DEA announces proposed rules for permanent telemedicine flexibilities

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allantois said:
COVID exception expires May 11.. still waiting on final DEA guidance
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Don’t expect any changes prior to the deadline. The public comments went poorly. Seems like the demand for Ryan Haight laws coming back is strong.
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TexasPhysician said:
Don’t expect any changes prior to the deadline. The public comments went poorly. Seems like the demand for Ryan Haight laws coming back is strong.
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Well they have to release the ruling
 
randomdoc1 said:
Of course! They know their bodies. What do we know?! We just read those books and research. Not “real life experience.”
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Don’t mansplain or gaslight me
 
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randomdoc1 said:
Of course! They know their bodies. What do we know?! We just read those books and research. Not “real life experience.”
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Isn't the same true of the doctors who run those online ketamine clinics? They had to do all the same series of steps to become doctors.

The ketamine mill near me that advertises itself as a panacea for everything is run by an ER doctor who works in the local hospital, presumably respectable, but looking to moonlight. How is he any less expedient than the patients who use him? Don't get me started on our urgent care, half of the facility is for IV treatments of something called "Meyer's Cocktail" which is some assortment of vitamins given by IV. They also offer "SpectraCell Micronutrient test." Both doctors there are board-certified in emergency medicine. And it's literally half the facility—one half very crowded and for real medical needs, the other half a pristine futuristic office with expensive snake oil.
 
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birchswing said:
Isn't the same true of the doctors who run those online ketamine clinics? They had to do all the same series of steps to become doctors.

The ketamine mill near me that advertises itself as a panacea for everything is run by an ER doctor who works in the local hospital, presumably respectable, but looking to moonlight. How is he any less expedient than the patients who use him? Don't get me started on our urgent care, half of the facility is for IV treatments of something called "Meyer's Cocktail" which is some assortment of vitamins given by IV. They also offer "SpectraCell Micronutrient test." Both doctors there are board-certified in emergency medicine. And it's literally half the facility—one half very crowded and for real medical needs, the other half a pristine futuristic office with expensive snake oil.
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Yea, but they actually "get me." The other docs are just "unempathic and judgmental. They don't actually take the time to listen to me."
 
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calvnandhobbs68 said:
Right, they don't "have" to release anything. Normal rules were suspended during the public health emergency. If nothing else is different, normal rules just fall back into place immediately after public health emergency ends.
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The DEA has said that they think they are discharging their responsibility for creating a special registration process by the rule changes they proposed; they are going to get a lot of heat if they don't put out something more than a straight return to Ryan Haight.
 
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clausewitz2 said:
If the final rule ends up looking like this, I am going to have to seriously contemplate whether I want to just start telling new patients that I am unable to prescribe controlled substances. I'm full enough that routinely going into the office just for new evals ain't worth it.
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I was just thinking the same thing or any controlled need to be seen in person monthly and only getting 30 days at a time.

When are the new rules supposed to go into effect so I can plan accordingly?
 
Shikima said:
I was just thinking the same thing or any controlled need to be seen in person monthly and only getting 30 days at a time.

When are the new rules supposed to go into effect so I can plan accordingly?
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The proposed rules are just proposals. They requested public opinion. Public opinion didn’t like the proposed rules.

There is no deadline for changes. They can ponder them forever.

Ryan Haight is returning in full. The DEA has already given notice that we should be preparing to enforce it. If they change their stance later today or 100 years from now, they’ll let us know.
 
TexasPhysician said:
The proposed rules are just proposals. They requested public opinion. Public opinion didn’t like the proposed rules.

There is no deadline for changes. They can ponder them forever.

Ryan Haight is returning in full. The DEA has already given notice that we should be preparing to enforce it. If they change their stance later today or 100 years from now, they’ll let us know.
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I’m really counting on that proposed 6 month transition period..

They got a lot of heat because their guidelines weren’t lax enough
 
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allantois said:
I’m really counting on that proposed 6 month transition period..

They got a lot of heat because their guidelines weren’t lax enough
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While it would make things easier, every clinic near me is already back in compliance.

DEA had equal complaints that the proposals should be dropped entirely. The DEA had many issues with places that were online pill mills during Covid.
 
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Another issue is that Ryan Haight laws place responsibility on pharmacists to not fill controlled meds that they believe are telemedicine to ensure compliance. The proposed rules don’t change that responsibility yet.

Pharmacy groups have said that they expect many pharmacies to ban telemedicine scripts even if the current proposed rules pass as it would be too difficult to follow-up with prescribers to ensure the many loopholes are being followed and which loophole with associated rules pertains to each script.

Pharmacists don’t want added work/risk. If pharmacies can’t get on board, we move closer to the extremes of full Ryan Haight or complete repeal of Ryan Haight to get proposed rules to make a difference.
 
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TexasPhysician said:
Another issue is that Ryan Haight laws place responsibility on pharmacists to not fill controlled meds that they believe are telemedicine to ensure compliance. The proposed rules don’t change that responsibility yet.

Pharmacy groups have said that they expect many pharmacies to ban telemedicine scripts even if the current proposed rules pass as it would be too difficult to follow-up with prescribers to ensure the many loopholes are being followed and which loophole with associated rules pertains to each script.

Pharmacists don’t want added work/risk. If pharmacies can’t get on board, we move closer to the extremes of full Ryan Haight or complete repeal of Ryan Haight to get proposed rules to make a difference.
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There is absolutely no difference between rx that are sent from tele apps vs in person ones
 
allantois said:
There is absolutely no difference between rx that are sent from tele apps vs in person ones
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Right but what a lot of pharmacies seem to be doing (at least this is what it seems) is looking at peoples NPI or DEA address and then questioning the prescriptions if the address is significantly (not clear how far away is too far) far from the patients address or the pharmacy address.

This has already been happening even before the rollback in a few weeks.
 
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calvnandhobbs68 said:
Right but what a lot of pharmacies seem to be doing (at least this is what it seems) is looking at peoples NPI or DEA address and then questioning the prescriptions if the address is significantly (not clear how far away is too far) far from the patients address or the pharmacy address.

This has already been happening even before the rollback in a few weeks.
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So essentially as long as you and the patient are in the same city, they have no way of discerning if you were tele or not.
 
allantois said:
There is absolutely no difference between rx that are sent from tele apps vs in person ones
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Exactly. That is part of the problem pharmacists are struggling with. So if via tele, what new loophole makes the script legit and how do they document/evaluate it? Currently, they look at the physical address of your DEA and determine if you likely could have seen this patient in person.

In the past, pharmacists farther away that aren’t used to seeing my scripts have called my office to see about me having a physical office and seeing patients in person. One didn’t believe my staff and required me to verbally attest to the script myself as having an in person visit.

If you introduce many new qualifications for legit tele scripts, pharmacists won’t be able to easily evaluate whether it was legally provided. The current wording of Ryan Haight puts responsibility on pharmacists to ensure controlled meds likely follow the rules.
 
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Really sucks for pharmacists.
 
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Have they announced when the updated DEA policy on Ryan Haight will begin as it relates to controlled substance prescriptions? Literally on 05/11/23 or is there a temporary grace period?
 
prominence said:
Have they announced when the updated DEA policy on Ryan Haight will begin as it relates to controlled substance prescriptions? Literally on 05/11/23 or is there a temporary grace period?
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The “proposed” updates may never even be voted on. Prepare for no grace period.
 
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I mentioned this before when COVID caused a lot of rules changes. There will be a COVID law confusion. Providers won't be sure if they're following the rules correctly, and when things change again cause of further COVID rises (although now this seems less and less likely) but also changes because COVID goes down, providers might not be aware of those changes.

Just as an example, a few months into COVID, I called my state medical board and controlled substances board just to clarify my understanding was correct and the idiot I got on the line was reciting rules from years prior and that guy didn't seem to know WTF was going on and was very, let's just say Torquemada about it. E.g. I asked him that given the new rules changes allowing for telemedicine, will the state give us any notice if prior restrictions come back, and if so how cause I didn't want to be out of the loop.

The idiot responded that telemedicine was 100% not allowed unless the patient was in a hospital, pharmacy, or was already in my office (this was the prior rule before COVID). At this point, it was widely known that telemedicine was allowed, even encouraged. The more I talked to him about it, the more vindictive he became as if he was playing bad cop. Reminds me of the days when I worked in a state hospital and half the people in it didn't know WTF they were doing.
 
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Not precisely related to this, but does anyone know why all the PHE measures didn't end when Congress and Biden ended them early sometime earlier this month? I've tried Googling it, and I haven't come up with anything. I thought the whole thing was that they were doing it a month earlier than scheduled, and yet everything still hinges on that May 11 date.
whopper said:
when things change again cause of further COVID rises
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I think they're doing a pretty good job making everyone as unaware as possible what the spread is. I doubt we'll know if we're in another wave or even if we're in one right now. I think death rates may be the only reliable metric left, but it doesn't tell you a lot about spread given decreased virulence. I can't imagine more transparency given prudence regarding Covid is politically very unpopular.
 
birchswing said:
Not precisely related to this, but does anyone know why all the PHE measures didn't end when Congress and Biden ended them early sometime earlier this month? I've tried Googling it, and I haven't come up with anything. I thought the whole thing was that they were doing it a month earlier than scheduled, and yet everything still hinges on that May 11 date.
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Not sure what you are referring to, the PHE ends on May 11.
 
splik said:
Not sure what you are referring to, the PHE ends on May 11.
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I just looked it up. It was the national emergency that was ended earlier this month, the PHE apparently is separate. I guess originally they were meant to end on the same day?

www.politico.com

Biden signs bill ending Covid-19 national emergency

The White House initially announced plans to extend the national emergency, as well as the public health emergency, until May 11.
www.politico.com www.politico.com

I guess I didn't read carefully at the time and didn't realize the public health emergency and national emergency were two different things, but that explains why the public health measures didn't end when the bill was signed.
 
Jules A said:
The DEA website lists it as "proposed permanent rules" so I would imagine, hope? they will address it one way or the other. If not that is just rude and additionally would likely contribute to even more confusion.

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It is a “proposed” change. There is no deadline to address it. Rude is their permanent status. Hope? I guess, but they still haven’t met the deadline Trump gave them what 4 years ago? How old is Ryan Haight? They never created the application process requested of them in Ryan Haight from the beginning.
 
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allantois said:
Is that how the DEA functions? Is there a voting board or?
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My attorney believes they are reviewing the public comments. There is no deadline for this. He believes they will likely issue revised proposals within 6 months. Decent chance future revised proposals will eventually pass by a vote as the DEA has entered a stipulation that these revisions fulfill its obligation to issue special clinic registrations.

Expect to have to write telemedicine on scripts that haven’t had an in-person by the prescriber and pharmacies can elect to not fill them.
 
Telehealth with limitations like the person's home address and pharmacy must be within 100 miles of your clinic location would solve the problem for 99% of doctors. Maybe the distance could be debated. It would have to be within proximity to the doctors actual clinic, not like Talkiatry is leasing office space there but the doctor actually works 2000 miles away.

Anything that gives carte blanche for prescribing controlled substance completely over telehealth regardless of distance means the pill mills have total reach to anywhere in the country, which will just continue unsafe practice and bad medicine. Which is exactly what Ryan Haight Act was intended to prevent. It's just that the capitalism of mental health being scalable over telehealth creates a breeding ground for startups to function as drug dealers for stimulants, benzos, ketamine, etc, under the guise of improving access.
 
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TexasPhysician said:
My attorney believes they are reviewing the public comments. There is no deadline for this. He believes they will likely issue revised proposals within 6 months. Decent chance future revised proposals will eventually pass by a vote as the DEA has entered a stipulation that these revisions fulfill its obligation to issue special clinic registrations.

Expect to have to write telemedicine on scripts that haven’t had an in-person by the prescriber and pharmacies can elect to not fill them.
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You have a specific attorney that looks into these matters for you or what kind of attorney are you referring to
 
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forchinet121 said:
You have a specific attorney that looks into these matters for you or what kind of attorney are you referring to
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I have an attorney that reviews new clinic contracts, reviews child custody related matters, helps get us out of testifying in civil matters, and advises on healthcare related changes.
 
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nexus73 said:
Telehealth with limitations like the person's home address and pharmacy must be within 100 miles of your clinic location would solve the problem for 99% of doctors. Maybe the distance could be debated. It would have to be within proximity to the doctors actual clinic, not like Talkiatry is leasing office space there but the doctor actually works 2000 miles away.

Anything that gives carte blanche for prescribing controlled substance completely over telehealth regardless of distance means the pill mills have total reach to anywhere in the country, which will just continue unsafe practice and bad medicine. Which is exactly what Ryan Haight Act was intended to prevent. It's just that the capitalism of mental health being scalable over telehealth creates a breeding ground for startups to function as drug dealers for stimulants, benzos, ketamine, etc, under the guise of improving access.
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Take my 1000 upvotes if I could. The great docs I know who worry about this impacting their practice are missing what is going to happen to controlled substances and the legitimate practice of medicine in general if these rules are not enforced.
 
FlowRate said:
Looks like the DEA may have asked to extend telehealth flexibilities: Pending EO 12866 Regulatory Review
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Yeah, they've been ducking the responsibility of creating a registration process since 2008 despite their legal mandate and once they started saying these proposed rules were going to satisfy that requirement, it became really hard for them to get away with just reverting to the previous rules.
 
clausewitz2 said:
Yeah, they've been ducking the responsibility of creating a registration process since 2008 despite their legal mandate and once they started saying these proposed rules were going to satisfy that requirement, it became really hard for them to get away with just reverting to the previous rules.
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Registration process for what?
 
FlowRate said:
For any patients established by Nov 11 2023 you have full telemed flexibilities to Nov 11 2024. But any new patients after Nov 11 2023 will be under whatever new (or old) R-H rules apply.
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Sounds pretty good overall hopefully the just extend everything in perpetuity
 
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And tele psychiatrists everywhere breathe a huge sign of a relief!!!
 
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This only applies to existing patients, not new intakes, right?
 
New telemedicine intakes before Nov 11, 2023 count for the one year grace period after that date.
 
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Yea, still going to be telling my telehealth patients that they need to get their controlled substances from their PCPs. I don't have time to call 6 pharmacies for every patient on Adderall trying to figure out who has enough pills to fill their Rx.
 
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Stagg737 said:
Yea, still going to be telling my telehealth patients that they need to get their controlled substances from their PCPs. I don't have time to call 6 pharmacies for every patient on Adderall trying to figure out who has enough pills to fill their Rx.
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Why would you be doing that? I send it to the pharmacy of their choice then it’s on them to call around
 
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