Ryan Haight Act may come back, threatening digital health delivery companies

“Everyone’s favorite (kidding) pandemic drove major and rapid adoption (words that almost never go together in healthcare land) of telehealth for patients and clinicians alike across the system,” Arpan Parikh and Amit Parikh write over on their Substack, focusing on potential reform of the Ryan Haight Act, which gives doctors the ability to prescribe medications to patients they have never met. “As two physicians practicing in digital health, we can personally attest to the seismic shift that has occurred over the last 24 months: https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality. This happened mostly out of necessity, as confusing at times social distancing guidance and totally appropriate and reasonable anxieties around getting sick meant patients couldn’t always make it to their doctors’ offices. Clinical organizations struggled to keep their staff (both clinical and non-clinical) safe. … Quickly, however, the necessity to deliver care through telehealth platforms (both synchronously and asynchronously through a variety of modalities including video, audio, and text) uncovered an opportunity ????. Why couldn’t virtual care delivery become the standard instead of just a temporary fallback? … What was different now was hard proof that patients and clinicians were willing and able to access and deliver care virtually. … There was also increased flexibility from CMS and major payers to enable coverage and payment for clinical services delivered virtually. This led to a frenzy of activity. …The public health emergency (PHE) declared by HHS Secretary Alex Azar on January 31, 2020 put into place specific provisions that further enabled these digital-only care delivery businesses to exist.  …We will focus on the two waivers that we find the most interesting, and have the most direct impact on this new crop of digital-only care delivery companies: a waiver of the Ryan Haight Act as well as waivers of specific Drug Enforcement Agency (DEA) regulations. The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 (RHA) was passed by Congress and is enforced by the DEA. The act has multiple regulations focused on the actions surrounding the prescription of controlled substances. The RHA regulation we’ll focus on here is the requirement that any practitioners prescribing a controlled substance conduct an in-person medical evaluation initially (without explicit in-person follow-up requirements) before prescribing a controlled substance. This was put in place to directly combat the unscrupulous practitioners who created online ‘pill mills’ in the late 90’s/early 2000’s, and came to be through fierce advocacy and lobbying.” Arpan Parikh and Amit Parikh, “There is an existential threat facing digital health care delivery companies,” Substack.