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More than 330 healthcare organizations signed letters this week urging the White House and Congress to extend a telehealth prescribing flexibility that was introduced during the Covid-19 pandemic. Failure to extend this policy would cause millions of Americans to lose access to “critically important healthcare treatment,” the organizations wrote. In 2020, Congress waived a rule that required an in-person visit to establish a relationship between a patient and their provider before any prescriptions can be given via telehealth. The Drug Enforcement Administration had originally planned to roll back this flexibility last year, but the agency extended it through the end of 2024 after receiving more than 38,000 comments on its proposed rule. presented by Health Tech The Promise of Value-Based Care and MedTech Innovation Monica Vajani, Executive Director for mHUB’s MedTech Accelerator, discusses how mHUB is helping innovators transition healthcare towards value-based care. By Monica Vajani For nearly four years now, providers have been using the telehealth prescribing flexibility to prescribe controlled substances. These include Schedule II drugs, such as stimulant medications to treat ADHD like Adderall and Vyvanse, as well as opioids like Percocet and Dilaudid. These also include Schedule III-V controlled substances, such as common psychiatric drugs like Xanax, Ambien and Prozac, as well as drugs that treat substance use disorder like buprenorphine. The DEA is still working on a new proposed rule that will dictate whether or not providers can prescribe controlled substances via telehealth after this year — but last week, its plans were leaked by media outlets. The agency’s rule — which is not final and is currently being reviewed at the White House — is definitely not what telehealth advocates were calling for. The rule would get rid of providers’ ability to prescribe Schedule II drugs via telehealth without a prior in-person appointment — either by establishing new regulations or simply allowing the pandemic-era flexibility to expire at the end of the year. On the other hand, Schedule III-V drugs would still be allowed to be prescribed via telehealth without an in-person visit. Sponsored Post What Healthcare Can Learn from Costco The path forward is clear: employers must evaluate their health plan the same way they do their Saturday shopping excursion. By Jeff Bak, Imagine360 CEO and President Additionally, the unpublished rule would require that no more than half of a provider’s prescriptions may be given via telehealth appointment. It also includes a mandate for prescribers to check all 50 states’ prescription drug monitoring programs before writing a prescription for a patient with whom they have never had an in-person visit. However, enforcing this requirement will be difficult, as providers say there is no national registry where providers could easily check whether or not the patient had obtained a prescription for the drug in another state. Many provider organizations have reacted to the leaked rule with outrage. On Tuesday, more than 300 groups sent separate letters to the White House, Senate and House, imploring them to roll back the strict rules that the DEA is reportedly planning to propose. Some of these organizations included Amazon, Cleveland Clinic, Mass General Brigham, Hims & Hers Health, the American College of Physicians, and the National Rural Health Association. “The ongoing challenges in accessing mental health and substance use treatment services, particularly in rural and underserved areas, underscore the importance of maintaining these flexibilities. More than half of U.S. counties do not have a psychiatrist. The shortage is even more prominent in rural areas, with nearly three quarters of rural counties lacking a psychiatrist,” read the groups’ letter to the White House. Extending the prescribing flexibility would mean that millions of patients in these underserved areas would get to keep their access to treatment, the organizations argued in their letter. The letter also pointed out that there is very little time to make this happen. “Given how late we are in the year and with the waiver expiring on December 31, there is very little time left for the DEA to release a draft rule for public comment, close the comment period, review the substantive feedback, and finalize the rule in time for the end of the year. Nearly 40,000 comments were submitted last year when the DEA first attempted to draft rules for a permanent framework on remote prescribing of controlled substances,” it read.

The companies will jointly control Cosette, with a focus on accelerating innovation and growth. Since Avista's initial investment in Cosette in December 2018, Cosette has launched new products through research and development efforts, acquisitions, and licensing deals. This includes the acquisition of Ambien and Ambien CR in the United States from Sanofi US. The company reports that these initiatives have led to significant EBITDA growth and free cash flow generation, positioning Cosette for future opportunities. Apurva Saraf, president and CEO of Cosette, said: “This partnership is a testament to the remarkable transformation our business has achieved over the past four years, driven by an unwavering commitment to strategic business development and operational excellence. I am immensely proud of the entire Cosette team for their dedication in delivering this robust growth. “We have successfully diversified our portfolio with branded products such as Clomid, Ambien, and Benicar, along with innovative, patent-protected drugs like Vyleesi and Intrarosa. With our strong R&D and business development pipeline, we are well positioned to drive substantial growth in partnership with Avista and Hamilton Lane." Financial strength and future opportunities for Cosette Pharmaceuticals The companies indicate that this transaction will enhance Cosette's balance sheet and support growth through investments in R&D and strategic acquisitions. The goal is to build a durable, high-growth, branded pharmaceutical company. As part of the transaction, Cosette has also secured a new term loan financing with Hayfin Capital Management and a new revolving credit facility provided by UBS Investment Bank, Capital One, National Association, and Santander Corporate & Investment Bank, who acted as joint lead arrangers and joint bookrunners for the financing. googletag.cmd.push(function () { googletag.display('text-ad1'); }); David Burgstahler, managing partner and CEO of Avista, added: “We value Avista's long-term relationship with Hamilton Lane and look forward to collaborating with them as a strategic partner to drive growth and value at Cosette. Our collective expertise will prove invaluable as Cosette evaluates larger M&A opportunities as part of the company's growth strategy.” Cosette Pharmaceuticals has made significant contributions to the pharmaceutical industry, particularly in the realm of specialty pharmaceuticals. The company has a strong focus on developing and commercializing branded and generic products that address unmet medical needs. With a diverse portfolio that includes notable products, Cosette has demonstrated a commitment to innovation and patient care. It says its strategic approach to research and development, coupled with targeted acquisitions and licensing deals, has enabled them to introduce groundbreaking therapies and expand their market presence, positively impacting patient outcomes and advancing healthcare solutions.