AHA Comment Letter to DEA on Telemedicine Prescribing of Controlled Substances Proposed Rule

March 29, 2023

The Honorable Anne Milgram
Administrator Drug Enforcement Administration
Submitted Electronically

Re: Telemedicine Prescribing of Controlled Substances When the Practitioner and the Patient Have Not Had a Prior In-person Medical Evaluation

Dear Administrator Milgram,

On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the American Hospital Association (AHA) appreciates the opportunity to provide feedback on a Drug Enforcement Administration (DEA) proposed rule for the telemedicine prescribing of controlled substances when there has not been a prior in-person medical evaluation. We are submitting separate comments on the DEA’s related proposed rule regarding the expansion of the induction of buprenorphine via a telemedicine encounter.

We recognize and appreciate the DEA’s continued efforts to support the safe prescribing of controlled substances via telehealth during the COVID-19 public health emergency (PHE). Indeed, during the COVID-19 PHE, the DEA enacted certain flexibilities to ensure patients could continue to receive lifesaving medications via telehealth while minimizing exposure and preserving provider capacity. These flexibilities, including waiving required initial in-person visits prior to prescribing controlled substances via telehealth and allowing the use of telephone evaluations to initiate buprenorphine prescribing, have proved critical in ensuring patients’ access.

The Ryan Haight Act of 2008 outlined specific requirements for in-person evaluations prior to the prescribing of controlled substances. However, this law also outlined several categories where an in-person evaluation could be waived, including, but not limited to PHEs (as was the case during COVID-19) and other circumstances to be defined by regulation. This category of “other circumstances” was an opportunity for the DEA to, in this rule, utilize lessons learned from the pandemic to set forth policies and pathways for providers to continue to safely administer prescriptions virtually, even after the PHE period ends. Instead, this proposed rule would impose burdensome restrictions and additional administrative requirements on providers and patients, which we are concerned will adversely impact patient access to medically necessary treatments. Therefore, we have several recommendations, outlined below, that we urge the DEA to adopt, each supporting improved access while continuing to ensure the safe prescribing of controlled substances.

Most importantly, we urge the DEA to expeditiously set forth a special registration process regulation to identify a pathway to waive in-person evaluations prior to the prescribing of controlled substances for practitioners who register with the DEA. Further, we strongly urge the DEA to extend the waivers for the in-person visit requirement for prescribing of controlled substances until the agency, with significant stakeholder input, develops and proposes such a process for prescribing controlled substances via telemedicine.

View the detailed letter below.