Congress Finally Moving to Expand Telemedicine Prescribing

Finally, US may make some long overdue steps to improve access to healthcare via telemedicine, and specifically improve mental health care.

Earlier this week, Congress released two draft bills to amend the federal Ryan Haight Act. In layman's terms, this law currently limits prescribing controlled substances via telemedicine.

First Proposal: Expanding Access to Mental health and Addiction Treatment

The "Improving Access to Remote Behavioral Health Treatment Act" would allow certain community mental health centers and addiction treatment centers to obtain DEA registration as a clinic, thereby allowing telemedicine providers to prescribe controlled substances to patients present at those sites without the need for an in-person examination. Currently, treatment sites are restricted to DEA-registered hospitals and some very limited other non-hospital clinics.

2nd Proposal: Telemedicine Prescriber Special Registration Congress simultaneously released a companion discussion bill titled the "Special Registration for Telemedicine Clarification Act". This registration would allow practitioners to use telemedicine to prescribe controlled substances without the per se in-person exam. Put the scope of practice back in the hands of medical professionals to decide when a course of treatment is appropriate via telemedicine. From here, the Attorney General and Secretary of Health and Human Services, to, within 30 days of passage of the Act, must create interim final regulations governing the special registration for the practice of telemedicine.

A Brief History of Online Prescribing Enforcement In 2009, The Ryan Haight Online Pharmacy Consumer Protection Act was created in response to the internet pharmacy "pill-mills" selling controlled substances online. The goal of Congress and the DEA was to eliminate prescribing to patients who did little more than fill out internet questionnaires. Unfortunately, the law has also had a chilling effect on real health care providers ability to treat their patients via telemedicine.

The Ryan Haight Act does not explicitly prohibit the use of telemedicine to prescribe controlled substances, providing telemedicine exceptions permitting prescribing if the provider and patient have had at least one in-person encounter. However, the exceptions are so narrow they are practically useless. And not permit prescribing directly to a patient outside of clinical setting, like at home. Telemedicine and the quality of technology that support is has improved drastically since 2009. For perspective, just think of the quality of your current smart phone and internet connection today compared to 2009. The law and regulations are now inadequate for direct-to-patient service models frequently sought by practitioners and patients in areas such as telepsychiatry or substance use disorder treatment.

Biggest Impact of Proposed Bills The biggest win for telemedicine practitioners and consumers can come from Congress proposed mandate to the DEA to create the "Special Registration" for telemedicine controlled substance prescribing. Lawmakers too often focus exclusively on eliminating the bad actors. The effect of the DEA rules eliminated pill-mills, but also hurt every day doctors. A special registration allows the law abiding practitioners to self-identify and treat patients to the full scope of their professional abilities. The Special Registration for Telemedicine Clarification Act, if passed, would legislatively mandate that the DEA create the Special Registration option for practitioner. The US is facing a there is a nationwide shortage of many specialist practitioners that could help more thousands more patients receive high quality treatment through telemedicine prescribing. The Special Registration can legitimize a needed expansion to the ability to prescribe controlled substances via telemedicine / telehealth, opening opportunities. Ultimately, it's about the right care and the right time by the right practitioner.