The new law allows providers to use telemedicine to prescribe most controlled substances, as long as they meet federal guidelines. It's an important step forward for a heavily-debated virtual care service.
A new law in Florida allows healthcare providers to prescribe many controlled substances via telemedicine, pushing the Sunshine State to the head of the pack in a heavily-debated virtual care service.
SB 312, signed this week by Governor Ron DeSantis, enables providers to use telemedicine to prescribe all but Schedule II drugs, while those prescriptions will be allowed via telemedicine if they meet one of four exceptions. Florida law had previously prohibited the prescribing of controlled substances via telemedicine except for a few situations.
The prescribing of controlled substances is a heavily regulated service, overseen at the federal level by the US Drug Enforcement Agency and the Ryan Haight Act, landmark legislation passed in 2009 that strongly limits how medications are prescribed online. Healthcare providers have to meet specific criteria to prescribe controlled substance via telemedicine, including conducting an in-person exam of the patient before moving to telehealth.
The healthcare industry, and telehealth advocates in particular, have long lobbied the federal government to ease those restrictions, saying they hinder access to care for those who can’t easily see a care provider in person and prevent a provider from reaching out to and treating more people in need of help (particularly in behavioral health and substance abuse services). The DEA has said in the past that it would relax those rules, but hasn’t done so yet, and federal waivers enacted during the pandemic to allow prescriptions by telemedicine will end with the public health emergency, which is scheduled to end later this year.
This makes Florida’s action particularly newsworthy.
“The law is a big win for Florida patients with medical conditions requiring controlled substances as part of the treatment regimen,” Nathaniel Lacktman, a partner with the Foley & Lardner law firm, chair of its telemedicine and digital health industry team and a national expert on digital health law, said in a recent blog post. “This includes, for example, endocrinology or substance use disorder (both of which use Schedule III medications now permitted under the new law), allowing these patients to obtain better access to more fulsome care. The law will also allow Florida clinicians to more easily prescribe refills in connection with their ongoing care management because the clinician can periodically conduct patient exams via telemedicine instead of requiring in-person exams even when those exams might be viewed as medically unnecessary.”
“Some stimulant medications commonly prescribed in psychiatry are Schedule II drugs, which could potentially meet one of the pre-existing exceptions if they are prescribed for treatment of a psychiatric disorder,” Lacktman added. “Most opioids are Schedule II drugs not allowed under this new law.”
Specifically, the new law amends Florida’s state statutes to allow providers to prescribe a controlled substance. That allowance is limited for Schedule II drugs to the treatment of a psychiatric disorder, inpatient treatment at a licensed hospital, hospice services, and treatment for residents in a nursing home.
Lacktman points out that the Florida law doesn’t supersede federal law, and providers need to make sure they meet both sets of laws. With the Ryan Haight Act, this means they still need to meet one of seven conditions that would allow them to prescribe a controlled substance via telemedicine without first scheduling an in-person exam.
But it puts Florida ahead of many states whose legislatures are still grappling with the idea of allowing doctors to remotely prescribe controlled medications. Opponents say the service offers too many opportunities for abuse, while supporters say it’s key component to improving clinical outcomes for underserved populations and others who can’t or won’t visit their doctor on a regular basis.
Eric Wicklund is the associate content manager and senior editor for Innovation, Technology, and Pharma for HealthLeaders.