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Post-Pandemic Telehealth Prescriptions: Here's What May Change for You 2023-04-13
Some changes to how we're able to get prescriptions online are likely coming soon. In late February, the US Drug Enforcement Administration proposed changes to pandemic rules that will affect certain controlled medications that are more strictly regulated by the government once the public health emergency for COVID-19 expires on May 11.
In a nutshell, patients who were prescribed controlled drugs during the pandemic would need to see a provider in person at least once to maintain their prescription. New patients would still be able to get a month's supply for many of these drugs, but would then need to see their provider in person.
The pandemic-era telemedicine boom has been a silver lining for many people over the last three years, at least from a health care access perspective. Along with the burst of new companies offering online health care, restrictions on how providers could treat and prescribe controlled medications were loosened, removing the need for a patient to see a doctor face to face for some key medications, including those for mental health and opioid addiction.
First, the good news: Prescriptions for many common medications and drugs will stay available via online consultation once the public health emergency ends. Common medications that people take to manage a health condition (insulin, blood pressure medication, birth control and more) won't be affected.
The DEA proposes that the new rules, which include specific record-keeping requirements by the telehealth provider, may help curb misuse of controlled medications, which include popular drugs such as Adderall. While there are blind spots in telemedicine, broader telemedicine access has provided health care access for those who don't have an easy time meeting with a provider in person, including people who live in rural areas or who have difficulty getting time off from work. While officials are keeping some aspects of telemedicine open, some experts worry that adding back in-person requirements or referrals will be a barrier to many people who've benefited from telemedicine.
If they're finalized (nothing is set in stone now), the rules will change care for some patients, though there are things you can do to prepare. There's also a proposed grace period for people who were given prescriptions during the pandemic via telemedicine.
Here's what we know.
What the new DEA rules will (and won't) affect
As of now, the pandemic rules for telemedicine are still in effect – the new ones may replace them when the public health emergency for COVID-19 ends on May 11. (The DEA just wrapped up a public comment period, during which citizens and health care groups submitted opinions on the proposal.) If they do change, it'll affect medications differently depending on how they're scheduled: The DEA classifies them based on its perception of the potential for misuse and how the drug is used medically. Schedule I drugs are the most restricted class and include drugs you'd have to buy illegally in many circumstances, including cannabis, LSD and more. At the other end, schedule V drugs include some painkillers and cough medicines, such as Robitussin.
If the proposed rules go into effect and you have a prescription for a schedule II drug, which includes Adderall and Ritalin, you'll need to see a provider face to face in order to fill, or refill, a prescription. If you haven't had a non-telemedicine visit with a provider, you'll need to get one in order to continue your treatment.
For some common anxiety medications, at-home ketamine treatment, drugs for opioid misuse and more, new patients will be able to get a month's supply of medication (30 days) but will need to find an in-person provider to continue their treatment and get a refill. This includes drugs like Ambien, Xanax and buprenorphine. Testosterone, which many transgender patients take as a part of their hormone therapy, is also controlled and will require an in-person appointment. Estrogen is not a controlled drug.
Here's a list of controlled substances so you can find out which class your medication is in. Here is a graphic the DEA has for its proposed rule changes. To be certain about how your medication is classified and how the rules will affect your particular case, check with your prescriber.
Then some wiggle room comes in. According to information from the DEA for medical practitioners, prescriptions written during the COVID-19 pandemic (from when the public health emergency was first declared in 2020 up until its expiration next month) you'll have an additional 180 days to get a referral or an in-person evaluation to keep your prescription active. This should apply to all medications, but check with your provider for specific details on prescriptions. (As with all rules in the proposal, this too might change with the finalized version.)
Many common medications you'd be prescribed at an urgent care or by your family doctor (such as antibiotics, birth control and insulin) are not controlled as strictly by the government and won't be affected by the changed rules, so you'd still be able to get them via telemedicine.
Changes in opioid use disorder medication
Buprenorphine is one of a few medications people can take to manage opioid use disorder, including addiction to heroin. It's essentially a weaker version of methadone. If the new rules go into effect, people who get their first prescription for buprenorphine will need to find an in-person provider within a month in order to keep their treatment – something that many addiction specialists have said poses a barrier to critical treatment.
How will this affect online ADHD treatment or mental health medications?
During the pandemic, there was a burst of online ADHD diagnoses and prescriptions, particularly among younger women. Sites including ADHD Online, Cerebral and Done will all have to abide by the DEA's rules for new prescriptions, should they go into effect later this spring.
According to steps patients need to take in order to keep their prescription active posted by ADHD Online, people with a prescription for something like Adderall will also likely be part of the pandemic-inspired 180-day grace period, meaning you should have until early November to make an appointment or find a "qualifying telemedicine referral" to stay a patient on the site.
How to find an in-person provider
Without the right connections, finding a provider that's able to prescribe controlled medication can be tricky, and expensive. As a good first step, contact your insurance company if you have health insurance and ask them to help guide you. You can also follow these medication-specific tips below.
Finding an ADHD provider
If you're a new patient looking for a new prescription of stimulant medication (schedule II drugs like Adderall) after May 11, you'll need to find an in-person provider who can diagnose and prescribe medication.
Additude Magazine, a publication for people with ADHD, published a guide for what patients should consider when looking for a provider. It's also worth noting that not all ADHD medications are stimulants, and non-stimulant types will have different rules than Adderall, for example.
General tips finding a mental health provider
Because the DEA's rules apply to the prescriptions of drugs, mental health support will still be available through many telemedicine or online therapy companies – whether you're looking for help with anxiety, depression, ADHD or something else. Here's a list of the best online therapy options out there right now, as well as best psychiatry services.
Help finding opioid use therapy
Buprenorphine can be prescribed at a physicians' office, and new patients will be able to get a month's supply if they start treatment online after the DEA's post-pandemic rules are in place. Then you'll need to find another provider to keep with the treatment.
If you don't have a primary care doctor, checking with your local health department would be a great first step. If you started a prescription during the pandemic, your buprenorphine prescription will be carried for the additional 180 days, which means you'll have a few extra months to find an in-person appointment. Big cities might have a directory of places and phone numbers especially for opioid addiction treatment, like this one in New York City.
People living in rural areas with fewer health care centers may have to travel longer distances to find health care. To help narrow down your search, the US Department of Health and Human Services has a provider search. To use it, type in your ZIP code and distance you're able to travel.
For help finding hormone therapy
Patients taking testosterone for gender-affirming care will also need to abide by any updated telemedicine rules post-pandemic. Again, patients living in more rural areas may have a harder time finding an in-person provider to maintain a prescription.
If you don't know where to look, contacting your local Planned Parenthood would be a good resource. Even if the branch doesn't prescribe your particular hormone therapy, they may be able to refer you to another location that does. And as is true for other health care services, if you don't have a primary care doctor, you can find and call your local health department in order to connect you to someone who can get your medication.