Criticism mounts over request easing telemedicine first-visit rules

Medical and pharmacy groups say the platform industry's request undermines the National Assembly’s legislative authority and the government’s administrative authority, “An attempt to undermine the agreed Medical Service Act”

Platform industry “We respect the Medical Service Act… is just seeking exceptions for patients who can provide medication history”

Rep. Chil-seung Kwon held a policy forum on the 13th at the National Assembly Members’ Office Building to discuss subordinate regulations under the Medical Service Act for telemedicine.

With the full-scale implementation of telemedicine about 4 months away, the medical and pharmacy groups are pushing back against the platform industry's request that the "limit on prescription days for first-time patients" should be left to "the physicians' discretion" rather than legal and administrative standards.

Healthcare groups argue that the platform industry's request amounts to a belated attempt to neutralize safeguards against the adverse effects of telemedicine that were agreed upon after months of deliberation in the National Assembly, where multiple bills were consolidated and reviewed. In effect, the medical and pharmacuetical industry’s criticism is that the proposal disregards both the National Assembly's legislative authority and the government's administrative authority.

The platform industry says it neither opposes nor rejects the principles of the Medical Service Act passed by the National Assembly to formalize telemedicine. Rather, it is asking policymakers to consider that an outright restriction, such as limiting first-visit prescriptions to seven days, could unintentionally infringe on the rights of physicians and patients and even threaten the viability of the telemedicine industry itself.

Even after subordinate regulations under the Medical Service Act set a limit on prescription duration for first-time patients, the industry is asking for exceptions that would give physicians discretion to prescribe beyond that limit when patients consent to the disclosure of their medication or medical history.

According to medical and pharmacy groups on the 14th, calls at a National Assembly policy forum the previous day to give physicians discretion over prescription duration for first-time telemedicine patients have drawn criticism as a demand that "disregards and undermines the intent of the Medical Service Act, the governing statute."

“Limits on first-visit prescription duration is a closed discussion…undermining the legislative intent right before implementation.'"

During deliberations on the Medical Service Act amendment, lawmakers from both ruling and opposition parties, the Ministry of Health and Welfare, and relevant professional groups reached a consensus on establishing clear guidelines for the safe implementation of telemedicine. These included ▲limits on eligible first-time patients and prescription duration, ▲restrictions on certain drugs with potential for abuse, and ▲limited permission for medication delivery. Given the nature of telemedicine and its greater potential for misuse than in-person care, clearly defining legal and administrative restrictions on prescription duration and the types of drugs that can be prescribed to first-time patients was a key premise of the legislative process.

At the recent forum, however, Professor Hun-sung Kim of Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, who gave a presentation, and the Korea Telemedicine Industry Council argued that prescription duration for first-time patients should not be uniformly restricted but instead left entirely to physicians' discretion and responsibility.

Medical and pharmacy groups have objected, saying “the proposal seeks to reverse an issue that has already reached the final stage through the legislative process without additional consultation or an administrative basis.”

Healthcare groups are concerned that removing legal standards for telemedicine and relying solely on individual physicians' discretion could dismantle the minimum safeguards intended to prevent misuse and abuse.

A medical industry official said, "Physicians' autonomy, discretion and responsibility must be exercised within a legal framework designed to protect patient safety. Calling for changes to standards reached after extensive review and agreement during the National Assembly's legislative process, with only 4 months left before implementation, shows disregard not only for the Assembly's legislative authority but also for the government's administrative authority."

The pharmacy community also expressed similar concerns. "Limiting prescription duration for first-time patients is the minimum legal safeguard needed to prevent drug misuse and adverse effects in telemedicine. Without administrative restrictions, the consequences of drug misuse will ultimately fall on the public. Given that various problems involving telemedicine and platforms have already been identified during the pilot program, calls to ease restrictions on first-visit prescriptions are inappropriate."

KTIC, “We are asking for exceptions when patients share their medical data”

As controversy grew, the Korea Telemedicine Industry Council said its proposal was not a call for unconditional deregulation or opposition to the Medical Service Act, but rather a request to establish specific exceptions based on the availability of patient medical data.

The association argues that if subordinate regulations uniformly limit first-visit prescriptions to seven days, the full-scale telemedicine program could end up being more restrictive than the pilot program, infringe upon the medical and medication rights of doctors and patients, and further lead to the collapse of the telemedicine industry itself.

Seul Lee, co-chair of KTIC, said, "First of all, we are not denying or opposing the principles of the telemedicine provisions in the Medical Service Act passed by the National Assembly. However, even if prescription duration for first-time patients is limited to 7 days, as in Japan, flexible exceptions should be established so that physicians can prescribe for longer than 7 days when patients consent to disclosing their previous medication or medical history."

Lee added, "When a patient's medical data are available, allowing room for physicians to exercise their own judgment rather than imposing an unconditional, uniform restriction would better protect physicians' right to provide care and improve patient convenience. If implementation of the Medical Service Act results in a full-scale program that regresses from the pilot program, it could cause considerable inconvenience for physicians and patients and negatively affect the telemedicine industry."

Full-scale rollout 4 months away…debate over subordinate regulations likely to continue

With the full-scale implementation of the telemedicine program approaching, renewed controversy over prescribing authority for first-time patients is expected to complicate the Ministry of Health and Welfare's task of drafting subordinate regulations and detailed guidelines.

However, because the issue was already discussed extensively at the National Assembly level, attempts to ease legal restrictions in the name of "physician discretion" are likely to face strong opposition from medical and pharmacy groups as well as criticism that they undermine the intent of the legislation.

The ministry is reportedly planning to gather opinions from the platform industry, medical community, and pharmacy groups before issuing an advance notice of the legislation of the proposed subordinate regulations under the Medical Service Act in early September.