DEA Proposes Rules to Govern Post-PHE Prescribing of Controlled Substances via “Telehealth”From NAHC On Friday, February 24, 2023, the Drug Enforcement Administration (DEA) released proposed rules intended to govern the prescribing of controlled substances via telemedicine for application at the end of the COVID-19 Public Health Emergency (PHE). The proposed rule — — Telemedicine Prescribing of Controlled Substances When the Practitioner and the Patient Have Not Had a Prior In-Person Medical Evaluation (RIN 1117-AB40/Docket No. DEA–407) – was developed in conjunction with the Departments of Health & Human Services and Veterans Affairs and is anticipated to become effective at the end of the PHE (which is scheduled to end on May 11, 2023). DEA is allowing only 30 days for comment and will accept comments received on or before March 31, 2023. The proposed rules focus on prescribing of a controlled substance via telemedicine consultation by a medical practitioner when no in-person evaluation of the patient has been conducted. For these types of consultations, the proposed rules would allow medical practitioners to prescribe a 30-day supply of Schedule III-V non-narcotic controlled medications, or a 30-day supply of buprenorphine for the treatment of opioid use disorder without an in-person evaluation or referral from a medical practitioner that has conducted an in-person evaluation, as long as the prescription is otherwise consistent with any applicable Federal and State laws. However, the proposed rules would prohibit prescribing of any Schedule II substances or the general prescription of a narcotic controlled substance via a telemedicine encounter as the DEA believes this would pose “too great a risk to the public health and safety.” The proposed rule does allow for the prescribing of any controlled substance which a practitioner is legally permitted to prescribe under applicable laws and regulations via a qualifying telemedicine encounter if the patient has been referred for treatment by a practitioner who has conducted an appropriate, in-person medical evaluation. Prescribing of controlled substances as a result of a telemedicine encounter would be time-limited for each patient (unless conducted by VA practitioners) such that practitioners could prescribe a medication only for a period of 30 days before an in-person medical evaluation must be conducted. Prescriptions written in response to a telemedicine encounter will require additional practitioner recordkeeping, including an indication on the prescription document that the prescription was written as the result of a telehealth encounter. The DEA has created a useful table that outlines the proposed rules. While the rule was released only a few days ago, there has been widespread concern expressed by proponents of telemedicine, particularly with respect to the potential harmful impact the rules could have on behavioral health treatment. However, based on an initial review and discussion with individuals in the hospice field, the National Association for Home Care & Hospice (NAHC) believes that the rules, if implemented, could also create barriers to timely access to drugs for pain and symptom management in hospice care, palliative care, and home health care. NAHC is in the process of examining the rule and will be discussing it with member agencies and other stakeholder groups. We welcome input from providers, including prescribing practitioners, as to how these proposed rules would impact the practice of hospice care, palliative care and home health care. Please submit any comments to Theresa Forster ([email protected]),Katie Wehri ([email protected]), and Mary Carr ([email protected]) at your earliest convenience. |