Congress passed the Ryan Haight Online Pharmacy Consumer Protection Act in 2008, which requires the DEA, in conjunction with HHS, to promulgate permanent rules to allow practitioners to prescribe certain controlled medications via telehealth through a special registration pathway.
As of today, the agency still had not done so. In the advent of the Public Health Emergency, the DEA allowed DEA-registered practitioners to issue prescriptions for certain controlled substances to patients via telemedicine without requiring an in-person medical evaluation. The DEA authorization was temporary and is set to expire at year-end.
The American Telemedicine Association reports that these flexibilities have been a lifeline for countless individuals across the country, ensuring uninterrupted access to essential mental health care, substance use treatment, end-of-life care, and many other crucial treatments during a time when in-person visits were impossible or unsafe.
The ongoing challenges in accessing mental health and substance use treatment services, particularly in rural and underserved areas, underscore the importance of maintaining these flexibilities. More than half of U.S. counties do not have a psychiatrist. The shortage is even more prominent in rural areas, with nearly three quarters of rural counties lacking a psychiatrist. Telemedicine has proven to be an effective tool in bridging the gap between patients and providers, reducing barriers to care, and supporting those most in need. At its pandemic peak, telehealth represented 40% of mental health and substance use outpatient visits, and still remains strong, representing 36% of outpatient visits currently.
Given the widespread provider shortage across medical professions and specialties, this flexibility has been essential in ensuring that patients receive timely and necessary care. Continuing these practices is vital to sustaining access to treatment and addressing the ongoing healthcare challenges in underserved areas.
For these reasons, this week, more than 330 stakeholder organizations asked Congress and the White House to intervene to ensure ongoing access to remote prescribing of controlled substances. The letters were co-led by the American Telemedicine Association (ATA) and ATA Action alongside other like-minded partners and organizations. Stakeholders anticipate, based on current reporting, that the Drug Enforcement Administration (DEA) will dramatically limit virtual prescribing, either through new regulations or by allowing the existing flexibilities to expire at year-end.
“This is a predictable and preventable crisis that is looming come January 1 and we are quickly running out of time to save countless patients from being abandoned, left without lifesaving clinically appropriate care,” said Kyle Zebley, the ATA’s senior vice president, public policy, and executive director, ATA Action. “With each day, we are losing precious time the DEA needs to properly develop a rule that appropriately permits and regulates the prescribing of controlled substances through telehealth without jeopardizing the health and safety of Americans, especially those in underserved communities.”
Specifically, the letters to House and Senate leaders urge Congress to include a two-year extension of pandemic-era remote prescribing flexibilities for controlled substances in an end-of-year legislative package.
The letter to the White House recommends that the Biden Administration work with the DEA and other relevant agencies to use existing authorities to extend these flexibilities for two years, providing the DEA with additional time to fulfill its congressional mandate to establish a special registration pathway that balances access to medically necessary care with appropriate enforcement.
“President Biden has already pledged to do all he can to protect all Americans, especially those who are vulnerable, from losing access to vital healthcare services, and we are grateful for the Administration’s longstanding commitment to establishing telehealth as a permanent part of care delivery,”
Zebley added. “It’s in the hands of our policy champions in the Administration and Congress to safeguard the American people, create predictability for our providers, and modernize our healthcare system to make sure patients receive timely and necessary care. We continue to stand ready to work with policymakers to make telehealth a permanent option in a modernized healthcare system.”