Telemedicine prescribing of stimulants for ADHD and medication for opioid addiction has been approved for another year, as the federal government again on Friday extended the telehealth flexibilities instituted at the beginning of the pandemic.
Such remote prescribing had been scheduled to end on Dec. 31, with a widespread expectation of chaos among patients and clinicians who had become accustomed to telehealth. Now, the end date for remote prescribing is Dec. 31, 2025.
“We continue to carefully consider the input received and are working to promulgate a final set of telemedicine regulations,” the Drug Enforcement Administration said in a statement. “However, with the end of 2024 quickly approaching, DEA, jointly with [the Department of Health and Human Services], has extended current telemedicine flexibilities through December 31, 2025. The full text of the extension, entitled ‘Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications,’ was submitted to the Federal Register jointly with HHS on November 15, 2024.”
The Federal Register version is here.
Telehealth became the norm
When the pandemic struck, telehealth quickly became the norm, after years of pushback from the healthcare system. Now everybody has gotten used to virtual care — doctor visits and telehealth prescribing of medications — and the in-the-breach setting of regulations seemed to work pretty well. But the pandemic-induced telehealth guidelines, referred to as flexibilities, were modified only by temporary extensions, and they had been set to expire this year.
The Centers for Medicare and Medicaid Services recommended in July that many telehealth flexibilities be extended through the end of calendar year 2025. The recommendations are detailed in this post from the Baker and Donelson law firm, primarily covering Medicare beneficiaries, providing “some level of certainty regarding the regulatory landscape while we await legislative changes that would be necessary to permanently remove certain statutory constraints” on telehealth services such as the originating site requirements,” the law firm wrote.
The extension was apparently the subject of behind-the-scenes arguments.
Marika Miller and Nathaniel M. Lacktman wrote in a post on the website of the law firm Foley & Lardner LP: “In late August 2024, POLITICO broke news on the D.E.A.’s internal plans to release an unworkable regulation that would render telemedicine prescribing of controlled substances functionally impractical. Although the draft rule was not publicly released, reporters uncovered how the U.S. Department of Health and Human Services strongly opposed the D.E.A.’s draft, having formally objected to its release at least three times and lodging approximately 400 line-item concerns regarding it.
“After the news broke, stakeholders were stunned and disappointed. Soon after, patients, clinicians, and leading advocacy associations such as the American Telemedicine Association, A.T.A. Action, and the Alliance for Connected Care, took action through online petitions, and a series of scathing letters from Senators and other members of Congress urged the D.E.A. to honor its prior promises to issue a set of telemedicine regulations before the end of 2024.”
Early chaos
Telemedicine practices during the pandemic started out being somewhat chaotic, partly because the healthcare system had long insisted that a doctor and a patient need to be in the same place at the same time physically for good medicine to take place. When Covid made that impractical and even undesirable, doctors, hospitals, urgent cares and others scrambled to come up with a workable system.
In some cases the payment system was the problem. In other cases, licensing across state lines was the problem — but many systems and doctors got credentials in other states, to make it work. Regulations of who had to be credentialed where seemed to work pretty well, for a time. Some states issued waivers, which lasted for a while; others made streamlined licensing processes.
Then one by one, starting as early as 2021, both legislatures and medical boards began rolling back telehealth access, reverting to pre-pandemic rules.
The Drug Enforcement Administration, which is in charge of telehealth regulations at the federal level, extended the telehealth flexibilities last October.
The issue also sparked a controversy over whether the D.E.A. should be in charge of this particular matter. Mandating in-person prescribing would create havoc for many patients and doctors.
