Alaskan lawmakers cleared April 25 a bill (HB 281) that would allow physicians to prescribe individuals non-controlled substances over the phone or online without first conducting a physical examination.
Under the bill, sponsored by Lynn Gattis (R- Wasilla), a physician would be prohibited from prescribing controlled substances remotely unless another “licensed health care provider is present with the patient to assist the physician with examination, diagnosis, and treatment.”
The bill would protect physicians from disciplinary actions by the state medical board for engaging in telemedicine to prescribe medications without conducting a physical exam, provided they adhere to the measure’s requirements.
Under the legislation, the prescribing physician, or her group practice, must be available to provide follow-up care to the individual. In addition, individuals must consent to all records of the encounter being sent to their primary care physician if the prescribing physician does not already fill that role. The prescribing physician must ensure the records are transmitted to the primary care physician.
“Nowadays, much of our life is conducted online or over the phone,” Gattis said in a statement. “In this age where we can do almost everything with a smartphone, it should not be necessary to drive to the doctor’s office to have a physical consultation for many common ailments.”
The bill is aimed not only at convenience, but also at access to routine medical care, particularly in the state’s rural areas, Gattis added.
The Alaska State Medical Board opposed the measure in a March 18 letter to state lawmakers, citing the potential for misdiagnoses, overprescribing, and additional liability and investigative costs. The letter also said the legislation would usurp the Board’s role as the traditional standard-setting body of the practice of medicine.
According to the letter, current rules allow physicians to lawfully engage in telemedicine if they either have an established physician-patient relationship or if a licensed health care provider is with the patient to facilitate the examination and diagnostic process. The proposed changes to these practices “allow for a corporate model of telemedicine without one or the other of these two elements, and would therefore be below the current standard of care in Alaska,” the letter said.
The Board also disputed the measure is needed to expand health care access in rural communities, noting there are few areas in the state that don’t already have a provider and existing telemedicine. Where access is an issue, the Board proposed a limited exemption to current regulations to allow expanded telemedicine in those areas specifically.
“As with many technological ‘advances’ in medicine, the motivation behind this bill seems more related to promoting technology and reimbursement than providing good patient care,” the letter said.
Alaska Governor Steve Parnell has not yet signed the bill into law.