Virtual prescribing of controlled substances is in limbo as PHE winds down

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Meanwhile, telehealth and traditional providers affected by the measure are figuring out their contingency plans.

Ophelia Health treats opioid use disorder virtually and its clinicians prescribe buprenorphine without ever seeing patients in person. Zack Gray, CEO and co-founder, said the company believes the government will make the waiver permanent beyond the public health emergency for buprenorphine, which is a Class III substance used for opioid use disorder. It could also tie the waiver to the open-ended opioid public health emergency rather than the COVID one that expires in May, Gray said. 

“We are taking the approach that any contingency plan is unlikely to be necessary based on guidance that we’re getting from the government,” Gray said.

The company has an office in Philadelphia that Ophelia can use in-person visits, Gray said. It also can work with affiliated licensed clinicians to assess patients in person before handing the patients off to the company for virtual care.

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Bicycle Health, a virtual care startup providing opioid use disorder treatments, was founded in 2017 with a single clinic in Redwood City, California.  After COVID, the company went exclusively virtual. While  founder and CEO Ankit Gupta said he is optimistic the waivers will be granted, they’ve had internal discussions about how to shift delivery of care in the event of a stringent enforcement decision. 

“It obviously increases risk [for providers],” Gupta said. “Every provider with a DEA license that is hired by Bicycle Health and any other company has to make that decision for themselves.”

Gupta said he expects some providers will stop prescribing the medications. Last year, the company sent providers to self-created pop-up clinics to satisfy in-person visit requirements in Alabama.

“I can’t give you a firm plan now but it will essentially be a scaled-up version of what we did in Alabama,” Gupta said. “It will probably significantly decrease the number of patients we can serve.”

Virtual providers operating in adjacent spaces to addiction treatment have similar worries.

Talkiatry, a virtual mental healthcare company, employs more than 400 psychiatrists and 60 therapists serving patients in 48 states and the District of Columbia. CEO Robert Krayn said individuals living in rural areas without mental health professionals would be the most acutely affected by the end of this flexibility.

“There are certain medications that we’re not going to be able to prescribe, even if it’s the best medication for the patient,” Karyn said. “That’s really unfortunate because there’s nobody else who can prescribe it to them because there’s no psychiatrist [where] most of these people live.”

Krayn said Talkiatry was able to expand access “significantly faster” without the burdens and costs associated with in-person clinics. He said the company has no capacity to see patients in-person.

“We do not have any infrastructure to be able to continue to see these patients,” Krayn said. “89% of our patients don’t live in the same city as their doctor.”

Krayn said approximately 18% or about 10,000 of Talkiatry’s total patients are prescribed medication that would require an in-person visit.

“It’s almost like doctors are going to be forced to make an ethical decision or a legal decision,” Krayn said.

This story first appeared in Digital Health Business & Technology.

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