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Telemedicine-based Prescriptions Gain Favor in Indiana

Proposed legislation, if passed, would enable providers to prescribe via telemedicine. It also clarifies the requirements for a physician-patient relationship.

By Eric Wicklund

- Indiana lawmakers are moving forward with legislation that would allow healthcare providers to prescribe via telemedicine.

House Bill 1263, submitted on Jan. 11, passed last week by a healthy 74-24 vote, and now faces Senate scrutiny. If enacted, it would place Indiana among the leaders in telemedicine access for prescription services.

As written, the bill would allow physicians, physician assistants and advanced practice nurses to issue prescriptions via telemedicine as long as the provider and patient have first established a relationship – which can also be done via telemedicine. To meet that requirement, a provider must obtain consent from the patient, study the patient’s medical history, discuss the diagnosis and treatment options and a plan for follow-up care and creating a medical record.

The bill would exclude abortion services via telemedicine, the prescription of controlled substances and vision services provided by fax, e-mail, instant messaging or phone or audio-only communications.

Among the opponents is State Rep. Ed DeLaney, D-Indianapolis, who worried the legislation would open the door to over-prescription and pave the way for out-of-state companies to flood the market with easily available drugs.

“So are they going to get on TV and see somebody in Ohio or Nevada who tells them, ‘Why don’t you take this or that and the other,’” he told Indiana Public Media.

The bill’s sponsor, State Rep. Cindy Kirchhofer, R-Indianapolis, noted Indiana may be launching a Telehealth Services Pilot Program, but it’s one of the few states “that does not fully offer telemedical services.” She noted such services would increase access to care in a state that hasn’t expanded Medicaid under the Affordable Care Act and ranks above the national average in uninsured residents.

Indiana’s standing with the American Telemedicine Association for telemedicine services is in the middle of the pack. The state scored a ‘B’ in the ATA’s recent report card for physician practice standards and licensure, dropping a grade from the 2015 report, and also made a ‘C’ in the ATA’s report card for coverage and reimbursement.

The ATA did praise the state last May for enacting telemedicine parity legislation. The new law, which went into effect July 1, 2015, requires coverage of telemedicine services under private insurance via interactive audio, video or other electronic media and prohibits a healthcare provider from being required to obtain a separate additional written health care consent for the provision of telemedicine services. 

While most states are moving toward allowing providers to prescribe certain medicines via telemedicine, the hang-up lies in the definition of a physician-patient relationship. Among the most notable exceptions is Texas, whose state medical board is pushing to prevent most prescriptions via telemedicine unless the patient and doctor have first met in person. 

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