Premier Comments on DEA Telehealth Proposed Rules

Premier submitted comments to the Drug Enforcement Agency (DEA) on the prescribing of controlled substances via telehealth upon the end of the public health emergency. In its letter, Premier expressed concern that the agency’s approach is too restrictive and fails to build upon the lessons learned during the pandemic, the positive results documented on patient access and outcomes, and the work of other agencies in this area such as recent Substance Abuse and Mental Health Services Administration (SAMHSA) proposals to further reduce restrictions on OUD providers. Therefore, Premier recommends the following:

• The DEA should align additional flexibilities for the prescribing of controlled substances with the Congressional timeframe for telemedicine extension. Therefore, DEA should consider an approach that permits additional waivers and flexibilities through Dec. 31, 2024 with an intent to further revise and refine based upon the availability of additional data at that juncture.
• The DEA should permit the prescribing of non-opioid Schedule II controlled substances via telemedicine for mental and behavioral health indications considering the national shortage of mental and behavioral health professionals, especially for the pediatric population. Individual prescriptions should be limited to 30-day supplies and require two-way audio-visual telecommunications (e.g. no audio only). The flexibility should continue through Dec. 31, 2024.
• The DEA should not permit the prescribing of opioid Schedule II controlled substances via telemedicine.
• The DEA should permit the prescribing of Schedule III-V controlled substances via telemedicine. Individual prescriptions should be limited to 30-day supplies with no refills. The flexibility should continue through December 31, 2024.
• The DEA should permit the prescribing of buprenorphine for OUD via telemedicine considering the national shortage of mental and behavioral health professionals. Individual prescriptions should be limited to 90-day supplies with no refills. The flexibility should continue through December 31, 2024.
• The DEA should hold prescribers accountable for fulfilling the obligations of the practice of medicine when prescribing controlled substances via telemedicine.
• The DEA should continue to gather data on the impact of prescribing flexibilities from controlled substances on patient access and outcomes while also studying the prevalence of diversion and abuse. The DEA should reissue proposed regulations in advance of expiration of these interim flexibilities in December 2024 to develop a permanent policy that is rooted in evidence.