Tensions between pharmacists and telehealth companies are surfacing as the two groups attempt to sway federal regulators on the issue of virtual prescriptions.
During public listening sessions Tuesday and Wednesday, telehealth companies whose business strategies depend on the remote prescribing of medications were broadly supportive of making permanent current flexibilities allowed by the Drug Enforcement Agency. The majority of pharmacy stakeholders expressed skepticism.
The DEA is weighing potential changes to its proposed remote prescribing rules. In May, the agency extended remote prescribing flexibilities for some controlled substances until Nov. 11. Its originally proposed rule in February would have allowed Schedule III-V substances like codeine, Xanax and Ambien to be prescribed over telehealth only for an initial 30-day dose. After the 30 days, patients would need to see a doctor once to get a refill. Schedule II substances like Vicodin, OxyContin, Adderall and Ritalin would have gone back to requiring an in-person visit before getting prescribed virtually.
Read More: Telehealth companies lobby on prescribing as DEA mulls rule change
The agency said it received a record 38,000 comments on its proposed rule—many of which were critical.
After Nov. 11, new relationships for the remote prescribing of controlled substances cannot be established unless the DEA publishes revised guidance. Relationships between provider and patient established before Nov. 11 can continue operating under the prior rules into next year.
Pharmacists who testified said maintaining the current framework indefinitely would create lasting challenges.
“At present, pharmacists are held to what seems to be an almost arbitrary and a nearly impossible standard of ensuring a valid patient [and] provider relationship exists before a prescription can be dispensed,” Tony Pratt pharmacy director at Piedmont Access to Health Services, a Virginia-based Federally Qualified Health Center, said Tuesday. “While pharmacists are typically comfortable with practices of our own local providers, it has become increasingly difficult to maintain this standard with the growth of out-of-town referrals to specialists and even more so with telehealth.”
While Pratt and the National Association of Chain Drug Stores supported the increased access to care offered by telehealth providers, many testified that it created challenges for pharmacists attempting to determine whether the prescriptions from unfamiliar providers were legitimate.
“I may only see one prescription from that physician,” Kevin Duane, a Jacksonville, Florida-based pharmacy owner, testified Tuesday. “You have to look in other places to understand was this prescription issued for a legitimate medical purpose in the usual course of professional practice.”
The potential middle ground could be a special registration process for large telehealth providers—a measure supported by the chain drug stores group as well as a group of researchers that testified.
"We believe that there is a potential compromise,"said Lori Uscher-Pines, a health services researcher at RAND Corporation, a nonprofit think tank. "When choosing between a guardrail that creates additional hurdles for patients or for clinicians, choose to inconvenience the clinician."
The American Hospital Association testified Wednesday it supported a special registration process that complemented current licensures by adding fields to existing forms physicians prescribing controlled substances are already required to complete.
The American Telehealth Association, a trade group representing a number of telehealth providers, supports some aspects of a special registration.
Kyle Zebley, executive director of ATA Action, a lobbying arm of the American Telemedicine Association, has said the ideal outcome for his members would the creation of a credentialing process by the DEA that would allow virtual providers to continue offering care without in-person restrictions.
On Wednesday, a bipartisan group of six of senators shared a letter sent to the agency outlining support for a special registration.
"Although we appreciate DEA not requiring a special registration for the initial prescriptions currently proposed, we are concerned that the proposed rule does not include the special registration directed to be created by Congress and even envisioned by the DEA," it read. "We appreciate the continuation of the comment process via public listening sessions, and encourage the DEA to review and incorporate stakeholders’ feedback in future rulemaking related to telemedicine prescribing."
