Can Providers Prescribe Emsam (Selegiline) via Telehealth?
Yes, providers can prescribe Emsam (selegiline transdermal system) via telehealth, but this requires careful consideration of regulatory requirements, appropriate patient assessment capabilities, and adherence to controlled substance prescribing guidelines that vary by jurisdiction.
Regulatory Framework for Telehealth Prescribing
Federal and State Requirements
Providers must understand licensure requirements across multiple jurisdictions where they and their patients are located, as telehealth prescribing is subject to state-specific regulations 1.
Prescribing providers need awareness of federal, state, and international guidelines around prescription of controlled substances, which have undergone significant changes in response to the COVID-19 pandemic 1.
In the United States, an emergency exemption to the Ryan Haight Act currently allows providers to prescribe controlled substances via telehealth without an in-person visit, though this exemption is temporary and set to expire when the official Public Health Emergency period ends 1.
The Center for Connected Health Policy maintains updated information on telehealth regulations for US federal agencies and state-by-state policies, which providers should consult regularly 1.
Clinical Appropriateness for Telehealth Prescribing
Mental Health Medications Are Well-Suited for Telehealth
Behavioral and mental health diagnoses, including medication management, are ideally suited to telehealth management, with provisions for in-person monitoring of growth and laboratory studies 1.
Mental health medication management can be effectively delivered via telehealth with comparable effectiveness to in-person care 2.
Emsam, as an antidepressant for major depressive disorder, falls within this category of medications appropriate for telehealth management 3.
Assessment Limitations to Consider
Current technological limitations may prevent thorough physical examinations, requiring providers to have a plan to convert telehealth visits to in-person encounters when necessary 2.
Providers must recognize when hands-on contact is needed and ensure they have available facilities to convert encounters to in-person visits 1, 2.
The same quality assurance protocols must apply equally to in-person and telehealth encounters to avoid a two-tiered system of care 1, 2.
Specific Considerations for Emsam Prescribing
Dietary Restrictions and Monitoring
At the 6 mg/24 hour dose, Emsam does not require dietary tyramine restrictions, making it unique among MAO inhibitors and potentially more suitable for telehealth management 3.
At higher doses (9 mg/24 hours or more), dietary restriction of tyramine intake is recommended, which requires patient education that can be effectively delivered via telehealth 3.
Emsam has demonstrated good tolerability and high rates of medication adherence in clinical studies 3.
Initial Assessment Requirements
Before prescribing via telehealth, providers should verify patient appropriateness for the medication, including assessment of depression severity, prior treatment failures, and ability to adhere to any necessary dietary restrictions 1.
Providers must obtain informed consent that includes discussion of the telehealth modality and emergency planning 1.
Patient and provider identification should be verified and documented at each session, including names, credentials, and locations of both parties 1.
Comprehensive Medication Management via Telehealth
Pharmacist Involvement
Clinical pharmacists can provide comprehensive medication management (CMM) via telehealth, which has been shown to reduce medication errors and improve patient safety 1, 4, 5.
Telehealth CMM services have demonstrated significant reductions in hospital readmission rates (2.9% absolute difference) and emergency department utilization (3.5% reduction) in high-risk patients 5.
Pharmacist-led telehealth services can improve medication adherence, particularly in older populations receiving care from remote clinics 1.
Standard Operating Procedures
Emergency Planning
Prior to engaging in telehealth prescribing, providers must develop and discuss an emergency plan with the patient 1.
This includes documenting the patient's location, distance to nearest emergency facility, and contact information for local emergency services 1.
Follow-Up and Monitoring
Telehealth should be used complementary to in-person visits to optimize management 1.
Regular follow-up via videoconferencing allows for medication adjustment, monitoring of side effects, and assessment of treatment response 1.
Interactive strategies that facilitate communication between providers and patients, including web-based portals and text messaging with medication adjustment capabilities, appear more effective 1.
Common Pitfalls and How to Avoid Them
Quality of Care Concerns
Avoid treatment shortcuts without appropriate assessment - the same confirmatory testing principles and diagnostic standards apply to telehealth as to in-person care 1, 2.
Do not rely solely on telehealth for conditions requiring physical examination that cannot be adequately performed remotely 2.
Communication and Presence
Providers must ensure adequate communication that includes both information and emotion to demonstrate empathy and maintain therapeutic connection 1.
Delayed responses, lack of initiative, and appearing unfriendly lead to patient dissatisfaction with telehealth visits 1.
Maintain eye contact with the camera and minimize distractions to establish presence, as patients want to feel their provider is fully engaged 1.