May I prescribe controlled substances via telemedicine to established patients? To non-established patients?
A: Yes, during the current state of emergency, controlled substances may be prescribed following a telemedicine consultation, provided certain conditions are met.
From NCMB’s perspective, if it is possible to gather sufficient clinical information during a telemedicine encounter to provide care that meets at least the minimum accepted standards of care, NCMB considers it appropriate to prescribe following that encounter. The Board recognizes that standards of care may shift during a state of emergency. Practitioners are encouraged to document deviations from typical standards of care and use their best clinical judgment.
The federal Drug Enforcement Administration (DEA) regulates controlled substances prescribing. During the declared federal state of emergency related to the coronavirus disease 2019 pandemic, DEA will waive the requirement for an in-person medical evaluation for both established and non-established patients prior to prescribing controlled substances as long as the following are met:
1) The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of his/her professional practice;
2) The telemedicine communication is conducted using an audio-visual, real-time, two- way interactive communication system; and
3) The practitioner is acting in accordance with applicable Federal and State laws.
If the above conditions are not met, then prescribing a controlled substance is not permitted.
Is it acceptable to prescribe medications after a telephone-only consultation with a patient?
A: In instances where controlled substances are not indicated, this is permitted. During the current state of emergency, NCMB considers prescribing after a telephone consultation with new or established patients to be acceptable provided the clinician can gather sufficient information to establish a diagnosis and create a treatment plan.
Controlled substance prescribing, which is regulated by the federal Drug Enforcement Administration (DEA), is handled differently depending on whether the patient is established with the practice or is a new patient. For established patients, DEA will permit a controlled substance prescription after a telephone consultation, during the current state of emergency. For new patients, DEA has waived the requirement for an in-person visit prior to prescribing a controlled substance, but still requires that an audio-visual consultation take place prior to prescribing. Therefore, DEA will not allow a controlled substance prescription to a new patient following a consultation by telephone.
My patient is not currently located in North Carolina. Is it legal for me to conduct assessments via telemedicine and prescribe to them?
If the state where the patient is located allows it, then yes. Most medical boards require a physician or PA to be licensed in the state in which the patient care is given. Each state has different laws and rules regarding licensure, telemedicine, and prescribing. Some of these restrictions may be lifted during a state of emergency, but you would need to contact the corresponding medical licensing authority of that state to determine its individual requirements. The Federation of State Medical Boards has compiled state-by-state guides to COVID-19 policies related to telemedicine and other topics.
In North Carolina, patients who are currently in the state but have an established relationship with a physician or PA in another state may receive care, including prescriptions, from the out-of-state clinician via telemedicine.