DEA Telemedicine Registration Deadline Approaches Amid Stakeholder Recommendations

Access to care is a major problem in our nation, with the national physician shortage reaching a staggering number of up to 121,900 full-time physicians by 2032, according to a report earlier this year by the Association of American Medical Colleges. The solution, thankfully, is available and clear: telehealth. That solution is becoming obvious to more than just healthcare innovators and entrepreneurs. Every year we are seeing more and more legislation passed that paints a picture of mainstream and governmental adoption of telehealth, and a growing awareness of the overall benefits and applications to many of the real problems this nation faces.

However, “the promise of telemedicine falls far short” if the ability for the telemedicine provider to prescribe whatever medications they deem necessary isn’t included in those legislative conversations. This was among the opening statements in a Stakeholder Letter to the DEA this month from the American Telemedicine Association along with 12 other stakeholder groups. The letter was addressing the fact that, despite a gaping absence of news or evidence of forward movement, the DEA has a very important deadline approaching in October. But first, a little background:

Every provider is aware of the Ryan Haight Act of 2008 that effectively prevents physicians from prescribing controlled substances in a virtual care setting. Included in that law was language directing the DEA to create a Special Registration for Telemedicine Providers that would allow them, within the confines of the law, to prescribe those medications. Ten years after that law was passed, there were still no signs of anything resembling that registration. Subsequently, in one of the biggest healthcare bills to pass since the Affordable Care Act of 2010, the SUPPORT for Patients and Communities Act was passed in 2018, which included the Special Registration for Telemedicine Act of 2018, requiring the DEA to implement registration regulations by October of 2019. This would give those providers in the registry the ability to prescribe controlled substances, thereby making the “promise of telehealth” so much more than the dream it can sometimes seem. 

As that deadline approaches, those in the healthcare and telemedicine space are urging the DEA to consider those who are the most affected by both the barriers to access to care as well as the current inability of providers to prescribe controlled substances. In their letter, the ATA and aligned stakeholders highlight the need for those with “serious, chronic, disabling, and debilitating conditions – such as obesity, insomnia, substance use disorder, and some psychiatric conditions,” especially in underserved or rural areas. Furthermore, they ask the DEA to consider that this could be an opportunity to do so much more for advancement of virtual care than just prescribing allowances. They encourage them to consider where such encounters for those services are most conducive to the furthering of the cause of working towards a healthier American population, no matter where they live or what their resources are. That would mean including locations such as workplaces, schools, and the home in the eligible sites for virtual care services that result in a prescription being given. 

The location of the patient at the time of service delivery, called the “originating site,” has been on everyone’s legislative mind in the healthcare sphere as this year has seen a record number of commercial giants – like CVS, Walgreens, Target, and, most recently Amazon – joining major players like American Well and TelaDoc in the DTC telehealth space. According to a new research study by Global Market Insights, Inc., the US Telemedicine Market is set to pass $64 billion by 2025. Doctor-owners of small family practices and large hospital and health system executives alike are realizing that they need to step into this space as well if they are to survive in the coming years. 

Around the same time, the Center for Telehealth & e-Health Law (CTeL) also sent a letter to Scott Brinks, the section chief of the DEA’s Regulatory Drafting & Policy Support Section. Their letter focused on urging the DEA to remove the in-person exam requirements. They spoke about the current Opioid crisis and how this registration is vital to the ability of our nation’s physicians to combat that, but that it will not be effective if that requirement is not removed. They include seven sections on individual reasons why they are encouraging this change to be made, including those titled “Prior Physical Examination: Not Always Medically Necessary” and “Inefficacy of In-Person Examinations in Deterring Unscrupulous Actors.”

As more voices join the conversation, we in the telehealth space are eagerly awaiting the outcome. Thankfully, the language in the SUPPORT for Patients and Communities Act requires the registration regulations to be published with a comment period before the final rule is made. We are sure that these organizations, among others, are waiting with pens poised and baited breath to ensure that whatever the result is, they are doing their part to make it the most beneficial as possible for all Americans.

To read the article from Foley & Lardner on the ATA letter, click here.
To read the article from mhealthintelligence on the CTeL letter, click here.  
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