In the final days of the Biden administration the U.S. Drug Enforcement Administration (DEA) proposed a rule that could change the game for prescribing controlled substances via telehealth, including some common hospice medications.

If finalized, this proposed rule would require prescribers to register with the DEA before they are allowed to prescribe schedule II-V controlled substances, along with some monitoring and other requirements. 

“DEA’s goal is to provide telehealth access for needed medications while ensuring patient safety and preventing the diversion of medications into the illicit drug market,” said former DEA Administrator Anne Milgram, in a statement. “We understand the difficulties some patients have accessing medical providers in-person, and we want to ease this burden while also providing safeguards to keep patients safe. These rules also mark a significant step forward for patient safety by requiring online telemedicine platforms to register with DEA and taking steps to establish a nationwide Prescription Drug Monitoring Program (PDMP).”

The proposal also includes an Advanced Telemedicine Prescribing Registration for schedule II medications for practitioners including psychiatrists; hospice care and palliative care physicians; physicians rendering treatment at long term care facilities; and pediatricians. 

The rule would not apply to telemedicine visits in which a patient has already been seen in-person by a medical provider. It only applies if a patient has never been seen in-person by the medical provider and the patient is being prescribed controlled medication.

If the proposal were finalized, it would create extra hurdles for hospice physicians treating patients via telehealth.

“This advanced telemedicine prescribing registration is very cumbersome and requires quite a lot of the physician and, indirectly, of the hospice, both in terms of qualifications, paperwork for continued reporting obligations, tracking obligations and the like,” Howard Young, partner with the law firm Morgan Lewis, told Hospice News. “You might say, well, it’s easy enough, just go see the patient once. But again, in the hospice context, that could be very challenging.”

Uncertainties abound regarding the future of this proposed rule. First, the Trump administration has taken a firm anti-regulatory stance. The president signed an executive order in his early days in office requiring federal agencies to roll back 10 rules for each one they promulgate.

However, this proposal slipped in before Trump took office and is already moving along in the rulemaking process, with public comments due March 18.

“Everything is on freeze, and yet this proposed rule had been published on that Friday before [Trump] took office,” Young said. “So in a sense, it made it into the process. It was not subject to this executive order.”