The Center for Connected Health Policy (CCHP) has created this video primer on telehealth prescribing policy:
- Historical Background: Prior to the COVID-19 pandemic and the declaration of the national Public Health Emergency (PHE), the Ryan Haight Act of 2008 allowed for certain exemptions in the use of telehealth to provide controlled substances without the telehealth provider having seen the patient in-person first. These exemptions, however, were narrowly tailored. Two such exemptions are:
- When a public health emergency (PHE) is declared, and
- If a provider is registered on a telehealth registry that the Drug Enforcement Administration (DEA) will create.
Such a registry has never been established. In 2018, Congress passed the SUPPORT for Patients and Communities Act as part of an effort to combat the opioid epidemic. The Act directed the DEA to promulgate final regulations for the registry that would allow providers to prescribe controlled substances through telemedicine under certain circumstances. The DEA officially missed its deadline, set at one year from the passing of the Act on October 24, 2019.
- Impact of the Public Health Emergency (PHE). The declaration of a Public Health Emergency (PHE) in March 2020 triggered an allowance in federal law that temporarily allows for the expanded use of telemedicine in prescribing controlled substances for the duration of the PHE. Following is a decision tree summarizing the policy changes regarding How to Prescribe Controlled Substances to Patients During the COVID-19 Public Health Emergency
- What Happens When the PHE Ends? As of right now, the allowances made for the PHE will expire at the end of the PHE (officially announced to end on May 11, 2023).
- In response to the lack of action by the DEA and given the worsening opioid overdose crisis, the Alliance for Connected Care convened more than 80 organizations, who jointly signed a letter urging the DEA to move forward with the telemedicine special registration process required by federal law that will enable SAMHSA waivered clinicians, community mental health centers and addiction treatment facilities to prescribe medication assisted treatment (MAT) drugs to patients with OUD employing telemedicine technology. To read about the issue in more detail and view the letter, see the Alliance for Connected Care’s webpage on the issue.
- In May 2021, Senator Warner sent a letter to Attorney General Merrick Garland regarding the long-delayed regulations and expressed great concern for the delay.
- In April 2022, Senators Portman and Whitehouse sent a letter to Administrator Anne Milgram of the U.S. Drug Enforcement Administration (DEA) and Secretary Xavier Becerra of the Department of Health and Human Services (HHS), urging the agencies to use their authority under the Ryan Haight Act to ensure Americans can continue to access important medication, such as Medication Assisted Therapies (MAT) for substance use disorder and other necessary drugs, via telehealth once the COVID-19 PHE ends.