DEA Proposes Permanent Telemedicine Flexibilities for Prescribing Controlled Medications

February 28, 2023

On February 24, the Drug Enforcement Administration (DEA) announced proposed permanent rules for the prescribing of controlled medications via telemedicine. The summary below includes relevant provisions for the oncology community in the proposal, but it does not include provisions regarding buprenorphine prescribing for opioid use disorder. That information is available via the “Additional Resources” section at the end of this document.

Patients Previously Evaluated In-Person

If a provider has evaluated a patient in-person at least once, they may prescribe that patient any scheduled controlled medication via telemedicine so long as the prescription is otherwise authorized by applicable federal and state law.

Patients Not Previously Evaluated In-Person

Existing Telemedicine Relationships

If a provider has a telemedicine consultation with a patient with whom they have an existing telemedicine relationship formed during the COVID-19 Public Health Emergency (PHE), but whom the provider has not evaluated in person, the proposed rules maintain telehealth flexibilities established during the PHE for an additional 180 days from the end of the emergency. To continue prescribing a controlled medication such a patient beyond 180 days from the end of the PHE, a provider must conduct an in-person medical evaluation of the patient.

Prescriptions written by medical practitioners via telemedicine during this 180-day period will require additional recordkeeping.

First-time Telemedicine Consultations

Permitted: 30-Day Supply of Schedule III-V Non-Narcotic Controlled Medication

For a first-time telemedicine consultation with a patient that has not been previously evaluated in person and was not referred by a medical practitioner who evaluated the patient in person, providers may prescribe up to a 30-day supply of a Schedule III-V non-narcotic controlled medication.

To issue more than a 30-day supply, providers must first conduct an in-person medical evaluation of the patient. This can include the patient’s in-person visit with another practitioner while on an interactive video link with you as prescribing practitioner.

Prescriptions written by medical practitioners via telemedicine based on a referral will require additional recordkeeping.

Not Permitted: Schedule II or Narcotic Controlled Medication

If you have a telemedicine consultation with a patient who you have not previously evaluated in person, did not first form a telemedicine relationship during the PHE, and was not referred to you by a medical practitioner who evaluated the patient in person, you may not prescribe a Schedule II or narcotic controlled medication.

Referrals

If another medical practitioner has conducted at least one in-person evaluation of a patient and subsequently refers the patient to you in the manner described in the rules, you would be able to prescribe that patient any scheduled controlled medication via telemedicine, so long as the prescription is otherwise authorized by applicable federal and state law.

Prescriptions written by medical practitioners via telemedicine based on a referral will require additional recordkeeping.

Additional Resources

  • DEA proposed rules summary chart
  • DEA highlights of the proposed rules for medical practitioners
  • DEA flowchart for patients
  • Telemedicine Prescribing of Controlled Substances When the Practitioner and the Patient Have Not Had a Prior In-Person Medical Evaluation proposed rule
  • Expansion of Induction of Buprenorphine via Telemedicine Encounter proposed rule

The public will be able to comment for 30 days on the proposed rules.

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