DEA Extends Telemedicine Flexibilities Until December 2024
Last month, the Drug Enforcement Administration (DEA) issued a second temporary extension of telemedicine flexibilities for prescribing controlled pharmaceutical drugs (CPDs) until December 31, 2024 (they were set to expire in November 2023). These flexibilities were first authorized by the agency in January 2020 in response to the COVID-19 Public Health Emergency (PHE). Prior to that, a prescriber could prescribe CPDs to a patient only after conducting an in-person evaluation of that patient. The flexibilities allowed a prescriber to prescribe CPDs in Schedules II-V via audio-video visits and CPDs in Schedules III-V intended to treat opioid use disorder via audio-only visits.
In March 2023, DEA issued a notice of proposed rulemaking (NPRM) that essentially was a compromise between the requirements pre-PHE and the flexibilities granted as a result of the PHE. The NPRM limits the current flexibilities by restricting the prescribing of CPDs via telemedicine to Schedules III-V only; the prescribing of CPDs in Schedule II would require an in-person evaluation. (CPDs in Schedule II include not only powerful analgesics like oxycodone and hydrocodone, but also stimulants used to treat ADHD like amphetamine.)
During the public comment period for the NPRM, DEA received over 38,000 responses. In May 2023, with the telemedicine flexibilities about to expire, DEA issued the first extension of them until November 2023. And, in an apparent response to the overwhelming number of public comments, DEA made the unprecedented move of scheduling live listening sessions to hear public comments on the NPRM. According to DEA, they heard from 58 healthcare professionals, experts, and patients during the sessions in September.
Now, in light of the written comments and the oral presentations, DEA has again kicked the can down the road, but this time for over a year. Prudence would dictate that DEA take time to consider all aspects of the NPRM as prescribing via telehealth impacts millions of prescribers and their patients and has unique opportunities for expanded care, but also for potential diversion. The question is, how will they strike the appropriate balance?