Upcoming end of COVID emergency injects uncertainty into telehealth

After the Biden administration announced an end to the public health emergency for COVID-19 on Monday, psychiatrist Adam Pruett posted a message on Reddit for telehealth clients: Make appointments now, while they still can.

A federal emergency declaration in January 2020 waived the requirement for health-care providers to meet patients in person before prescribing tightly regulated drugs known as controlled substances, ranging from opioids to benzodiazepines. That enabled Pruett, who is based in Vermont, to build a nationwide telehealth practice prescribing ketamine as a mental health treatment.

Once the emergency declaration expires May 11, that practice could be in legal limbo.

“My office is going to plan to operate as normal and follow the law, whatever that may be,” Pruett said by phone Tuesday.

He isn’t alone in his uncertainty. The waiver of in-person requirements fueled a telehealth boom, with providers emerging virtually overnight to prescribe drugs such as Adderall and Ritalin to patients online, raising millions of dollars from investors and treating thousands of patients nationwide.

Those businesses were built on the temporary suspension of a regulation designed to guard against abusing prescription drugs. Without government intervention, the end of the emergency declaration would restore the requirement for doctors to meet patients in person to prescribe a controlled substance.

That could disrupt some patients’ access to drugs they’ve been taking for nearly three years now. Some telehealth companies have been making contingency plans to facilitate in-person meetings, while pressing their case with lawmakers and regulators that telemedicine makes health care more accessible and that the waiver should be permanent.

A Drug Enforcement Administration official said Tuesday that the agency would soon unveil new proposals related to telemedicine.

Wondermed, a prominent telehealth start-up prescribing ketamine, said that as it awaits DEA guidance, “we continue activating our in-person clinic network partnerships to allow the continuation of care for our patients with an in-person consultation.”

The return of an in-person requirement could affect a broad cross-section of patients, from those receiving care for opioid-use disorders to gender-altering care, said Kyle Zebley, a senior vice president for the American Telemedicine Association, which lobbies on behalf of the industry. Such patients, he said, “will have to try to find in-person care in an overburdened health-care system with too few providers.”

Zebley said two pending regulatory actions could create a framework for providing controlled substances by telehealth: a special DEA registration process, and a separate rule regarding Buprenorphine for treating opioid addiction.

Sen. Mark R. Warner (D-Va.) has called on DEA and Justice Department officials to explain their plans to ensure continuity of care for patients who have been prescribed controlled substances virtually.

In December, the Justice Department responded to an August letter from Warner, saying it is “committed to publishing regulations that will allow legitimate telehealth providers to continue treating patients” when the emergency declaration ends.

Pruett said he is waiting for DEA guidance to inform his next steps. It isn’t clear, he said, whether patients who have been receiving purely virtual care under the emergency declaration must have an in-person visit or if they would be “grandfathered in.”

“I’m just going to hold steady until the end of March, until I start to think about what I need to put in place,” he said, “if I need to start talking to patients about making a trip to Vermont.”