(Updated as of 10.06.23)
UPDATE: The DEA has officially Extended Telehealth Flexibilities through the end of 2024!
The DEA announced that due to the overwhelming response from patients and providers, they will extend current telehealth prescription flexibilities through the end of 2024 while they consider everyone's input and develop a better proposal for future regulations.
Your voice is making all the difference.
You can read the DEA's statement here.
UPDATE: The DEA is Listening. Literally.
The DEA just announced that they are holding several listening sessions in September to understand the importance of telehealth better, and are open to some of the changes we've been advocating for together. You can read more about it here.
UPDATE: The DEA is Extending Telehealth Flexibilities!
Great news! Our collective voices were heard. The DEA announced that they are extending the Public Health Emergency rules that allow for telehealth prescriptions of buprenorphine without any in-person restrictions until at least November.
New patients now have until November of this year to start with a telemedicine provider in order to be grandfathered into a one-year period to at least November 2024 before any changes to the requirements might apply to them. Existing patients will not experience any changes throughout this period.
The DEA received a record 38,000 comments expressing concerns about the rule and are taking your input seriously. They are still considering how to amend and finalize their proposal during this extension, so we expect to hear more closer to November. When they announce additional information, or if the expanded access rules are finalized, we will update this page with the latest details.
(Details on the original proposal they are now considering how to amend are below.)
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The DEA wants to change the rules around telehealth addiction care. But what do those changes actually mean?
Late on Friday, the DEA announced new proposed rules for prescribing controlled substances — including buprenorphine (suboxone) for opioid use disorder — after the end of the COVID Public Health Emergency (PHE) on May 11.
These changes, if made, would affect our telemedicine patients by adding one (single) in-person requirement to their care in order to get continued prescriptions from telemedicine.
This is disappointing, after several years of success for patients and providers that proved how safe, effective, and valuable virtual care can be. We know that telehealth has been helping patients like you overcome some of the barriers you face to getting the care you deserve.
Rest assured that while these rules would create new challenges for patients and providers, telehealth will still be an option in the years to come, and Boulder is here for you.
We have been preparing for something like this, even as we remain hopeful that these proposals will not turn into official rules.
Please also know we are using all of our resources to advocate and fight for your right to get care. We are committed to keeping you safe, informed, and empowered at every step.
The most important things for you to know right now:
- For each and every patient in our care, we will offer individualized support to make sure your medication treatment continues uninterrupted
- One in-person visit might be required (for new and existing patients) with a local clinician and your Boulder clinician, but you’ll have our help getting it and coordinating with them as needed
- For current patients (or those who enroll before May), we will have until November 2023 to make an in-person visit happen. Nothing about your program will otherwise need to change
- You will NOT be required to meet in-person every 30 days. This is a one-time visit requirement, and it can be with most local providers (as long as they are registered with the DEA)
- For new patients who enroll in telemedicine care AFTER May 11, you can still BEGIN treatment via telemedicine and receive your initial prescription for up to 30 days BEFORE fulfilling the visit requirement
Why are these rule changes being proposed?
As part of the PHE declared around the COVID-19 pandemic in 2020, the government eased a number of rules that allowed patients to get treatment without having to be in-person. Those rules showed how effective telemedicine could be for people with substance use disorder, expanding access to treatment for many people who could not reach brick-and-mortar options before.
For the last year, the Biden administration, HHS, the DEA, SAMHSA, and the ONDCP have all repeatedly said that patients being treated for Opioid Use Disorder (OUD) with buprenorphine (aka Suboxone) would be able to keep access to their treatment even after the PHE expires. They saw how helpful telemedicine has been and promised to keep those improvements going.
But now, the draft rules are more complex and restrictive than what has been in effect under the PHE. If these new rules become official, they will result in many patients left without ongoing treatment and support, and force providers to stop prescribing for patients if they are unable to access an in-person, DEA-registered clinician within 30 days of initiating treatment. They are claiming that these rules are being put into place for patient safety, but we believe they will have the opposite effect.
Increasing access to compassionate, evidence-based care is WHY WE EXIST at Boulder. Therefore, we are fighting this proposed requirement, alongside most every other major medical, telemedicine, and harm reduction agency.
The good news is, this isn’t final yet. The proposed rule will be open to public comment for 30 days, so you can make your voice heard now.
You deserve access to multiple, high-quality options — in person or online — and every available support to overcome addiction. We hope you will advocate for getting the healthcare you need and deserve.
We encourage you to join us in telling the DEA how important telemedicine is to you. You can submit comments directly to them here.
When would this all start?
The rule, if enacted, will take effect when the PHE expires on May 11.
For patients seen during the PHE – that is, anyone receiving telemedicine care currently, or who enroll before May 11 – the rule provides for 180 days in which to satisfy the in-person exam. That means a patient must either have an in-person visit or receive a “qualifying telemedicine referral” from a provider who has physically seen the patient by November 7 to continue care.
For new patients, the rule will apply immediately if you enroll after May 11.
Boulder’s Promise to You
Our mission is to deliver the best care possible, and a big part of that is keeping people in treatment for as long as it is helpful to them. We will move mountains to ensure that everyone in our care can meet these requirements with ease and without interruption.
Fortunately, we already partner with a strong network of in-person providers we trust in every market where we treat patients. We employ a team of highly skilled Boulder Care Navigators who are trained to help coordinate care, facilitate secure referrals, and connect with local providers for our patients to see when needed.
Our team is at your service to make your care as convenient as possible.
Many Boulder patients were already referred to us from in-person providers. We will review existing records and documentation to determine if referrals meet the standard outlined in the rule, or if you need a new in-person visit. If the latter, we will facilitate it for you from start to finish.
What the proposed rules are, in depth
DEA proposed creating two new, limited options for telemedicine prescribing of controlled substances without a prior in-person exam. These options are:
30-day telemedicine prescription
Telemedicine clinicians can issue telemedicine-based prescriptions (i.e. without the patient having received an in-person exam) not exceeding 30 days’ supply
- This rule applies to non-narcotic Schedule III, IV, or V controlled substances, and buprenorphine for treatment of OUD
- Multiple prescriptions for the same patient are allowed, up to a total of a 30-day supply
- Before any additional prescribing can occur, the patient must undergo an in-person exam (either a three-way referral coordination visit with a DEA-registered clinician or “qualified telemedicine referral”)
Qualified telemedicine referral
A telemedicine clinician can issue telemedicine-based prescriptions when a patient has an initial in-person exam with a local, DEA-registered practitioner, who subsequently refers the patient to the Boulder clinician for treatment.
Documentation and timing requirements:
- The referring clinician must conduct an in-person medical exam and provide a diagnosis, evaluation or treatment to the patient
- The referring clinician must then issue a written referral to the Boulder clinician (via secure electronic communication), including: 1) the reason for the referral, 2) a copy or link to the medical record, and 3) a description of the diagnosis, evaluation, and treatment provided to the patient
- The written referral form must also include: 1) the name and NPI of the referring practitioner (i.e. the one who conducted the in-person exam) and 2) the name and NPI of the telemedicine clinician to whom the patient is being referred)
- The evaluation and written referral must occur and be received by the telemedicine provider before a prescription refill can be issued.
For more, read this post from regulatory counsel Foley & Lardner.
For current patients with questions, please direct them to your care team through the Boulder app.
