Instant online prescriptions banned in health regulator crackdown

New telehealth guidelines are set to restrict how patients can get access to medication online. Here’s what will change.

Patients will no longer be able to fill in online questionnaires to get access to prescriptions after the health regulator issued a long-anticipated crackdown on the booming industry.

The new telehealth guidelines, released on Wednesday, will kick in on September 1 and aim to significantly restrict the growing practice of patients receiving scripts online without talking in real time to a doctor.

While not an explicit ban, the new standards could effectively end the practice as — in the case of a patient complaint or adverse event — doctors would struggle to defend their actions as within medical guidelines. There are caveats for exceptional circumstances.

The guidelines will not prohibit online prescriptions, meaning doctors can see a patient for the first time via telehealth and issue them both new and repeat prescriptions.

Medical Board of Australia chair Dr Anne Tonkin said telehealth was “here to stay” but prescribing medication should not be a “tick and flick exercise”.

“The interaction between a doctor and their patient is an important element in all consultations, including telehealth consultations,” she said.

“A doctor who has not consulted directly with the patient and does not have access to their medical records is unable to exercise good, safe clinical judgement.”

In response to the new guidelines, InstantScripts — who offer online questionnaires for scripts — announced all new InstantScripts patients will need to have an “initial telehealth consultation with a doctor” when requesting scripts “in the coming weeks”.

Chief operating officer Richard Skimin said they were “committed to continuing to deliver the highest quality online healthcare and exceptional value to our patients, while fully adhering to the Medical Board’s revised guidelines”.

Medical Board of Australia chair Dr Anne Tonkin says prescribing medication should not be a ‘tick and flick exercise’.

InstantScripts was one of several online telehealth providers which criticised draft versions of the guidelines when they were released in December last year.

In a joint submission with the Australian Patients Association, they said the prescribing of medication via text, email or online “provides access to healthcare when Australians need it” and restricting it would have a “detrimental impact” on Australians.

“The Medical Board have not provided an evidence-based rationale to support this process,” they said.

“About half of InstantScripts patients said there would be occasions where they would have to stop taking their regular medication if access to asynchronous healthcare were not available.”

Eucalyptus, which runs four brands (Pilot, Juniper, Software and Kin) offering online prescription and telehealth services, also heavily criticised the draft release at the time.

They said the guidelines should recognise that telehealth questionnaires “can be suitable for certain patients and certain medical conditions”.

“The board appears to assume that all asynchronous telehealth is a ‘tick and flick exercise’, which does not allowed doctors to ask the patient for follow-up questions,” they said.

“This is simply untrue.”

The Royal Australian College of General Practitioners submission struck a different tone.

They said they agreed that “requests for medication via text, email or online where a face-to-face or real-time telehealth consultation with that patient have not occurred prior, are not good practice”.

The Australian Medical Association’s written submission said telehealth should “should be seen as an additional tool to assist doctors to provide good care”.

But they raised the alarm about providers they said “exploit particular niches such as providing scripts for specific medicines including nicotine vaping products”.

“(Telehealth) should not become a vehicle for the provision of substandard medical care, particularly from corporate entities who have never seen or physically examined a patient,” they said.

The Pharmacy Guild of Australia’s submission warned that their members were reporting “an ever increasing number of online algorithm-based prescribing services”.

“These online platforms offer immediate prescriptions for a range of medications where the patient completes a digital questionnaire generated by an Artificial Intelligence bot.

“The prescription (if granted) is then sent directly to a pharmacy that the prescriber has a commercial arrangement with … patient safety is completely disregarded in this model.”