DEA announces proposed rules for permanent telemedicine flexibilities

[deleted1153076]

This seems quite limited, almost no different than Ryan Haight. Seems almost easier to not change anything.

No stimulants without in person
30 days max of benzos and bup. Essentially transitioning care to get them somewhere better.

Someone reading this differently?

three approaches

1)One single initial eval in person
2)in person evaluation with another DEA approved provider present(I am using an NP to do this)
3)Telemed referral from PCP(waiting for final rules to see how this would look)

It requires more footwork up front but its not unworkable by any means

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[deleted1153076]

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.

Put this task on the patient. Not our job

 

[Stagg737]

Why would you be doing that? I send it to the pharmacy of their choice then it’s on them to call around

Put this task on the patient. Not our job

D/t the nature of the clinic I inherited and the geographics, this hasn't been working. Irl example from last month:

I prescribe refills of Adderall XR 20mg BID (ultra/rapid metabolizer for 2D6 and 3A4, working 12+ hour shifts) to patient's preferred pharmacy which is the only pharmacy within 30 minutes of them. Pharmacy informs patient they only have 15 tabs available and cannot fill their Rx and only has IR 10mg tabs available (patient would need >200 tabs for equivalent dosing). Patient calls 2 other pharmacies, finds one that can fill it and sends my clinic a message. I see the message next day, cancel the previous order, and place a new order at that pharmacy. Patient calls pharmacy that afternoon to get med and they now only have 20 tabs left, but they do have 20mg IR so pharmacy wants to talk to me to see if this can be done. I discuss that they'd need at least 90 tabs of the IR to suffice and pharmacy says they have 70-something tabs. Now I have to discuss with patient if they want to pay for a partial refill or not. Patient ends up getting the partial refill which they have to drive over an hour to get and lasts them a little more than 3 weeks d/t needing to take it TID to QID depending on shift length. So then restart the merry-go-round in 3 weeks.

I don't go through those lengths for many patients, but there's a small handful that I do because they're the patients with legitimately severe ADHD who get in car accidents or lose jobs when they don't have the stimulants they've been on for 15+ years. This is also a mostly rural population, some patients will have 1 local pharmacy where the whole town gets meds and the nearest Wal-Mart pharmacy/Walgreens is over 60 minutes away where other people will also travel 60+ minutes from another direction to get available stimulants. This clinic is a relatively small portion of my job, so I can take the time to do this for a couple patients, but there's also no reason these patients' PCPs can't be prescribing these either. This was also a clinic I inherited which was not being run how it was meant to, so patients are being transitioned back to PCPs anyway. It's easier to just have a policy of not prescribing controlled substances than to fight with referring PCPs over who will prescribe them on multiple levels.

 

[milesed]

Another extension while they ponder things-

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