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The U.S. Drug Enforcement Administration (DEA) and the Department of Health and Human Services (HHS) have issued a Fourth Temporary Extension of the COVID-19 Telemedicine Flexibilities for the Prescription of Controlled Medications, allowing providers to remotely prescribe Schedule II-V controlled medications indefinitely, following at least one initial in-person medical evaluation.
"This permits the practitioner to remotely prescribe controlled substances to that patient indefinitely, regardless of how much time has passed since the initial in-person medical evaluation or whether that evaluation was for a separate medical concern, so long as such prescriptions are issued for a legitimate medical purpose while acting in the usual course of professional practice and in compliance with other relevant federal and state statutes and regulations," the extension reads.
Schedule II-V controlled medications include those with high abuse potential, such as strong opioids and stimulants, to medications with low abuse potential, like cough medicines with small amounts of codeine.
The COVID-19 Telemedicine Flexibilities were initially issued in March of 2020 during the public health emergency to allow telehealth providers to prescribe controlled substances without a prior in-person visit. The telemedicine visits, at the time, could be video or audio only.
Under the Fourth Extension issued by the DEA, providers can continue to prescribe controlled substances via telemedicine, but an initial in-person visit may be required for certain Schedule II medications.
"Additionally, audio-only telemedicine encounters remain permissible for prescribing Schedule III-V narcotic controlled medications approved by the Food and Drug Administration (FDA) for maintenance and withdrawal management treatment of opioid use disorder, without requiring an in-person medical evaluation," the DEA said in a statement.
"Due to the impending expiration of the flexibilities provided in the Third Temporary Rule, DEA, jointly with HHS, has elected to again extend those flexibilities to maintain access to care during a limited window of time," the extension reads.
The fourth extension is effective through Dec. 31, 2026.
THE LARGER TREND
The extension highlights the need to avoid what many call the "telemedicine cliff," meaning the expiration of telehealth flexibilities that could cause an abrupt disruption in care overnight if the policies are not made permanent.
"DEA has received numerous communications from patients, providers and other stakeholders warning that expiration of the current telemedicine flexibilities, without further regulation, could potentially and abruptly limit patients' access to care until promulgation of a final set of regulations," the extension reads.
"The abrupt end to the ability to prescribe controlled substances to patients who have not had an in-person medical evaluation is often referred to as the 'telemedicine cliff.' The potential harms are widespread."
