Telehealth laws relaxed during Covid have made it easier for people to see virtual care providers, no matter where they live. However, regulations such as the Ryan Haight Act restrict prescriptions for controlled substances through telehealth without the need for an initial in-person visit. It’s unclear how the law will change once the public health emergency is over.
One company the law will definitely affect is Ophelia, a digital health provider, Connect prescribers via video with people who need a prescription to control opioid addiction, such as Suboxone, to control cravings, ease withdrawal, and prevent overdose. As the opioid crisis continues to wreak havoc, the company’s founder, Zack Gray, took to Zoom to explain how the services it offers are meeting a huge need for patients. Gray calls for widespread reimbursement telemedicine Medication-Assisted Therapy (MAT) services after the pandemic emergency is officially declared over.
“The pandemic has helped us understand what’s possible, and it’s hard to go back to what it was now,” Gray said.His company Ophelia provides MAT is used for opioid use disorder and is considered the most effective treatment by the CDC and others. Ophelia saw its first patient in April 2020.
Gray was personally affected by the loss of a loved one to his addiction. Like many people with opioid use disorder, the person relies on the black market instead of going to a legitimate supplier for a prescription to ease withdrawal symptoms. That led him to launch Ophelia to target the “invisible 80%” of opioid users in the U.S. who are forced to participate in the health care system due to the onset of complications.
“These patients are more or less invisible to the healthcare system until they get to the emergency room,” Gray said.
Once you get them involved, the results are very promising. The startup had a 70% retention rate at 6 months and a 60% retention rate at 12 months — in other words, patients continued to work with the Ophelia provider. It now has regional and national contracts covering 75 million people with Medicare, Medicaid, and commercial insurance. Ophelia is licensed to provide nursing care in 29 states, including New York, where it is headquartered, as well as New Jersey and Pennsylvania, among others.
Gray said patient demand has been struggling to keep up. In order to prescribe buprenorphine or its brand name Suboxone, clinicians need to obtain a separate license from the federal government, called an x-waiver, which only 5% of people have.They also limit the number of patients they can treat — The upper limit is 30 patients at a time. To address this, Ophelia mobilized doctors to get them licensed and trained to deliver MAT.
The company’s success in user retention and ability to win national and regional CMS and commercial payer contracts has attracted significant investor attention.In December, Ophelia announced that it had raised a $50 million Series B round led by Tiger Globe. This comes shortly after raising $15 million in a Series A round in April 2021. . Menlo Ventures.
It will benefit further if federal laws around in-person visit requirements change. Currently, Ophelia and other companies have to contend with several states that have their own versions of federal laws.Gray thinks Limit access to life-saving medicines.
However, earlier this month, Florida lifts some restrictions This limits access to Suboxone, and questions remain about how other states will follow suit.
Despite the uncertainty about telehealth laws, Gray is optimistic that federal legislation that will benefit telehealth providers treating opioid patients is on the horizon. His main concern is the laws in the states and who will pay for the treatment.
“States need to properly reimburse this treatment through a structure that incentivizes the things that matter to patients, namely retention and care,” Gray said.
Most providers are unable to provide treatment until Medicaid plans and managed care facilities pay for it.
The bottom line, Gray said, is that “by preventing emergency treatment, MAT can save lives and save the health care system a lot of money.”
Photo: Sorbet, Getty Images
