Subordinate regulations for telemedicine first visits in progress

MOHW gathers opinions from KMA, KPA and Telemedicine Industry Association ahead of December rollout

With telemedicine set to become a formal healthcare service in December, the government has begun working-level consultations with the medical community, pharmacists and intermediary platform operators to prepare amendments to subordinate regulations.

The discussions mark the start of efforts to reconcile sharply differing views among professional groups over some of the most contentious issues, including geographic restrictions for first-time patients, limits on prescription duration and restrictions on drugs that may be prescribed remotely.

According to the medical community on the 12th, the Ministry of Health and Welfare (MOHW) has met with the Korean Medical Association (KMA), the Korean Pharmaceutical Association (KPA) and the Korea Telemedicine Industry Association, among others, to gather views on key issues that must be addressed in the subordinate regulations before the full-scale launch of the system.

The biggest points of contention are how to set geographic restrictions for first-time patients, how many days of medication may be prescribed upon a single visit for such patients, and which drug categories should be prohibited from remote prescribing.

For geographic restrictions, one issue is whether remote first visits should be permitted only near the patient’s residence – when the medical institution providing telemedicine is located within the same city, county or district.

Some have argued that a patient’s real-time location, based on GPS data, should instead be used to determine whether a remote first visit may be provided.

The National Assembly and the MOHW agreed on the broad principle that first-time patients with no prior in-person treatment history should receive telemedicine only from medical institutions located within their area of residence. The Medical Service Act was amended accordingly to prevent patient concentration at major hospitals in the Seoul metropolitan area or at certain telemedicine-focused clinics, while also ensuring a safety net for emergency referrals to in-person care.

The medical community and pharmacists’ association have also supported regional restrictions on first visits, deeming such safeguards necessary to prevent telemedicine from disrupting the ecosystem of frontline medical institutions and pharmacies.

The platform industry, however, has opposed overly restrictive regional rules, arguing that more than 60% of users seek care from clinics in other regions when their usual hospitals are closed or during nights and holidays, and that excessively tight geographic restrictions would undermine the effectiveness of the system.

There are also significant differences over limits on prescription duration for first-time patients. The medical community, pharmacists, and platform operators hold differing views on how many days of medication should be allowed for patients with no prior in-person treatment history, amid concerns over misuse and adverse events associated with long-term prescriptions issued remotely.

The medical community and pharmacists argue that prescription duration should be kept as short as possible for patient safety. Their position is that telemedicine should be permitted only as a supplement to in-person care.

Platform operators and some users, however, pointed to the irony of how even patients with chronic diseases who are already taking medication are classified as first-time patients when they change hospitals. They contend that setting blanket limits on prescription duration would increase the financial and time burden by stimulating more frequent medical visits.

Restrictions on non-reimbursed medicines with high potential for misuse, including obesity and hair-loss treatments, are another major issue. The parties remain divided over whether remote prescribing should be restricted not only for existing prohibited categories such as narcotics, psychotropic drugs, drugs with misuse or abuse concerns (including erectile dysfunction treatments), and emergency contraceptives, but also for non-reimbursed drugs such as GLP-1 obesity treatments and hair-loss medicines.

Against this backdrop, the National Assembly plans to hold a policy forum to seek broader social consensus on subordinate regulations for telemedicine.

Rep. Chil-seung Kwon of the Democratic Party of Korea, a member of the National Assembly’s Health and Welfare Committee, will hold a policy forum at the National Assembly Members’ Office Building on the 13th under the title “Policy Forum on Subordinate Regulations under the Medical Service Act for Telemedicine (subtitle:  Directions for Designing Subordinate Regulations to Support the Successful Introduction, Development and Safe Expansion of Telemedicine).”

The MOHW plans to combine the views collected through working-level consultations with opinions presented at the National Assembly forum, refine the detailed criteria, and finalize the subordinate regulations in time for the amended Medical Service Act to take effect.

A medical industry official said, “The key to transitioning telemedicine to a full-scale system is to guarantee public access to healthcare while minimizing the risks of drug misuse and medical accidents. It is the ministry’s responsibility to fully gather the views of the medical community, pharmacists and industry through working-level consultations and establish reasonable detailed guidelines, but a consensus may not be easy because the parties maintain sharply different stances.”