MDToolbox Blog

Prescribing Controlled Substances via Telemedicine - What you need to know Post-Pandemic

Thu, 13 Apr 2023 15:31:00 -0500

2025 STATUS UPDATE:

On November 19, 2024 the DEA announced an additional extension: A third extension of telemedicine flexibilities for the prescribing of controlled medications extends the ruling until December 31, 2025. With this new extension, telemedicine providers can continue to see their patients online and prescribe medications without first needing an in person encounter for most medications.

Additionally, the DEA also has proposed 3 New Rules that will be permanent rulings for telemedicine providers - All three are currently under review and we will have more details later this year as they progress and get finalized.

To read the extension go to:

https://www.federalregister.gov/documents/2024/11/19/2024-27018/third-temporary-extension-of-covid-19-telemedicine-flexibilities-for-prescription-of-controlled

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MAY 2023 STATUS UPDATE: On May 9, 2023 the DEA has announced a temporary extension of the Public Health Emergency ruling that allowed electronic prescribing of controlled substances via telemedicine encounters. The flexibilities allowed during the COVID-19 pandemic were set to expire on May 11, 2023. With this new extension, telemedicine healthcare providers can continue to see their patients and prescribe medications without first needing an in person encounter for most medications. The extension has been set for 6 additional months while the DEA reviews feedback they received on their February proposed ruling for new regulations with telemedicine prescribing post-pandemic.

For more information see the DEA press release at:

https://www.dea.gov/press-releases/2023/05/09/dea-samhsa-extend-covid-19-telemedicine-flexibilities-prescribing

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ORIGINAL POST April 2023:

On April 11, the Biden Administration signed a bill ending the pandemic emergency. After three years, the federal public health emergency (PHE) will expire May 11, 2023.

Three years ago when the emergency was declared, several rules that affected healthcare were changed. One of the biggest ones in e-prescribing was the Ryan Haight Act which stated Controlled Substances could not be prescribed via telemedicine. With the new PHE emergency declared, this rule was temporarily paused, controlled substances could now be prescribed via telemedicine without an in person encounter prior to.

The Drug Enforcement Administration (DEA) has proposed a new ruling (Ryan Haight Act Amendment) which would allow limited controlled substance prescribing via telemedicine only visits but it is only proposed – it has not passed yet. If this ruling does not pass, on May 11, 2023 telemedicine only encounters/visits no longer can prescribe controlled substances again. If it does pass then it is likely a limited set of controlled substances will be able to be prescribed via telemedicine.

Details on the Proposed Ruling:

In late February, the DEA announced a set of proposed rules that would both include and roll back some of the flexibilities allowed during the pandemic for the prescribing of controlled substances via telemedicine. Prior to the PHE, in most cases prescribing of controlled substances via telemedicine was not allowed. A prior in person visit was required for schedule 2-5 prescribing.

The proposed new rule which is currently being voted on would restrict Schedule 2 drugs via telemedicine again. However, for many Schedule 3-5 drugs, patients would be able to receive an initial 30-day prescription via telehealth. But after the initial fill, patients will need an in-person visit to get a refill. The proposed rule was open for comments during March and many medical associations and providers have commented they think it should be longer than 30 days, some even saying 6 months or a years worth before needing an in person visit. The main push is because of Schedule 3-5 drugs that treat controlled substance addiction. Many believe giving patients easier access to medicines that treat substance abuse is helping fight the addiction problem in the U.S.

The proposed ruling also contain several other new rules including the requirements for “record keeping” (prescribers would need to be able to produce a list of all patients and medications prescribed via telemedicine on demand if requested by DEA investigation) as well as all prescriptions prescribed by telemedicine would need to include a note that the prescription was prescribed by a telemedicine encounter.

MDToolbox already has the ability to produce reports as well as the ability to include the required note (pharmacy note field) as well as other small enhancements are being considered as we await the final ruling. Another update will be published after the DEA final ruling announcement. To start e-prescribing via telemedicine contact us today to get your free 30 day no-obligation trial. https://mdtoolbox.com/eprescribing-free-trial.aspx

Illinois Mandates Electronic Prescribing!

Thu, 14 Oct 2021 10:12:00 -0500

Illinois Governor JB Pritzker has recently signed the State’s electronic prescribing mandate into law. Illinois House Bill 3596 mandates healthcare providers to electronically prescribe all controlled substance medications with an effective date of January 1^st, 2023.

The Illinois mandate contains the most concise language seen from any state mandate thus far, totaling just over 200 words. The mandate allows for providers who prescribe less than 25 prescriptions in a calendar year an exception for complying with the law. Currently, there are no penalties for non-compliance listed in Illinois. The Act states that violations shall not be grounds for disciplinary actions. The bill states that the Department of Financial and Professional Regulation will establish rules and requirements around implementing further exemptions.

Illinois Figures & Statistics

Illinois is currently above the national average for opioid-related overdose deaths, with roughly 17 deaths per 100,000 people when comparing the population of the State in 2018 to the number of overdoses provided. Prescription opioid overdose deaths continued to gradually rise until rising more sharply in 2015, then began to fall after 2017.[1] Illinois has passed legislation attempting to tackle their Opioid dependence issues. Laws passed in 2010 and 2015 made Opioid Reversal drugs progressively easier to obtain and increased training initiatives involving law enforcement, schools and emergency responders. In 2017 the State allocated federal funds for education and addiction treatment throughout the state including establishing an Opioid Crisis hot-line that is accessible 24 hours per day. Illinois currently requires prescribers to consult the State PMP database when prescribing.

Illinois has a 50.4% prescriber enablement for electronic prescribing of controlled substances, well below the national average of 67.1%. Pharmacy enablement in Illinois for EPCS is 96.6%, just above the national average of 96.1%[2] MDToolbox encourages providers not to wait until the last minute to setup electronic prescribing.

Please see our website for other states that have either passed or have pending legislation that mandates electronic prescribing. MDToolbox looks forward to providing tools and resources to assist providers throughout Illinois to ease the transition and help our customers combat the opioid epidemic. With MDToolbox, providers have access to tools such as Electronic Prescribing of Controlled Substances (EPCS) and convenient on the go e-prescribing with our mobile app! We offer a free 30 day free trial, so Contact us for more information!

[1]https://www.drugabuse.gov/drug-topics/opioids/opioid-summaries-by-state/illinois-opioid-involved-deaths-related-harms

[2]https://surescripts.com/enhance-prescribing/e-prescribing/e-prescribing-for-controlled-substances/

Missouri Passes Bill Establishing State PMP

Tue, 31 Aug 2021 10:38:00 -0500

The State of Missouri has passed legislation establishing their State PMP (prescription drug monitoring program) to track controlled substances that have been prescribed to patients throughout the State in an effort to curb Opioid overdoses. Missouri is the final state in the US to establish a PMP. St. Louis County, along with 75 additional Jurisdictions had previously established its own PMP which now covers 85% of the State population but is not sanctioned by the State. This County-run PMP also recently signed an agreement to share data with 18 other States.[1] The St. Louis County PMP will now likely be absorbed into the State program once it becomes active.

Legislation to establish a State-wide PMP had been presented annually since 2005, but stalled or was dismissed at various stages of the legislative processes. Senator Holly Rehder has filed Missouri’s PMP legislation for nine consecutive years.[2]

Missouri Senate Bill 63 is the 2021 legislation that has become law establishing the PMP. The Act was signed into law by Missouri Governor Mike Parson on June 8^th, 2021. Governor Parson said. “SB 63 will help provide necessary information to health care professionals and empower them to make decisions that better serve their patients and assist in fighting the opioid epidemic in Missouri.” The Act establishes the Joint Oversight Task Force for Prescription Drug Monitoring which will supervise and regulate the collection and use of patient dispensation information. The task force is to contractually enter an agreement with a vendor to operate the program. The St. Louis County PMP currently utilizes Appriss Health as their vendor. The Task Force will also enforce fines that the legislation establishes for dispensers that fail to report controlled substance dispensings.

The legislation goes on to set specifications for data that must be included in the PMP entries by dispensers within 24 hours of dispensing the medication. Beginning January 1^st, 2023, the State is expected to begin phasing in real-time reporting to the PMP, with a mandate for real-time reporting required by January 1^st, 2024.

MDToolbox makes checking most State PMP databases convenient with our PMP Integration. This allows prescribers to pull a patient specific PMP report directly from the prescription writer, drastically reducing the steps required to check the database. Prescribers save time by not having to navigate to another website, login, search for a patient and pull up the report. See our recent blog post on the benefits of integrating your State’s PMP.

While some studies have not found a clinically significant reduction in Opioid prescribing rates due directly to PMP usage, certain specific PMP features have been shown to reduce Opioid related Emergency Department visits. According to a study produced by the Healthcare Cost and Utilization Project[3], States that have implemented mandatory PMP usage have shown a 6% reduction in the growth of ED visits for Opioid overdoses over States that did not require PMP usage. Studies such as this demonstrate that with proper utilization, PMPs can be a powerful tool for reducing Opioid Overdoses.

MDToolbox applauds the State of Missouri for passing legislation to create their PMP and join the rest of the country in further attempting to remedy the Opioid Crisis. We continually encouraging providers to take full advantage of the time and stress saving technologies we provide including Electronic Prescribing of Controlled Substances (EPCS), Electronic Prior Authorization (e-PA) and Real-time Price Transparency as they are important tools to use in fighting the devastating opioid epidemic and making electronic prescribing as convenient as possible for prescribers. Contact us for more information on about electronic prescribing and setting up a PMP Integration.

[1] https://pdmp-stlcogis.hub.arcgis.com/

[2] https://themissouritimes.com/missouri-legislature-gives-final-approval-to-statewide-pdmp-bill/

[3] https://hcup-us.ahrq.gov/reports/PDMPsAndOpioidHospitalizations.pdf