From a friend of mine:
Attention DEA:
I am a military veteran and patient who has been diagnosed with hypogonadism, depression, and PTSD by multiple doctors over 20 years. I have been under the care of a telemedicine provider who has been prescribing me testosterone replacement therapy for more than 10 years. I also receive care from a different specialist at the same telemedicine clinic and am prescribed other medications which sometimes include a Schedule V medication for anxiety. I travel often to different States for work and currently have a residence in two different States. Not only has telemedicine provided me with a convenient way to receive care that includes testosterone replacement therapy, but my telemedicine provider has offered me outstanding care and results. I was not able to find adequate care from any local provider, and without telemedicine, it would be difficult to find a specialist who can provide the care I need. My current telemedicine care team has literally saved my life, and they go with me wherever I go.
DEA's proposed rule update for the Ryan Haight Act will eliminate my ability to continue receiving care from my current provider and will harm many other patients like me who are receiving care through telemedicine. My current care includes a follow-up done by virtual or phone consultation, and blood work performed every 6 months. When I am in a location that does not allow for two-way video, I opt for a phone call with my provider. The phone call is sufficient to address my lab results, lifestyle management, and symptoms. I receive a 3-4 month supply of testosterone along with ancillary medications, shipped to my home from a pharmacy or sometimes filled at a retail pharmacy if they carry the dosage form I am prescribed, which often the local pharmacy doesn’t have the exact medication I need.
DEA's proposed RHA rules will require me to find a local physician to conduct a physical examination and referral to my telemedicine specialist. The requirement for a physical examination doesn't make sense clinically as my therapy is monitored through comprehensive lab work and consultations that are conveniently conducted by phone. Additionally, it will be difficult, or impossible, to find a local physician who is willing to provide a referral for a medical service they know nothing about. In fact, any primary care provider I have seen admits to knowing nothing about my testosterone replacement therapy and sometimes tries to steer me toward other treatments that have caused me significant side effects in the past (ie SSRIs, Benzodiazepines, etc). DEA expects the examining physician to be present during my telemedicine encounter, which is tremendously inconvenient and again challenging as few to no physicians would want to participate in this. When I do see a conventional provider for an exam or something else, rarely do they see more for longer than 3-5min and it's usually a nurse who conducts most of the examinations. I don't see how a local provider with an over-flowing waiting room and few resources, not to mention the low payment received for an examination, would have any interest in attending a telemedicine encounter with a patient who just needed an examination.
DEA should not require an in-person examination for a life-long hormone replacement therapy that is adequately managed through a telemedicine specialist. If DEA does want to require an in-person exam to qualify for telemedicine care, as they did pre-COVID, then a simple transfer of records and ID verification is all that should be required. The prosed rules will make it near impossible to qualify for telemedicine care.
DEA's proposed RHA rule update will only allow patients like me a 30-day supply of a medication that I am taking for the rest of my life. This means I will have to time my refill request every 3-4 weeks and hope that I receive it in time for my next administration, for the rest of my life if I want to receive telemedicine care. I administer my testosterone twice per week and missing a single dose results in suffering and side effects including depression, loss of sex drive, muscle pain, and fatigue. Limiting my testosterone to a 30-day supply also limits my options to a few, expensive and hard-to-find single-dose vials instead of the convenient and cost-effective 5mL or 10mL sizes that last me about three months. The 30-day rule will cause me to suffer and increase my treatment cost. DEA should allow for a 90-day minimum, and recognize the pharmacy controls currently in place that mitigate diversion.
DEA's proposed RHA rules will require me to use two-way video, which is unnecessary for my life-long, managed TRT care. I receive good care by talking to my provider by phone and through HIPAA-secured chat. In fact, my telemedicine provider is more engaging and accessible than any "in-person" conventional or VA provider. This creates a burden as I am often in locations that do not have two-way video technologies, or sometimes don't have an adequate internet connection. DEA should not require two-way video and allow the medical doctor to determine what methods they want to establish patient care and engage the patient, as long as its a HIPAA-compliant platform.
Lastly, I read in the proposed rules that the DEA believes that most patients receive telemedicine care from inside a hospital or medical facility. Most patients I know receive telemedicine care from wherever they are located, and in their own home. Testosterone and mental health care is best received in a private, comfortable, and convenient setting. The care I have received by my telemedicine team in the comfort of my home is far better than any treatment experience I’ve had with a physcian in a hospital or facilty.
deathwithdignity.org
www.reuters.com
