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As states decide how to manage telehealth after the pandemic, unexpected stakeholders are making far-reaching decisions about telehealth prescribing for opioids, Walmart announced a complete halt on providing controlled drugs to telehealth patients unless they have had an in-person visit in the last two years. Patients had access to telemedicine prescriptions for controlled substances during the pandemic, including Medications for Opioid Use Disorder (MOUD). As discussed in Permanent Telehealth Reimbursement Update: Bipartisan Legislation for Telehealth Extension, legislators are backed by many organizations to make telehealth reimbursement permanent.
What Caused The Walmart Change in Telehealth Prescribing?
The permission to prescribe via telehealth during the pandemic was due to temporary changes to the Drug Enforcement Administration policy. After a year-long investigation revealed that telemedicine prescriptions for controlled substances were dispensed without legitimate reasons, the Justice Department filed a lawsuit against Walmart in 2020. Walmart’s change of policy soon followed. Other retailers, including CVS, Costco, and Walgreens, have also begun rejecting telemedicine prescriptions.
A key issue of note is that with the advent of nationwide pharmacies getting involved with telehealth, far-reaching decisions regarding telehealth practices have moved from regulators and reimbursement sources to retailers. This precedent is likely to manifest in other areas where consumers are impacted.
Issues for Patients Seeking Telemedicine Prescription Refills
The benefits of telehealth for opioid addiction are outlined in an article published by the Pew Charitable Trusts. It states:
Emerging research shows that allowing telehealth-based OUD treatment during the pandemic helped patients initiate and remain on medication treatment, and also that these patients stayed in treatment and abstained from illicit opioids at rates comparable to individuals who received care in person.
The article suggests that state Medicaid agencies and lawmakers take measures including:
- Requiring public and private insurers to reimburse OUD treatment providers for all services delivered via telehealth.
- Setting public and private reimbursement rates for telehealth-based OUD services on a par with in-person treatment.
- Expanding locations where patients can receive OUD treatment services via telehealth, including their homes.
- Allowing patients with Medicaid to access OUD treatment services by telephone.
- Enabling correctional institutions to use telehealth for OUD treatment services.
Walmart’s New Telehealth Prescribing Policy
The concern about Walmart’s new telehealth prescribing policy is that it could be restrictive. As quoted in Fierce Healthcare, Anna Legreid Doppuch commented, “policies are a threat to patient safety and recovery.” The senior director of clinical guidelines and quality improvement at the American Society of Health-System Pharmacists continued, “It is a step backward in leveraging virtual care to increase patient access to medications for opioid use disorder and to address the opioid crisis.”
Repercussions of the current change in telehealth prescribing are that the shifts in telehealth policy could:
- Create hardship for patients forced to find alternative, more expensive options.
- Require patients to travel miles to access the medication needed to prevent relapse.
- Deter patients from trying telemedicine because obtaining telemedicine prescription refills will be more difficult.
What are your thoughts? Please leave your comments about telemedicine prescriptions for opioid treatment below.
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How do they know who is seen by a telehealth visit and who is not? I understand when the prescriber’s DEA or other address information is nowhere near the patient’s address. However, I work near a state line and have had difficulty with a pharmacy just over the state line to the north refusing to fill prescriptions for a patient who comes to my office for in person visits as I am closer than then nearest provider in their state. The pharmacist told the patient he “needed to find someone local.”
Cynthia, The enforcers are the state boards or civil courts. They do not police, rather, they investigate when they get a complaint for any reason, usually not telehealth-related. In response to your question, the boards and courts will know that you did something illegal when they respond to a complaint about your work. When they investigate, they give themselves permission to look at everything you do, including your telehealth practices. Please let me know if any of this is unclear or if you disagree.
Thank you for this great information.