DEA Prepares to Issue Rule on Telehealth Prescribing

The Drug Enforcement Administration (DEA) is nearing the final stages of its rulemaking process for prescribing controlled substances via telehealth, but leaked details reveal a more restrictive approach than anticipated.¹

New draft rule imposes strict limitations on telehealth prescriptions as advocates push for extension of current flexibilities. | Image credit: NIKCOA - stock.adobe.com.

While advocates are once again lobbying the White House and Congress to extend a waiver on the use of telemedicine to prescribe medications, leaked details suggest this prescribing route will be limited, according to anonymous sources speaking to Fierce Healthcare and Politico.^1,2

The telehealth prescribing flexibility rule has been used since 2020 to prescribe medications for conditions such as substance abuse disorder and attention deficit disorder. Last year, the DEA proposed 2 rules for telehealth controlled substance prescribing but withdrew them after receiving 38,000 public complaints.

According to the anonymous source, the draft telemedicine prescribing rule, expected to be out in September, limits the types of medications that can be prescribed using telehealth and mandates that half of all prescriptions be conducted in person.¹

The reports come amid concerns from health care advocates and organizations about the feasibility of implementing such restrictions without a national prescription drug monitoring registry.

According to HealthLeaders Media, the Alliance for Connected Care is preparing stakeholder letters to the White House and Senate and House leadership, urging the DEA to extend a pandemic-era waiver that would allow providers to use telemedicine prescriptions for another 2 years.³

Additionally, a telehealth lobbyist told Fierce Healthcare that the Biden administration has the authority to extend the pandemic flexibilities without action from Congress, and that an extension through the administration would likely be easier than passing an extension through Congress.¹ Furthermore, because other telehealth extenders are likely to make a year-end legislative package, there should be enough time to include an extension of the DEA rules as well.

Sen Mark Warner, D-Virginia, responded to the reports of the telehealth restrictions, advocating that the DEA lift some of the reported restrictions on telemedicine prescribing without the patient and provider being required to meet in person.

“As currently reported, the DEA’s proposal provides an even worse solution than the one put forth under the first proposed rule," Warner said in a statement. "This arcane approach would represent a significant step back for patients who rely on telemedicine for critical medications, and yet another failure by the DEA to establish a meaningful special registration, which Congress has repeatedly directed it to do for over a decade."⁴

He noted that since 2008, Congress has prodded the DEA to set up a special registration process to regulate the safe online prescription of controlled substances.

“We don’t need an arbitrary new set of regulations – we just need DEA to set up the minimum training requirements for providers and a special registration that allows the DEA to do its job to monitor telemedicine prescribing of these medications and catch bad actors,” he said.

References

1. Beavins E. Advocates rush to Congress, White House to extend telehealth prescribing for two years, after DEA’s plans leaked. Fierce Healthcare. September 4, 2024. Accessed September 4, 2024. https://www.fiercehealthcare.com/regulatory/former-dea-official-leaks-plans-telehealth-prescribing-rule-advocates-are-running

2. Leonard B. DEA eyeing substantial limits to telemedicine prescribing. Politico Pro. August 28, 2024. Accessed September 4, 2024. https://subscriber.politicopro.com/article/2024/08/dea-eyeing-substantial-limits-to-telemedicine-prescribing-00176574

3. Wicklund E. The clock is ticking on telemedicine prescriptions. HealthLeaders Media. September 3, 2024. Accessed September 4, 2024. https://www.healthleadersmedia.com/technology/clock-ticking-telemedicine-prescriptions

4. Statement of U.S. Sen. Mark R. Warner on DEA telemedicine rulemaking. News release. Mark R. Warner. August 29, 2024. Accessed September 4, 2024. https://www.warner.senate.gov/public/index.cfm/pressreleases?id=278E92B7-4383-4D93-AAB6-2C6AEC7B0B9B