Understanding Telemedicine and the Ryan Haight Act

In the late 1990s, people were thrilled about the Internet. It was a time of experimentation and innovation. Remember Webvan? Or how WebMD revolutionized the doctor-patient relationship by giving consumers more information about their own health? We also saw the beginning of online pharmacies.

By the early 2000s, though, it became clear that many of these pharmacies posed a serious threat to people’s health—either by prescribing drugs people didn’t need, feeding addictions, or marketing one drug as another. Enter the Ryan Haight Act, or the Online Pharmacy Consumer Protection Act of 2008. Originally designed to prevent unsafe and irresponsible prescribing practices, this law has almost certainly saved many lives. The challenge is that it was written for a different time—before telemedicine and well before COVID.

Here’s what you need to know about it, and how it might change telemedicine.

What Is the Ryan Haight Act?

The Ryan Haight Act establishes that controlled substances require a prescription and that the person issuing the prescription has a doctor-patient relationship with the patient. This seems reasonable, but the narrow definition in the law of the doctor-patient relationship means that a telemedicine-based relationship may be inadequate because the law specifically requires an “in-person evaluation.”

There’s no current clarity on how often this evaluation has to occur. For example, can a clinician evaluate a patient in person once and then continue to prescribe to them indefinitely? The lack of this guidance worries clinicians who want to follow the law but remain uncertain about what it actually requires. The DEA has promised several revisions to the law, but so far, none have been broad enough to protect prescribers.

Telemedicine Exceptions

The law does provide some exceptions for telemedicine, but because it was written before the advent of contemporary telemedicine, these exceptions do not adequately contemplate how telemedicine actually works today. They generally only apply to hospital settings, or to the case of national public health emergencies.

There is currently no exception for licensed providers providing controlled substances to patients they have not physically examined. This is especially problematic for mental health providers since mental health care does not usually require a physical exam. A doctor or therapist can perform all of the same functions virtually that they would perform in person.

The Importance of Telemedicine

Telemedicine is increasingly critical to patient care and well-being. Some of its benefits include:

• Access to care even when ill. People who need mental health care can still get it, even when they are sick or quarantined for COVID.
• Increased accessibility. Telemedicine improves access to care by helping providers reach people who cannot attend in-person appointments, as well as those who face barriers, such as social anxiety, to show up in person.
• More privacy. Telemedicine appointments allow people to connect to care from the privacy of their own homes, which may ease the minds of people who do not want others to know they are in therapy.
• High efficacy. Research consistently shows that telemedicine works.
• Less stress. Telemedicine decreases the amount of time it takes to seek care. Consumers no longer have to fight traffic or take several hours off of work. It’s a great complement to working from home.
• Less burnout for clinicians. Telemedicine enables clinicians to work from home, too. This may mean less commuting stress, a more comfortable working environment, reduced expenses, and the ability to better serve a wider group of patients.

The Future of Telemedicine

The public health emergency spurred by the COVID-19 crisis may soon end, and with it, the broad allowance that enabled more telemedicine appointments. This could force prescribers back into the office, at least part-time. And it might mean that patients have to come in s well, at least for an initial assessment. At the Rochester Center for Behavioral Medicine, we plan to continue offering access to telemedicine services for as many patients as feasible. But the in-person assessment requirement may limit some patients’ access, especially if they live far away or face other barriers to seeking in-person care.

We encourage patients to educate themselves about this law and to advocate for political change that they feel best represents their needs, including broad access to telemedicine.