At Chilivis Grubman, we strive to keep you abreast of crucial developments in healthcare regulations. In December, we notified you of significant changes to telemedicine prescribing by the Georgia Composite Medical Board (the Board).

The Ryan Haight Online Pharmacy Consumer Protection Act, enacted in 2008, aimed to address concerns regarding the illicit distribution of controlled substances online. One key provision mandated an in-person medical examination before prescribing controlled substances, emphasizing direct patient-physician interaction for proper evaluation.

However, in response to the challenges posed by the unforeseen COVID-19 Public Health Emergency (PHE), the Drug Enforcement Agency (DEA) temporarily allowed physicians practicing via telemedicine to prescribe Schedule II-V controlled substances, including Schedule III-V narcotic-controlled medications for opioid use disorder treatment. While the PHE ended on May 11, 2023, the DEA and the Substance Abuse and Mental Health Services Administration (SAMHSA) extended telemedicine flexibilities through a temporary rule, allowing physicians to prescribe controlled substances via telemedicine until December 31, 2024.

But in its December 2023 meeting, the Board voted to rescind its previous position on the flexibility allowed through the DEA’s telehealth prescribing policy during and after the COVID-19 pandemic, asserting that effective January 1, 2024, all licensees in Georgia would be required to adhere strictly to the Medical Practice Act and Board Rules for proper prescribing practices. Under Chapter 360-3 of the Rules of the Georgia Composite Medical Board, when initially prescribing a controlled substance for the treatment of pain or chronic pain, a physician must have a medical history of the patient, conduct a physical examination, and obtain informed consent. 

The sudden reimposition of the pre-pandemic rules confused prescribers over what exactly was and was not permissible. Doctors sought clarity on what that meant for existing patients and how to handle upcoming refills. Some doctors decided to stop seeing virtual patients for controlled drugs altogether until the board clarified what was legal.

Amongst the confusion, the Board has decided to delay the ban until May 1, 2024. Currently, we know that doctors writing prescriptions for controlled substances/dangerous drugs must start with an in-person visit with the patient. After that, requirements will vary based on the type of scheduled drug. For instance, opioids such as Oxycodone will have different rules than Adderall, used to treat Attention-deficit/hyperactivity disorder (ADHD).

Dr. William Bostock, the Board’s chair, told a reporter that such rules are important “to protect the citizens of Georgia from dangerous medication which requires direct provider supervision to help prevent diversion (for illegal use) and unnecessary prescribing.” The Board indicated it is developing some answers to frequently asked questions about telemedicine and tele-prescribing which will be published on its website.

While telemedicine has proven invaluable during the pandemic, recent shifts underscore the evolving regulatory landscape. The attorneys at Chilivis Grubman counsel clients of all types and sizes in connection with healthcare law. If you need assistance with such a matter, please contact us today.