Telehealth prescribing flexibilities may be extended by 1 year

The Drug Enforcement Administration is poised to extend pandemic-era telehealth prescribing rules for a third time.

The agency sent a rule titled third temporary extension of pandemic-era telehealth prescribing rules to the White House’s Office of Management and Budget (OMB) last Thursday. It remains to be seen if the rule will clear OMB given the infighting sources say has been occurring between DEA and the Department of Health and Human Services (HHS) over the guardrails for telehealth prescribing of controlled substances.  

A third temporary extension of the rules would allow telemedicine companies to continue prescribing schedule II-V controlled substances without requiring an in-person visit for a patient. One source told Fierce Healthcare the extension would last for one year.

If the extension goes through, it could bail out the telemedicine companies who have been concerned about the future of telehealth prescribing and the upcoming deadline at the end of the year. 

A third extension would likely punt the decision about a second DEA proposed rulemaking into the next administration, whether under former President Donald Trump or Vice President Kamala Harris. 

The DEA submitted a second NPRM to the White House in June. In late August, a former DEA official gave the details of the rule to Politico and to several lobbyists working closely on extending the telemedicine flexibilities.  

According to Politico’s reporting, the second rule would have required half of a provider’s controlled substance prescribing to occur in-person. It also would have required providers to check every state’s prescription drug monitoring program to see if the patient had been prescribed the medication in another state. Providers have pointed out that this is currently infeasible.  

Reportedly, the rule excluded schedule II substances like Adderall. A source who reviewed the second DEA rule told Fierce Healthcare that is not true. According to the source, the rule includes the ability to prescribe schedule II substances, but with heavy-handed restrictions to the point that the drugs would be virtually impossible to prescribe, the source said.  

A cadre of industry groups have pleaded with the DEA, White House and members of Congress to block the rule. 

Here’s a timeline of how telehealth prescribing rules have evolved in the past four years:

• March 1, 2023: The DEA published a notice of proposed rulemaking (NPRM). This is considered the first DEA telemedicine rule. That rule pulled back COVID-era remote prescribing flexibilities and faced immediate objections from telehealth providers and advocates.

• May 10, 2023: The DEA extended pandemic prescribing flexibilities for six months, to November 2023. This is considered the first extension. 

• May 11, 2023: The federal public health emergency ended. Two days before, on May 9, 2023, the DEA extended telehealth prescribing flexibilities for six months.

• October 10, 2023 – DEA did a second extension of pandemic telemedicine prescribing flexibilities through the end of 2024. 

• June 14, 2024: The DEA’s second notice of proposed rulemaking went to the OMB. This is considered the second proposed rule. It has not been officially proposed to the public. 

• August 28, 2024: A former DEA official leaked some of the big ticket items included in the DEA’s second proposed rule. The rule remains at OMB and has not been proposed to the public. Sources said HHS was not happy with the rule.