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Over the past three years, the expansion of telehealth has made care more accessible to many people, especially in rural areas. Patients have been able to receive prescriptions from providers without seeing them in person. But that may change on May 11, when the federal government is ready to end the covid-19 public health emergency statement that made this convenience possible.
Before the pandemic, doctors were subject to the conditions of the Ryan Haight Lawthat required at least one in-person examination before prescribing a controlled drug, said Dr. Shabana Khan, chair of the American Psychiatric Association’s Committee on Telepsychiatry.
“There are seven exceptions, and one of them is a public health emergency declared by the (health and human services) secretary, which is what we’ve had for the last three years,” Khan said. “It was immensely helpful…and allowed many Americans to get medical care without having to come in person, so we were able to treat patients completely remotely.”
“The administration and HHS released a notice that they do not intend to renew it further,” Khan said, “so the federal public health emergency will expire on May 11.”
Returning to pre-pandemic rules means that people who were prescribed controlled medications via telehealth, such as stimulant medications for attention deficit/hyperactivity disorder, benzodiazepines for anxiety, or medication for substance use disorder opioids, sleep or pain, they will need a doctor in person. exam to continue with these prescriptions or start new ones.
US Drug Enforcement Administration website. has a general list of controlled substances and an exhaustive list It can be found here.
Patients will still be able to obtain prescriptions for non-controlled medications, such as antibiotics or birth control, through telehealth. The pre-pandemic rules would also not affect telehealth care by a doctor who has already performed an in-person exam on a patient.
To put some flexibility into the telehealth framework going forward, Khan said, the DEA has submit proposals (PDF) that would allow telehealth professionals to prescribe a 30-day supply of buprenorphine, an opioid use disorder medication, or non-controlled Schedule III-V narcotic medications without first conducting an in-person examination. A patient would have to have an in-person exam before the second prescription of any kind of drug, under those proposals.
But there’s no guarantee that will happen: Public comment on the proposals was open until March; the DEA has since been considering the comments before drafting the final regulations.
“It’s really important to start planning now,” Khan said. “For many drugs, it can be a risk to stop treatment abruptly.”
People who take medication for opioid use disorder, ADHD, or anxiety and do not have an in-person exam between May 11 and the next time they need to refill their prescription may experience withdrawal symptoms that require a travel to the hospital or negative effects on health, relationships, employment or academics, he added.
Here’s what you need to know about the changes and the steps you need to take, according to Khan.
This conversation has been lightly edited and abridged for clarity.
CNN: How should people prepare to make sure their recipe routine isn’t interrupted?
Khan: It is important that patients who are prescribed one of these types of medications by a telemedicine doctor or other professional contact that professional to discuss this issue and ensure they have a plan. And if it’s feasible to see that telemedicine doctor in person, schedule that as soon as possible.
CNN: What if you can’t see your telehealth provider in person?
Khan: Let’s say a telemedicine doctor practices completely remotely; then the patient would discuss with them what the next steps would be.
In the proposed rule, the qualifying telemedicine referral may allow a local DEA-registered physician to see a patient. So, for example, maybe your primary care doctor or pediatrician, if they’re registered with the DEA, could go through the qualified telemedicine referral process so they can see you in person and still prescribe the drug. Or patients can contact their health insurance provider for a list of local referrals.
CNN: Is there a downside to seeing general practitioners or pediatricians for prescriptions for controlled medications?
Khan: Some may say that they will not prescribe certain medications, such as psychiatric medications. Some may say they are comfortable with it and others may say they will prescribe it for a short period of time until you contact a specialist. So there is variability.
CNN: Would the patient have to continue to see the referring provider after that first in-person appointment?
Khan: In terms of what is required at the federal level, if a patient has that in-person exam with a provider through that qualified telemedicine referral process, they would not necessarily have to see that provider again unless they are part of their treatment plan being discussed. .
With the qualified telemedicine referral in the proposed rule, as written, it doesn’t necessarily have to be the referring physician who prescribes the drug; they just need to take the exam in person. The referring doctor can refer the patient to the telemedicine doctor, who can prescribe the medication.
The other factor that is significant here is that we discuss all the proposed rules and the state at the federal level, but there is also the state level. States also have rules about controlled prescription drugs, and they may not always align with federal law. Let’s say the DEA publishes its final rule and there’s some flexibility: some states could adopt the older language of the Ryan Haight Act from the federal level, so they might actually be stricter than what we’ll see at the federal level. When federal and state laws don’t align, providers generally have to follow whichever is more stringent.
CNN: Will patients need to see their provider in person every time they need a prescription refill?
Khan: The DEA has indicated that the absolute requirement at the federal level is an in-person exam. Beyond that, it would be left to the discretion of whoever is seeing the patient.
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