PHA supports finalizing DEA’s permanent telemedicine rule on its November timeline. The following seven recommendations would make it workable in practice. Each reduces cost without removing a safeguard on which the rule relies, and each was also requested on the public record by leading medical, hospital and pharmacy organizations. PHA submitted specific replacement language for each provision to the Office of Management and Budget, which is reviewing the final rule under Executive Order 12866.
- One national registration. Clinicians list the states where they treat patients on a single DEA special registration, rather than obtaining a separate registration, at a separate fee, for each state.
- Prescribing standards for Schedule II medications. Replace the proposed same-state and 50 percent prescribing limits with the proposed rule’s specialist and treatment-purpose requirements, and add board-certified internal medicine, family medicine and addiction medicine physicians to the advanced registration.
- Achievable prescription database checks. Before prescribing, clinicians query the patient’s home-state monitoring program, including the interstate data it returns, and document the query in the chart. A nationwide check takes effect once DEA confirms a single national query tool is available. By DEA’s own estimate, these checks account for 97 percent of practitioner compliance costs.
- A focused telemedicine platform definition. Entities that host medical records, provide flat-fee administrative or technology services, or hold pharmacy arrangements that do not vary with prescribing should not be required to register with DEA as telemedicine platforms.
- No duplicative pharmacy reporting. Remove the proposed monthly pharmacy report, since pharmacies already report every controlled prescription they fill to state monitoring programs, and limit the annual report to Schedule II prescription counts by state. A pharmacist who verifies the prescriber’s registration through DEA’s validation tool and fills in good faith should not be liable for a defect in the form of the prescription.
- Identity verification consistent with state law. Clinicians verify each patient’s identity by a method consistent with the law of the patient’s state and document it in the chart, rather than storing a photograph of every patient holding a government ID.
- A 12-month compliance runway and bridge. Set a compliance date 12 months after publication; allow clinicians with a pending application to continue prescribing; extend current flexibilities through the compliance date; and include a severability clause so the remainder of the rule stands if any provision is challenged.
