Common Challenges in Telehealth Prescription and Dispensing

Enhancing Oversight and Mitigation Strategies

In the realm of telehealth prescription and dispensing, Pharmacy Benefit Managers (PBMs) stand as vigilant gatekeepers, meticulously scrutinizing each telehealth claim to ascertain its legitimacy. Often, instances of chargebacks flagged under the label of “Invalid patient/prescriber relationship” spark a cascade of meticulous investigations. Such probes delve into various dimensions, including:

1. Verification of Location: The first step entails verifying the geographical whereabouts of both the prescriber and the patient.

2. Authorization Confirmation: Subsequent to location verification, PBMs delve into ensuring that the prescriber possesses the requisite authorization to prescribe the specific medication in question.

3. Establishing Valid Relationships: Further investigation involves confirming the establishment of a valid and legitimate patient-prescriber relationship, a cornerstone of ethical telehealth practice.

These investigations, comprehensive in nature, demand a significant investment of both time and resources. Often, PBMs find themselves engaging in extensive outreach efforts directed towards prescribers, soliciting statements or evaluation notes to bolster their inquiries.

Among the arsenal of strategies aimed at mitigating risks associated with telehealth prescriptions, one emerges as particularly potent: the validation of prescribers’ licensure and their authorization to practice across state lines, where applicable. This proactive approach not only fortifies compliance efforts but also serves as a bulwark against potential regulatory pitfalls.

A key resource in this endeavor is the repository provided by the Federation of State Medical Boards, offering nuanced insights into the telehealth laws of each state and the waivers granted in light of the prevailing pandemic circumstances.

Traditionally, telehealth providers were bound by the requirement of licensure in the patient’s state of residence. However, the landscape has undergone significant shifts in response to the pandemic, with waivers easing restrictions on out-of-state prescribing. Notably, the DEA has introduced regulations extending the purview of DEA-registered practitioners to prescribe controlled substances via telemedicine across state lines, provided they hold registration elsewhere.

In the face of heightened enforcement actions targeting telehealth providers, diligent adherence to telehealth requirements becomes paramount. Thus, consulting the aforementioned survey stands as an indispensable step in the quest for regulatory compliance and risk mitigation in the issuance of telehealth prescriptions.

To overcome challenges in telehealth prescription and medication dispensing, stakeholders must collaborate and adhere to regulations. They should establish effective communication between healthcare providers, pharmacists, and PBMs. Investing in telehealth platforms and electronic prescribing systems can streamline processes. Additionally, utilizing AI and machine learning can help stakeholders detect discrepancies and fraud. Healthcare professionals must undergo education and training to ensure compliance. Embracing collaboration and technology enables stakeholders to provide safe and accessible care for patients.

Trust our experienced team for comprehensive solutions tailored to your telehealth legal needs, including compliance, regulatory guidance, and legal support. We stay updated on telehealth law to ensure your practices align with regulations. Whether it’s licensing issues, regulatory changes, or contract advice, we’re here to support you. With our expertise, navigate telehealth law confidently while focusing on patient care.

For expert advice on legal matters about your telemedicine business, consider scheduling a free discussion with Dike Law Group. You can do this at

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