Closing the Gap: From Telehealth Prescription to Life-Saving Medication
Telehealth has been a revolutionary force in expanding access to treatment for opioid use disorder (OUD), connecting thousands of individuals to the life-saving medication buprenorphine. Yet, a critical gap in the care continuum persists, one that undermines this progress and puts lives at risk: the pharmacy counter. Despite receiving a valid prescription from a licensed clinician, many patients face stigma and systemic barriers that prevent them from accessing their medication, transforming a promising solution into a dangerous point of failure.
This isn't just an inconvenience; it's a life-threatening interruption. Buprenorphine is a proven, evidence-based medication that significantly reduces the risk of overdose and improves retention in care. However, a recent multi-state study of patients receiving OUD treatment via telemedicine found that nearly a third (31.9%) had missed buprenorphine doses due to pharmacy-related problems. Alarmingly, a quarter of those individuals went without their medication for seven days or more—a duration directly associated with an increased risk of relapse and fatal overdose (Hendy et al., 2025). The message is clear: when pharmacy practices block the dispensation of legitimate, telehealth-originated prescriptions, patients pay with their health and their lives.
“The message is clear: when pharmacy practices block the dispensation of legitimate, telehealth-originated prescriptions, patients pay with their health and their lives.”
The Evidence: Unpacking Pharmacy-Level Barriers
The obstacles patients face are not theoretical. The primary cause of missed doses is insufficient pharmacy stock (54.5%), followed by insurance and prior authorization hurdles (22.4%), and pharmacist hesitancy specifically due to the prescription’s telehealth origin (19.4%) (Hendy et al., 2025). This occurs within a paradoxical policy environment. While federal actions, such as the DEA’s telemedicine flexibilities during the pandemic and the elimination of the X-waiver in 2022, have legally expanded clinicians' ability to prescribe buprenorphine, the downstream effects of other regulations have created new roadblocks. For instance, monitoring systems like the Suspicious Orders Report System (SORS), designed to prevent diversion, have led some pharmacies to erroneously treat all telehealth-originated buprenorphine prescriptions as "red flags," compounding stigma and access problems (MedPage Today, 2025).
Insights from the Front Lines of Virtual Care
Mental health and addiction clinicians providing virtual services offer a critical perspective that is often overlooked. They report that telehealth lowers significant barriers for patients, who often prefer remote care to avoid the judgment and logistical challenges of in-person visits. The result is often higher engagement from individuals who might otherwise avoid treatment altogether. Furthermore, robust clinical data shows that when proper protocols are in place, patient outcomes for telehealth-based buprenorphine treatment are comparable to in-person care.
Successful virtual care programs often incorporate continuity supports that directly address pharmacy barriers. The integration of team-based workflows, remote care coordinators, and dedicated pharmacy liaisons has been shown to substantially reduce missed doses. Clinicians find that proactively communicating with pharmacists—providing clear clinical context, standardized treatment plans, and a dedicated contact for verification—can dismantle suspicion and expedite fills.
A Roadmap for Change: Policy, Practice, and Technology
Closing the gap between prescription and dispensation requires a multi-pronged approach that targets policymakers, pharmacies, and the digital health community.
1. For Policymakers:
Codify Telehealth Prescribing Rights: Make the pandemic-era telemedicine flexibilities for buprenorphine permanent at the federal level to provide lasting clarity and stability for clinicians and pharmacists.
Reform Punitive Monitoring: Amend suspicious order frameworks to carve out legitimate buprenorphine prescriptions, ensuring that the delivery channel (telehealth) is not a trigger for investigation.
Mandate Supply Chain Transparency: Enact state-level policies that require pharmacies to maintain a minimum stock of buprenorphine or implement transparent, rapid processes for ordering and transferring prescriptions.
2. For Pharmacies and Payers:
Modernize Dispensing Guidance: State boards of pharmacy should issue clear guidance that telehealth prescriptions are legitimate and should not be treated as a standalone “red flag.”
Expand Training and Anti-Stigma Campaigns: Fund continuing education for pharmacists on evidence-based OUD care, the clinical validity of telehealth, and harm-reduction principles.
Remove Payer-Side Hurdles: Payers must eliminate prior authorization requirements for buprenorphine and ensure payment parity for OUD treatment delivered via telehealth.
3. For the Digital Health Community:
Integrate Pharmacy Liaison Workflows: Build tools into telehealth platforms that automate communication with pharmacies, provide standardized treatment summaries, and offer one-click verification to reduce perceived risks.
Scale Delivery and Partner Networks: Integrate verified mail-order or licensed delivery services into care pathways to bypass local stocking issues, particularly in rural and underserved areas.
Monitor and Report Outcomes: Collect and publish de-identified data on prescription fill rates and reasons for failure to enable targeted advocacy and drive quality improvement.
Support Patient Navigation: Fund care coordinators who can proactively troubleshoot insurance issues and pharmacy fills on behalf of patients.
Conclusion: A Call to Action to Change the Narrative
Telehealth is a proven, indispensable tool in our fight against the opioid crisis. It is time to stop treating prescriptions delivered through this channel as inherently less valid. The narrative must shift from one of suspicion to one of trust and support, grounded in the overwhelming evidence of clinical effectiveness.
Policymakers must protect telehealth flexibilities and remove perverse monitoring incentives. Pharmacies must adopt evidence-based dispensing practices. And the digital health community must innovate to build bridges where systemic cracks now exist.
CTeL stands ready to convene stakeholders, develop standardized communications and training, and pilot integration projects that improve outcomes. If we are to meet this crisis with the best tools available, we must change our systems so that every legitimate buprenorphine prescription is trusted, filled, and delivered without stigma or delay.
References
Hendy LE, Hill LG, Olguin A, et al. Pharmacy Barriers to Receiving Buprenorphine Among Patients Undergoing Telemedicine Addiction Treatment. JAMA Netw Open. 2025;8(8):e2527418. doi:10.1001/jamanetworkopen.2025.27418
MedPage Today. (2025, August). Pharmacy barriers can hinder telehealth treatment for opioid addictions. Retrieved from the specified MedPage Today article.
Beetham, T., Saloner, B., Wakeman, S. E., & Busch, S. H. (2022). A survey of physicians' perspectives on prescribing buprenorphine and methadone via telehealth. Journal of Substance Abuse Treatment, 139, 108785.
Husain, I., Keener, M., Joshi, K., et al. (2024). Impact of telehealth, in-person, and hybrid care modalities on buprenorphine discontinuation among patients with opioid use disorder: A retrospective cohort study on commercially insured individuals. The Lancet Regional Health – Americas, 34, 100742.
Jones, C. M., Shoff, C., Blanco, C., & Compton, W. M. (2022). Treatment for opioid use disorder in the United States: A national study. JAMA Psychiatry, 79(5), 454–463.
Legal Action Center. (2023). Overcoming Barriers to Buprenorphine in Retail Pharmacies. Retrieved from https://www.lac.org/assets/files/Overcoming-Barriers-to-Buprenorphine-in-Retail-Pharmacies.pdf
Substance Abuse and Mental Health Services Administration. (2024). Buprenorphine Telemedicine Prescribing: Questions and Answers. Retrieved from https://www.samhsa.gov/substance-use/treatment/statutes-regulations-guidelines/buprenorphine-telemedicine-prescribing