Telemedicine Prescriptions and the Ryan Haight Act: What You Need to Know

Special Alert for Physicians in Georgia: The Georgia Composite Medical Board has voted to extend teleprescribing flexibility to Georgia physicians until December 31, 2024. Please see below for the board’s news release, which includes links to related information.

Georgia Composite Medical Board Press Release

Executive Summary:

The COVID-19 pandemic led to unprecedented times including a patient’s inability to meet in-person with their physician. To address this, the DEA issued waivers to the Ryan Haight Act which allowed physicians practicing via telemedicine to prescribe schedule II-V controlled medications, including schedule III-V narcotic controlled medications approved by the Food and Drug Administration (FDA) for maintenance and withdrawal management treatment of opioid use disorder.  

In May 2023, a temporary extension of telemedicine flexibility for the prescription of controlled medication under the Ryan Haight Act was issued. On October 10, 2023, the DEA and HHS issued another temporary rule extending the telemedicine prescribing of controlled substances without an in-person evaluation until December 31, 2024. In other words, the rule means that doctors can continue to prescribe certain drugs, such as opioids, to patients via telemedicine (live video or telephone for buprenorphine), even if they have never met them in person, until the end of 2024 or until new regulations are made.

Background:

The Ryan Haight Online Pharmacy Consumer Protection Act, commonly known as the Ryan Haight Act, is a United States federal law enacted in 2008 to address the growing concerns related to the illegal sale and distribution of controlled substances over the internet.

Prior to the Ryan Haight Act, online pharmacies and telemedicine services posed a significant challenge in ensuring the safe and legitimate distribution of prescription medications. The Act was named after Ryan Haight, a teenager who died from an overdose of prescription medication acquired through an online pharmacy.

A key provision of The Ryan Haight Act requires a prescribing physician to conduct at least one in-person medical examination of a patient before prescribing a controlled substance.

Waivers & Temporary Rules:

When COVID-19 became a Public Health Emergency (PHE), waivers were issued, allowing physicians to prescribe controlled substances via telemedicine without prior in-person visits. This was permitted for Schedule II-V substances if the telemedicine appointment included both audio and visual components. For Schedule III-V drugs, this was allowed when treating opioid withdrawal.

The COVID-19 public health emergency (PHE) officially ended on May 11, 2023. However, to prevent undue stress on the health system and patients, the Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a temporary rule in May 2023, and extended it in October 2023. The rule allows physicians to prescribe certain controlled substances via telemedicine without prior in-person visits, as they did during the PHE.

The temporary rule extends the telemedicine flexibilities established during the COVID-19 PHE until December 31, 2024.

Implications for Physicians:

Until December 31, 2024, physicians can prescribe controlled substances via telemedicine as outlined during the COVID-19 PHE. After this date, new patients will require at least one in-person evaluation prior to the prescription of controlled substances.  One of the major reasons provided for the extension is to address the urgent public health need for continued access to the initiation of buprenorphine as medication for opioid use disorder in the context of the continuing public health crisis.

Conclusion:

Telemedicine emerged as a lifeline for patients and healthcare providers during the COVID-19 pandemic. The flexibility it offered, allowing physicians to remotely prescribe controlled substances, was made possible by waivers to the Ryan Haight Act.

When the COVID-19 PHE officially concluded in May 2023, the DEA and SAMHSA extended the telemedicine flexibilities temporarily. There was a further extension announced in October 2023. This extension eases the transition back to pre-pandemic regulations and provides a bridge for patients and healthcare providers.

For physicians, it's essential to be aware of the evolving telemedicine regulations under the Ryan Haight Act. Until December 31, 2024, they can continue to prescribe controlled substances via telemedicine as they did during the COVID-19 PHE. Beyond this date, new patients will require in-person evaluations before such prescriptions can be issued.

Remaining informed is essential to delivering quality care while complying with the evolving regulations surrounding telemedicine and the prescription of controlled substances.

Additional Resources & Legal Aids:

1. Ryan Haight Online Pharmacy Consumer Protection Act of 2008
2. 21 U.S. Code § 829 - Prescriptions
3. Second Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications
4. DEA & DOJ COVID-19 FAQ