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How to Prepare for the Proposed Changes to Telehealth Prescriptions
How to Prepare for the Proposed Changes to Telehealth Prescriptions
(3 days later)
The expanded telemedicine rules adopted during the Covid-19 pandemic have been extended once more, and will now remain in effect through the end of 2024, the Substance Abuse and Mental Health Services Administration announced in October.
The expanded telemedicine rules adopted during the Covid-19 pandemic have been extended once more, and will now remain in effect through the end of 2024, the Substance Abuse and Mental Health Services Administration announced in October.
During the pandemic, the telemedicine expansion allowed patients to receive medical care and prescriptions for controlled medications virtually, without the need to meet a provider in person. This flexibility proved transformative for many people, especially those in rural areas.
During the pandemic, the telemedicine expansion allowed patients to receive medical care and prescriptions for controlled medications virtually, without the need to meet a provider in person. This flexibility proved transformative for many people, especially those in rural areas.
In February, the Drug Enforcement Administration proposed new, tighter rules for prescribing certain medications. Those rules were expected to go into effect when the pandemic public health emergency expired but have now been postponed twice.
In February, the Drug Enforcement Administration proposed new, tighter rules for prescribing certain medications. Those rules were expected to go into effect when the pandemic public health emergency expired but have now been postponed twice.
The D.E.A. received more than 38,000 responses from the public on the proposed telemedicine rules, and the agency has said it is considering input from those comments and public listening sessions as it works to develop “a final set of telemedicine regulations by the fall of 2024.”
The D.E.A. received more than 38,000 responses from the public on the proposed telemedicine rules, and the agency has said it is considering input from those comments and public listening sessions as it works to develop “a final set of telemedicine regulations by the fall of 2024.”
If the proposals are approved as currently written, in 2025, doctors will need to follow different, more restrictive guidelines when writing online prescriptions for controlled medications like the attention deficit hyperactivity disorder drug Adderall; the addictive painkiller OxyContin; Xanax, which is used for panic or anxiety disorders; and buprenorphine, a medication used to treat opioid addiction.
The Times asked Dr. Shabana Khan, a child and adolescent psychiatrist and the chairwoman of the American Psychiatric Association’s committee on telepsychiatry, to help people who take mental health medications understand the anticipated changes and how to adjust for them.
Questions and answers have been condensed and edited for clarity.
Is there anything patients can do now to ensure that they don’t experience a disruption in their controlled medicine prescriptions?
If you are currently a patient being prescribed a controlled medication by a telemedicine practitioner who you have never met in person, contact them now to ask about this issue and work with them to develop a plan.
Patients will have until Dec. 31, 2024, to be seen in person.
Even though we have this extension, it may be helpful to schedule your in-person appointment sooner.
Over the past three years, many patients have received care completely remotely and were prescribed a controlled medicine. All of these patients will need to schedule an in-person visit, and that will lead to a bottleneck and scheduling delays.
What if you cannot see your telemedicine practitioner in person because they live far away from you?
Ask them about other options to ensure that you are able to continue your medication after the flexibilities expire. Your telemedicine practitioner may refer you to someone else locally who can see you in person.
Can you explain a little more about how the referral process works? Would the in-person doctor take over the prescription from that point onward?
Not necessarily. Let’s say the telemedicine practitioner has prescribed a 30-day supply of medicine without having seen a patient in person. After that, the telemedicine practitioner can refer the patient to another D.E.A.-registered practitioner who can see them in person. The in-person practitioner can then make a referral back to the telemedicine provider, who can continue to prescribe the medicine. This would be a “qualifying telemedicine referral” under the proposed rule. It is important to note that we don’t yet know if this will be included in the final rule.
So in this scenario we’re sort of ping-ponging between referrals then?
That’s what it’s sounding like, yeah.
Do you need to see someone in person every time you need a prescription refill for a controlled medicine?
The D.E.A. requires just one initial in-person examination, whether it’s with the telemedicine doctor themselves or the other referring practitioner.
However, practitioners do have to look at state rules as well. States may have different requirements around controlled substance prescribing, and typically practitioners have to follow whatever requirement is more strict.
Additionally, an individual, organization or practice may have their own policies on controlled medicine prescribing.
Can someone see their primary care doctor or pediatrician for an in-person appointment if they can’t find a mental health provider?
Eventually, yes, as long as the “qualifying telemedicine referral” that is currently in the proposed rule is included in the final rule. However, some providers may not feel comfortable doing this, given that they are not experts in diagnosing or treating the condition the controlled medicine is being prescribed for.
What are some other ways to try to find someone for an in-person appointment?
Contact your health insurance provider for a list of local referrals. It may be particularly challenging to connect with a new doctor in areas with an uneven distribution of specialists or in parts of the country where there is a shortage of providers, so starting the process now is key. The sooner, the better.
