Industry Voices—The DEA should consider most disadvantaged in teleprescription rules
Despite significant advancements, many Americans struggle daily with serious and disabling medical conditions—such as obesity, spina bifida, and psychiatric disorders—and are unable to access dependable, quality healthcare either because of where they live or because of mobility limitations due to age or poor health status.
From inadequate transportation options, hospital closures and a lack of qualified providers, to limited local offerings of treatment options, millions of individuals and families face a variety of challenges that impede their access to high-quality care.
These barriers, in turn, impact their health and well-being.
Patients in rural and underserved communities along with the elderly are particularly vulnerable. By 2032, the Association of American Medical Colleges estimates there will be a shortage of between 21,100 and 55,200 primary care physicians in the U.S. Individuals living in rural areas are almost five times less likely to have a PCP than those in urban or suburban communities; 44 million Americans currently live in a county with a PCP shortage (defined as less than one PCP per 2,000 people).
As we know all too well, the cost of care also prevents too many from accessing the services they need.
This is not acceptable. All Americans need access to quality care regardless of their location or personal circumstances. This is where technology-enabled telemedicine must play an essential role in bridging the care gap.
Virtual care, especially with significant advances with smartphones and high-speed internet, provides patients an avenue for safe, convenient, cost-effective treatment, particularly for those in underserved communities or with limited access to care.
As we begin to make much-needed progress in expanding America’s broadband network infrastructure, increasing access to telemedicine will be an indispensable tool in meeting the healthcare needs of hard-to-reach populations or those with mobility and access impediments, such as older Americans, people with spina bifida and other disabilities.
Instead of traveling long distances for an appointment or waiting weeks to meet with a physician or other provider in person, patients can have timely access to a healthcare provider via telemedicine. Using a smartphone, a tablet or a desktop computer, patients can have a face-to-face encounter with a healthcare provider. Patients not only can connect with healthcare experts faster and at a lower cost, but smaller, rural hospitals can improve continuity of care and offer specialized care to patients.
For example, with a nationwide shortage of psychiatrists, rural hospitals often do not have one on staff but can still offer psychiatric evaluation and treatment by giving patients access to psychiatrists via telemedicine who may be at a hospital hundreds of miles away.
Telemedicine also has the potential to improve treatment and outcomes for a range of diseases and conditions, such as obesity.
Obesity often goes untreated for a number of reasons, including social stigma and mobility limitations, and is associated with other health-related issues such as cardiovascular disease, arthritis, type 2 diabetes, asthma, depression and low back pain. Research has demonstrated that too many patients with obesity do not seek in-person treatment.
In fact, social stigma related to obesity and other conditions plays a major factor in preventing patients from speaking openly with primary care providers and qualified practitioners and from seeking treatment. The use of telemedicine for prescribing and treatment of obesity could increase access to care and help reduce the estimated $315 billion-$342 billion in obesity-related annual medical costs each year and help decrease the incidence of so many of the disabling, life-threatening and expensive conditions.
Fortunately, there is a near-term opportunity for the Trump Administration to help improve access to urgently needed treatments via telemedicine. Last year, President Trump signed into law the SUPPORT for Patients and Communities Act, which included the Special Registration for Telemedicine Act of 2018. This provision requires the Drug Enforcement Administration to specify the limited circumstances in which a special registration may be issued for a healthcare practitioner to prescribe a controlled substance via telemedicine.
The statutory deadline for the agency to issue implementing regulations is coming up in October. It is imperative that these new DEA rules are written in a manner that facilitates access to care and treatment for all patients, especially those in underserved communities, who can benefit most from teleprescriptions. While the DEA must ensure to keep controlled substances out of the wrong hands, it also has a responsibility not to impede treatment for patients in need by imposing a new set of restrictions and barriers to new forms of virtual care.
As the DEA proceeds with the rulemaking process for the Special Registration process, it is vitally important that the rule address important public health priorities and significant unmet medical needs. Specifically, healthcare professionals must be able to treat patients with a full range of medical conditions, including psychological disorders such as anxiety, ADHD and depression, where appropriate and safe, by being able to secure a special registration so they can prescribe necessary treatments.
In addition, DEA should carefully consider where patients can engage with providers via telemedicine.
In order to most effectively facilitate access to care for patients in underserved communities or those unable to seek treatment for other reasons, providers should be able to treat them wherever they are located—whether in their workplaces, medical facilities, pharmacies or their homes—while also balancing access to care with the DEA’s important focus on preventing diversion.
In line with the Trump Administration’s agenda and Congressional interest to improve access to care throughout the country, this is a unique opportunity to serve those needing treatment for their medical conditions and help deliver improved health outcomes.