2am thoughts pages11/13/2023 Allowing this situation to persist gives a single state more authority than it is intended to have. The example of telemedicine shows how a single state ban can become a de facto national ban for patients with limited access to health care. Texas’s attempt to ban a single drug by mail order highlights the problems with a decision like Dobbs, mandating a state solution in a world increasingly connected nationally and globally by technology. Requiring these providers not only to comply with the FDA, DEA and Postal Service requirements but also to note state-by-state where doctors are located, patients are located and where prescriptions are being mailed every single time a prescription is dispensed by mail would interfere with telemedicine efficiencies. The law requires doctors to practice only in states where they are licensed, but doctors rely on telemedicine patients to tell them where they are located to ensure that they are not practicing in a state without a license. Some insurance providers encourage mail order by minimizing or eliminating co-pays completely for mail order maintenance prescriptions. The Veterans Affairs Department launched its Meds by Mail program in 2009, and it now provides about 80 percent of all outpatient prescriptions by mail to veterans in all U.S. Well-established pharmacies like Walgreens and CVS have expanded their mail-order services, Amazon has gotten into the mail-order pharmacy business through the acquisition of PillPack in 2018, and new companies like Nurx, Teledoc Health and PlushCare have emerged that combine virtual health care with prescriptions by mail. The National Institutes of Health estimates that 25 percent of all prescriptions were filled by mail in 2022. Telemedicine and the ability to receive prescriptions by mail is not just good health care, it’s good business. Postal Service without challenging the way telemedicine works? The looming question for legislators: Is banning a single medication worth jeopardizing the convenient and cost-effective health care telemedicine provides for millions of Americans? While Texas can ban mifepristone, by what authority can it restrict its order and transportation through the U.S. How can a state regulate who provides treatment to people within its borders and where medication authorized by the Food and Drug Administration (FDA) and Drug Enforcement Agency (DEA) is delivered when patients can receive treatment through their smartphones and computers anywhere in the world? In efforts to ban abortion by restricting the delivery of a single medication, mifepristone, we’re witnessing a major flaw and recognizing telemedicine has a technology and jurisdictional problem. But just when we thought telemedicine and prescriptions by mail were established, some states have begun to run interference.
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