How to Prepare for the Proposed Changes to Telehealth Prescriptions

During the pandemic, the expansion of telemedicine proved transformative for many people, especially those in rural areas. It allowed patients to receive medical care and prescriptions virtually, without the need to meet a provider in person.

On May 11, however, the pandemic public health emergency is set to expire, and the Biden administration has proposed new rules for prescribing certain medications online once it ends. If and when these proposals go into effect, doctors will need to follow different, more restrictive guidelines when writing online prescriptions for controlled medications like the attention deficit hyperactivity disorder drug Adderall; the addictive painkiller OxyContin; Xanax, which is used for panic or anxiety disorders; and the anticonvulsant drug Klonopin, which is also used to treat anxiety.

The proposals underwent a 30-day period of public comment, which ended March 31. The Drug Enforcement Administration will now review the comments and draft the final regulations, the agency said in a statement.

If the proposals are approved as currently written, patients who are receiving prescriptions for controlled medications from a provider they have never seen in person will need to have at least one in-person appointment after the public health emergency ends in order to continue receiving their prescriptions.

News of the proposals has been met with criticism, praise and confusion. So The New York Times asked Dr. Shabana Khan, a child and adolescent psychiatrist and the chair of the American Psychiatric Association’s committee on telepsychiatry, to help people who take mental health medications understand the anticipated changes and how to adjust for them.

Questions and answers have been condensed and edited for clarity.

Is there anything patients can do now to ensure that they don’t experience a disruption in their controlled medicine prescriptions?

If you are currently a patient being prescribed a controlled medication by a telemedicine practitioner who you have never met in person, contact them now to ask about this issue and work with them to develop a plan. If it is possible to see your telemedicine practitioner in person, schedule that appointment as soon as you can, rather than waiting until May 11.

The DEA’s proposed rules include a 180-day extension, which would allow patients to continue receiving prescriptions online until Nov. 7 without seeing anyone in person. Does that mean patients can bank on having extra time beyond May 11 to figure this out ?

We won’t have the proposed 180-day extension unless it is included in the final regulations. And even if we do have that extension, it is helpful to schedule your in-person appointment now, because for various reasons there can be delays.

Over the past three years, many patients have received care completely remotely and were prescribed a controlled medicine. All of these patients will need to schedule an in-person visit, and that will lead to a bottleneck and scheduling delays.

Also, in preparation of the upcoming changes, many practitioners may decide now that, moving forward, they will not prescribe a controlled medicine for new patients unless they are seen in person. This could also result in delays.

What if you cannot see your telemedicine practitioner in person?

Ask them about other options to ensure that you are able to continue your medication. Your telemedicine practitioner may refer you to someone else locally who can see you in person.

Can you explain a little more about how the referral process works? Would the in-person doctor take over the prescription from that point onward?

Not necessarily. Let’s say the telemedicine practitioner has prescribed a 30-day supply of medicine without having seen a patient in person. After that, the telemedicine practitioner can refer the patient to another DEA-registered practitioner who can see them in person. The in-person practitioner can then make a referral back to the telemedicine provider, who can continue to prescribe the medicine. This would be a “qualifying telemedicine referral” under the proposed rule.

So in this scenario we’re sort of ping-ponging between referrals then?

That’s what it’s sounding like, yeah.

Do you need to see someone in person every time you need a prescription refill for a controlled medicine?

The DEA requires just one initial in-person examination, whether it’s with the telemedicine doctor themselves or the other practitioner.

However, practitioners do have to look at state rules as well. States may have different requirements around controlled substance prescribing, and typically practitioners have to follow whatever requirement is more strict.

Additionally, an individual, organization or practice may have their own policies on controlled medicine prescribing.

Can someone see their primary care doctor or pediatrician for an in-person appointment if they can’t find a mental health provider ?

Yes, primary care providers and pediatricians can see a patient in person as part of a “qualifying telemedicine referral” outlined in the proposed rule. However, some may not feel comfortable doing this, given that they are not experts in diagnosing or treating the condition the controlled medicine is being prescribed for.

What are some other ways to try to find someone for an in-person appointment?

Contact your health insurance provider for a list of local referrals. It may be particularly challenging to connect with a new doctor in areas with an uneven distribution of specialists or in parts of the country where there is a shortage of providers, so starting the process now is key. The sooner, the better.

This article originally appeared in The New York Times .