Implications of Regulatory Telemedicine Prescribing Flexibilities on Patients With Opioid Use Disorder

OBJECTIVES: The Ryan Haight Act requires that clinical providers have at least one in-person evaluation before prescribing certain controlled substances. The US Drug Enforcement Administration (DEA) and US Department of Health and Human Services (HHS) relaxed this rule further and allowed providers to prescribe controlled substances without an in-person evaluation during the COVID-19 pandemic. These flexibilities still exist. Healthcare providers, insurers, and patients have embraced this new rule due to expanded access to care while others have concerns that the rule may worsen opioid use disorder (OUD). This research aimed to determine if telemedicine prescribing policy impacted healthcare utilization among patients with OUD.

METHODS: We examined a cross-section of MarketScan commercial claims to quantify OUD diagnoses in 2020. We extracted all outpatient encounters and identified patients who used telemedicine and those who did not in 2021. Following a patient’s outpatient visit, we pulled any prescription fills of controlled substances within 7 days of the visit and compared subsequent hospitalizations, Morphine Milligram Equivalents (MME)/day and total costs. Wilcoxon tests were used to compare unadjusted data by telemedicine use status.

RESULTS: Patients who used telemedicine had more hospital admissions than non-telemedicine users; however, opioid related admissions did not differ significantly. Telemedicine users had more prescription fills for controlled substances, higher total mean drug costs, and less MME/day than non-telemedicine patients.

CONCLUSIONS: Our findings suggest the implications of telemedicine prescribing flexibilities may have impacted patients diagnosed with OUD. Other factors may be driving telemedicine prescribing rates for opioids. For example, relaxing Ryan Haight Act rules increased access to medications for opioid use disorders (MOUD) and rates of MOUD initiation. Although this temporary policy has existed for approximately three years, the long-term effects of relaxed prescribing rules are unknown and should be explored.