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Telemedicine Controlled Substance RXing Update

Content Asian medic having video call during telemedicine consultation

Big hello to my nurse practitioner sisters and brothers! I come with semi-good news for those who prescribe controlled substances via telemedicine!

Many of you are already aware of the upcoming restrictions in terms of our ability to prescribe controlled substances via telemedicine that will go into effect in May (I wrote about that a couple weeks ago HERE for those that have no idea what I am talking about just FYI.). I know this has been anxiety producing for many of you, but it looks like the DEA pulled through with some new updated regulations, as I expected they would.

So, the DEA just announced some new proposed PERMANENT rules and regulations for the prescription of controlled substances via telemedicine. In a nutshell: they realize that the prescription of schedule III-V non-narcotic controlled substances has been done in a relatively safe manner over the past 2 years since the beginning of the COVID pandemic and they are going to permanently extend our ability to do so. Now, this isn’t 100% set in stone yet, but when they propose rules like this, it typically becomes the case. Therefore, I am confident we can expect this to become the permanent standard of care for the issuance of controlled substances via telemedicine. But lets hope they listen to the feedback from the medical community.

Now, to summarize specifics that you need to know:

The DEA is going to extend many of the flexibilities adopted during the public health emergency.

These rules will not involve telemedicine consultations that result in a prescription of a non-controlled substance, so don’t worry about any of this if you don’t prescribe any controlled substances.

If you have ever conducted an in-person visit with a patient and issue them a controlled substance prescription via telemedicine, then you don’t need to worry about this.

If another medical provider, who has done an in-person visit with the patient, refers you the patient and you see them via telemedicine, then you can issue them a controlled substance prescription. There are no specifics outlined with this, so it will be interesting to see if there are any updates with this regulation.

If you have never seen the patient in-person, you will have the ability to provide them 30-day supplies for a prescription at a time of schedule III-V non-narcotic controlled medications. It appears this is only limited to a one time supply, and then an initial in-person visit needs to be done.

You can prescribe a 30-day supply of buprenorphine for the treatment of opioid use disorder without an in-person visit.

You need to ensure you are still following the standards of care and following federal and state law when it comes to prescribing a controlled substance.

That basically summarizes it up. It appears that they are going to request public opinions on the matter and use those before drafting the final regulations and pushing this through. You can read more about all of this at this THIS link. I am glad that they are making these preparations 3 months before the previous restrictions go back into effect, so I think many of us will be in the clear that operate telemedicine practices that prescribe controlled substances such as testosterone and other various non-narcotic medications.

The big take away from this is that you can prescribe an initial 30 day supply of controlled substances for patients that you have NOT seen in-person. But it also appears that it is only for a one time supply… The announcements from the DEA in this regard are confusing so we can hope to see some additional clarification here.

We will see what comes out of the public forums and backlash from the medical community to the DEA. If it is in fact just a one time 30-day prescription, that is not very helpful for those with 100% telemedicine practices. Hopefully they will be more helpful and liberal about this as a one time 30-day prescription does not help those with telemedicine practices that much. It is a step in the right direction though.

27 Responses

  1. I am thinking of starting a medical marijuana certification telemedicine business in New York State. I imagine that this is considered a controlled substance but do not see any information on this on the state website. I was hoping to structure the business as telemedicine only, so now with the new regulations I am not sure if that is possible.

      1. So performing medical marijuana certifications is not considered ‘prescribing a controlled substance’? All I can find is that marijuana is still considered schedule I and do not see any specifications for medical marijuana. As I want this business to be telemedicine only I want to make sure that these changes will not hurt my proposed business.

        1. You are not prescribing anything… you are signing off on a card that states they are qualified to purchase medical cannabis in the state. All explained in the medical cannabis clinic course

  2. This new regulation for CIII-CV means we don’t have to see patients in office at all, but we have to schedule a follow-up telemedicine visit with them monthly to provide the above CIII-CV meds?
    What about my current ADHD patient? I understand that any new ADHD patients requiring CII will be in office the first time. What about all the follow-up ADHD patients I have? Continue monthly every 30 days refills and seeing them monthly?

    Thank you for clarification.

    1. Not sure how often you have to see the patient… I don’t see much guidance on that issue yet. More rules will come out.

      As long as you have seen the patient one time in person, you can continue prescribing CII

  3. Justin, just to clarify, it’s a 30 day rx whether you have or have not seen the patient in person? Thank you for this great news!

  4. For a tele-visit with a patient with no previous in-person visits: The way I read this is not a disqualifying of prescribing testosterone (level 3), but limiting us to a 30-day supply at the initial visit and then an in-person visit is required for additional prescriptions.

    So, my interpretation is that once we issue a 30 day controlled RX via telehealth, if not seen in person previously they have to be seen in person for any refills. As it’s written now as a proposal prior to public comments. If I see this correctly, you may consider an addendum to the article. To stay compliant with regulations, if not changed, it does not appear we can just write 30-day refills.

    1. Ya I just went through it some more. There are some contradictory statements in this announcement and confusion. I updated the article. We will see what comes of this.

    1. Thanks, just say that PDF. I wish they would have been more forthcoming with their announcement and not have so many contradictory statements.

  5. Either way to see this new proposed rule change, if someone has been on Ambien for example and he or she will come to me as a new patient to continue treatment, I can only give them a 30 supply and they still have to find someone in office to continue refill it. Therefore we are all limited for a 30 day one time prescription, and if you are like me 100% telemedicine in rural areas, those patients will be doomed again in 30 day.
    This is not good guys.