2020-10-29 OMA Agenda - Board of Trustees

Our goal in this article is not to change reimbursement, nor do we think our perspective has the ability to do so. The barrier to initiation of phentermine or other controlled substances by telehealth is actually the DEA, who have temporarily lifted this restriction for initiation. There was and continues to be no barrier to continued refills of controlled substances by telehealth (though certainly there may be states with specific policies). Our goal is to support our colleagues to safely treat obesity utilizing phentermine and diethylpropion as indicated, through telehealth. We start by stating “Our goal is to advise providers treating obesity on how to prescribe phentermine safely utilizing telemedicine.” We also state this at the end of our perspective as well. “We hope this guidance will help providers safely continue the care of patients with obesity throughout the pandemic and beyond.” We do not believe the barriers to insurance coverage of telehealth is unique to obesity care and specifically chose not to focus on this aspect as a result. The authors, I presume, have a wealth of clinical experience with the use of phentermine, so they should develop their perspective on the drug more in detail ie dosing, monitoring, use of APPs/MA, SMA, etc specifically with this medication in the setting of virtual visits. The use of AOMs in telemedicine doesn’t veer much from that seen in face-to-face visits, outside of monitoring vital signs and insurance coverage. Therefore, I think this topic may be useful in a general medicine journal . Certainly, the use of telemedicine for obesity care will now be forever be utlized, but I think should be separated in this perspective piece We do think more articles on obesity care by telehealth would add to the care of patients with obesity. We would love to see a more comprehensive set of information about obesity and telehealth. However, we chose to focus specifically on phentermine prescribing as we heard from many colleagues that there were many unknowns around this topic. There is already a fair amount of stigma around the use of AOMS, particularly those that are controlled substances. While our colleagues felt they could often safely prescribe phentermine by telehealth, they also felt they had little support for doing so. Our goal was to quickly get information and discussion around this topic to our colleagues to help support continued care of patients with obesity. Lastly, on a much more minor point, I'm not sure given the large number of authors if this is a small consensus from numerous centers/institutions or the conclusion of a working group. But this may be helpful to state. I appreciate the authors raising awareness on the use of phentermine in this setting and hope they can further develop their perspective Thank you. After feedback we have decided on calling ourselves a working group. Our group already meets as part of an obesity advocacy group for a specialty organization and this issue became of interest to us when the pandemic started and telehealth became more widely utilized. We had several phone and video calls and used an electronic shared document to craft our opinions between calls. We have added this information to the perspective.