restrictions on the virtual prescription of controlled substances until the end of 2024. This extension grants healthcare providers the flexibility to prescribe controlled medications through telehealth for new patients without prior in-person examinations. This is the second extension provided by these agencies, the first of which was originally set to conclude in November.
The decision to extend these flexibilities comes after encountering strong opposition from healthcare organizations, trade associations, telehealth service providers, and various stakeholders. The DEA had initially planned to limit the scope of virtual prescriptions of controlled substances following the conclusion of the public health emergency (PHE) declaration prompted by the COVID-19 pandemic. During this period, the DEA temporarily relaxed the requirement for in-person examinations before telehealth prescribing of controlled substances, streamlining the process and ensuring continued access to necessary medications.
The DEA introduced a proposal to permanently extend certain pandemic-era telehealth rules related to virtual prescribing while ending others in February 2023. The proposal aimed to permit remote prescription of a 30-day supply of Schedule III-V non-narcotic controlled medications and a 30-day supply of buprenorphine for treating opioid use disorder (OUD) only if a prior in-person examination had taken place. Schedule II controlled substances like Adderall, Oxycodone, Vicodin, and Ritalin were excluded from this flexibility.
The DEA’s proposal received significant feedback, with numerous organizations expressing concerns. The American Hospital Association, for instance, argued that these proposed rules would introduce burdensome restrictions and additional administrative requirements for providers and patients, potentially hindering patient access to essential treatment.
In response to the feedback and concerns, the DEA extended the virtual prescribing flexibilities through November and held listening sessions in the preceding month. During these sessions, stakeholders from across the healthcare industry urged the DEA to permanently allow the virtual prescription of controlled substances without requiring prior in-person examinations. Healthcare providers emphasized the importance of this flexibility in enabling patients to receive essential care conveniently through telemedicine.
Healthcare stakeholders suggested the establishment of a telemedicine special registration process to ensure that virtual prescriptions without prior in-person examinations do not compromise patient safety. Such a process would enable practitioners to affirm their adherence to patient safety protocols and have plans in place for in-person assessments when necessary.
Telehealth advocates have welcomed the recent extension, recognizing its significance for patients and clinicians. This extension, now valid until 2024, implies that the coming year is poised to be a pivotal one for telehealth, with multiple other pandemic-era telehealth flexibilities also extended until the end of 2024. These include eliminating geographic restrictions on originating sites for telehealth services and maintaining coverage of audio-only telehealth services under the Medicare program. The DEA and HHS’s decision to extend virtual prescription flexibilities until the end of 2024 reflects their responsiveness to the concerns raised by healthcare stakeholders. This extension acknowledges the importance of telemedicine in delivering healthcare services and aims to strike a balance between accessibility and safety in the prescription of controlled substances through virtual means. The ongoing evaluation and development of regulations in this area demonstrate a commitment to the evolving landscape of healthcare delivery.