A recent article on the Healthcare Law Today web site discussed how telemedicine providers are dealing with e-prescribing and controlled substances. As providers become more comfortable with delivering care via telemedicine, telehealth, and digital health technologies, some are exploring services beyond low acuity consults. One area of opportunity – and notable confusion – is prescribing controlled substances via telemedicine. This particularly affects specialties that couple chronic disease management with pharmacotherapy.
Providers are increasingly inquiring about telemedicine prescribing laws and rules, as well as strategies and approaches for business models and service lines that not only satisfy patient needs, but comply with the layers of intersecting state and federal laws on telemedicine, medical practice, fraud and abuse, and controlled substances. Indeed, telemedicine prescribing of controlled substances was one of the “Telehealth Top 10” for 2015, and has only continued to generate interest since that time.
What is the Federal Ryan Haight Act?
The Ryan Haight Online Pharmacy Consumer Protection Act was designed to combat the rogue internet pharmacies that proliferated in the late 1990s, selling controlled substances online. The Act took effect April 13, 2009 and the Drug Enforcement Agency (DEA) issued regulations effective that same date. The Act essentially imposed a federal prohibition on form-only online prescribing for controlled substances. Although the Act was intended to target “rogue” internet pharmacies, legitimate healthcare providers who prescribe controlled substances via telemedicine must carefully review the regulations to ensure compliance.
What Does the Ryan Haight Act Mean for Healthcare Professionals?
Under the Ryan Haight Act, no controlled substance may be delivered, distributed, or dispensed by means of the internet (which, for all practical purposes, includes telemedicine technologies) without a valid prescription. A valid prescription is one that is issued for a legitimate medical purpose in the usual course of professional practice by: 1) a practitioner who has conducted at least one in-person medical evaluation of the patient; or 2) a covering practitioner. An “in-person medical evaluation” means a medical evaluation that is conducted with the patient in the physical presence of the prescribing practitioner, without regard to whether portions of the evaluation are conducted by other health professionals.
While the DEA has historically viewed the lack of an in-person medical evaluation as a red flag of potential drug diversion, the Ryan Haight Act makes it unambiguous that it is a per se violation of the federal Controlled Substances Act for a practitioner to issue a prescription for a controlled substance by means of the Internet without having conducted at least one in-person medical evaluation, except in certain specified circumstances. Once the prescribing practitioner has conducted an in-person medical evaluation, the Ryan Haight Act does not set an expiration period or a mandatory requirement of subsequent annual re-examinations (although specific controlled substances, such as suboxone, may have their own rules). Of course, this does not mean that conducting one in-person medical evaluation is sufficient in every clinical situation. Even where the practitioner has conducted an in-person exam, a prescription for a controlled substance must still be issued for a legitimate medical purpose by a practitioner acting in the usual course of his or her professional practice.
Can a Health Care Provider Prescribe Controlled Substances via Telemedicine?
The Ryan Haight Act does not prohibit the use of telemedicine to prescribe controlled substances, and a provider may do so if federal and state requirements are met. However, the challenge for many providers is understanding these laws and applying them to the processes of their specific service line or business. There are solutions and approaches that can work for primary care practices, hospitals, telepsychiatry groups, and the like.
EazyScripts is one of those solutions. We have taken into consideration all of the compliance issues dealing with telemedicine e-prescribing in the development of our e-prescribing software. The benefits of e-prescribing software can be extended to prescribers, payers, pharmacies, and patients. In general, the benefits of e-prescribing fall into the following categories: patient safety, improved prescribing, efficiency/workflow, and cost savings.
E-Prescribing is rapidly growing in the telemedicine field, not just because of the technology, but because of the substantial benefits for patient’s safety and physicians’ workflow. The advantages of e-prescribing for telehealth providers are numerous:
- Prevents prescription drug errors — e-Prescribing eliminates handwriting errors/illegibility and gives both physician and pharmacist access to a patient’s prescription history to reduce the chance of the wrong drug being dispensed.
- Speeds up the medication reconciliation process — clinicians can instantly view a patient’s medication history and won’t have to manually reconcile medication lists or commit clinical information to memory, such as drug-drug interactions.
- Instant notification of allergies, drug interactions, duplicate therapies and other clinical alerts — e-Prescribing gives physicians full visibility into all of a patient’s documented allergies and previously prescribed drugs and will trigger clinical alerts if a newly prescribed drug has any potential for negative reactions.
- Monitor controlled substances abuse — enables physicians to electronically prescribe and monitor controlled substances in a single workflow. With e-prescribing, physicians can track how many controlled substance prescriptions a patient has received, reducing the likelihood of over-prescribing or doctor shopping.
- Reduces the risk of readmissions –built-in safety features such as clinical alerts and duplicate therapy alerts reduce the risk of adverse drug reactions. Roughly 20 percent of all hospital readmissions can be traced to adverse drug reactions.
- Improves medication adherence — chronic underuse of medications is the most common form of non-adherence, with patients using a lower dose than was prescribed or prematurely stopping therapy.
- Makes it easier to verify insurance — E-Prescribing tools make it easier to choose formulary medications that will be covered by the patient’s drug benefit. Prescribing a drug the patient can afford makes it more likely that the patient will fill it and take it.
These advantages were confirmed recently in an article in the American Health Information Management Association (AHIMA) newsletter, Perspective. The article cites statistics that illustrate just how effective e-prescribing can be in improving patient safety and the quality of healthcare.
Results of their research show that e-prescribing reduces prescribing errors, increases efficiency, and helps save on healthcare costs. Medication errors have been reduced to as little as one-seventh of their previous level, and cost savings due to improved patient outcomes and decreased patient visits are estimated to be between $140 billion and $240 billion over 10 years for healthcare organizations that implement e-prescribing.