Another result of telehealth policies being in flux is uncertainty around the long-term landscape in terms of prescribing controlled substances post-pandemic. Existing federal law, mainly the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, restricts the prescribing of controlled substances via telemedicine except in very specific and limiting circumstances. Given these federal restrictions, this may be a telehealth policy barrier states have trouble tackling completely on their own. There is a potential pathway for the prescribing of certain controlled substances without an in-person exam post-PHE, which is if the U.S. Drug Enforcement Administration (DEA) creates the telemedicine special registry they were mandated to establish rules for by October 2019 but never did. Thus, the specific medications and the criteria to qualify for the registry is yet to be seen. In the first official mention of the long awaited regulations since December 2019, last month the DEA said in response to comments on a recently proposed (yet unrelated) rule about narcotics: “Although these comments regarding telemedicine special registration are beyond the scope of this rule, DEA understands commenters' frustration with the delay. DEA intends to promulgate regulations for the telemedicine special registration in the near future.”

In addition, a few of the current federal bills CCHP is tracking that would alter the Ryan Haight Act include:
* S. 445/HR 1384 – Makes exceptions for narcotic drugs in schedules II, IV, or V for community health aides or community health practitioners prescribing to an individual for treatment or detoxification
* S. 340 – Allows for a telehealth evaluation for schedule III or IV drugs under certain circumstance
* S 1457 – Similar language to S. 340 is in Sec. 205 of bill.

CCHP will continue to track this issue and provide updates as they occur. Existing federal laws around prescribing can be found on CCHP’s website through both the policy finder tool and the pending federal legislation page at https://www.cchpca.org/federal/pending-legislation/.