- Ohio physicians can use telemedicine to prescribe both non-controlled and controlled drugs – as long as they meet a long list of guidelines.
The two rules passed earlier this month by the Ohio Medical Board, 4731-11-09 and 4731-11-01, enable physicians to establish a doctor-patient relationship through telemedicine, rather than through an in-person, in order to issue prescriptions.
In doing so, the state is following in the footsteps of several others who have loosened restrictions around telemedicine to further adoption of the virtual visit platform. A few states still mandate that a doctor and new patient first meet in person before that doctor can use telemedicine for certain services, like prescriptions. Some states exclude phone calls, e-mails or online questionnaires from the list of allowable formats for first-time visits, while others require that the patient be in a healthcare facility or in the presence of a clinician.
Ohio’s medical board “has chosen to take an approach consistent with several other states’ more recent statutory/regulatory amendments to their telemedicine rules,” Martin T. Durkin Jr., of the law firm of Pietrangallo Gordon Alfano Bosick & Raspanti, LLP, writes in Lexology. “That is, rather than delineating a set of specific requirements as to how a physical exam should be conducted remotely, the [board] has taken a more balanced approach focusing instead on documentation of the visit, informed consent, follow-up care, etc. With regard to the issue of how to properly conduct a remote physical exam, the rule leaves the discretion of whether or not telemedicine is the appropriate forum for the patient visit where it belongs, with the provider.”
In order to prescribe a non-controlled substance during an online or virtual visit, the physician must:
- Verify the patient’s identity and location;
- Obtain informed consent for treatment through remote examination;
- Per patient consent, forward the medical record to the patient’s primary care provider or other healthcare provider, if applicable, or refer the patient to an appropriate healthcare provider or healthcare facility;
- Conduct a medical evaluation that meets the minimal standards of care appropriate to the condition for which the patient presents;
- Create a diagnosis and treatment plan, including documentation of necessity for the use of a prescription drug and any contraindications to the recommended treatment;
- Document the care provided, patient’s consent, medical information and any referrals made to other providers in the patient’s medical record;
- Either provide or recommend any necessary follow-up care;
- Make the medical record of the visit available to the patient; and
- Use “appropriate technology sufficient for the physician to conduct the above as if the medical evaluation occurred during an in-person visit.”
Unlike most states, Ohio’s medical board is also allowing physicians to prescribe controlled substances via telemedicine – but the guidelines are very restrictive. The physician must meet all of the above requirements as well as prove that this meets one of six situations:
- The patient is an “active patient” of a colleague of the physician, and the prescription is being provided through an on-call or cross-coverage arrangement. An “active patient” is defined as a patient who has been seen at least once in the past 24 months by the physician, either in person or through a telemedicine visit.,
- The patient is at a DEA-registered hospital or clinic;
- The patient is being treated by, and in the physical presence of, an Ohio-licensed physician or healthcare practitioner registered with the DEA;
- The telemedicine consult is conducted by a practitioner who has obtained a DEA special registration for telemedicine;
- A hospice program physician prescribes the controlled substance to a hospice program patient in accordance with the board of pharmacy rules; or
- The physician is the medical director of, or attending physician at, an “institutional facility,” the patient has been admitted as an inpatient to or is a resident of an institutional facility, and the prescription is transmitted to the pharmacy by a means that is compliant with Ohio board of pharmacy rules.
Telemedicine advocates note that the guidelines for prescription of controlled substances follow exceptions granted under the federal Ryan Haight Act, and as such severely restrict when and where physician can issue those prescriptions.
Writing in the National Law Review, attorneys with the law firm of Foley & Lardner, LLP, say the DEA, encouraged by the American Telemedicine Association, is expected to amend the Ryan Haight Act sometime this year to create a special telemedicine registration for providers.
The Buckeye State now joins others (e.g., Delaware, Florida, New Hampshire, and West Virginia) that have carved out express exceptions to allow for telemedicine prescribing of controlled substances,” the attorneys wrote. “This is encouraging news for providers using telemedicine in their practice, as controlled substances are an important and clinically significant component of certain specialties, including telepsychiatry and hospitalists/emergency medicine.”