Although telemedicine has been formally legalized in Korea through revisions to the Medical Service Act, debate about its efficacy continues. The Korean Association of Internal Medicine Practitioners has followed the Korean Pharmaceutical Association in calling on the government to discontinue the telemedicine pilot program and scrap plans for full implementation, warning of repeated and excessive prescriptions and drug misuse and abuse, Korea Biomedical Review reported.

In a recent strongly-worded statement, the association said the pilot program should be ended before discussions on institutionalizing telemedicine continue. Not doing so would amount to the government continuing to sanction “distorted medical shopping and drug misuse and abuse.” The revised Medical Service Act, which institutionalizes telemedicine, is scheduled to take effect Dec. 24.

The internists’ association referenced telemedicine prescription cases disclosed by the pharmacists’ group earlier this month as evidence of inadequate safeguards.

According to the KAIMP, one patient repeatedly obtained prescriptions for the antidepressant Stablon (tianeptine) from multiple medical institutions over about 10 days, KBR said. Among the cases disclosed, one prescription was marked as providing about 600 days’ supply. In another case, 1,800 tablets were prescribed, with instructions to take 10 tablets three times a day for 60 days.

The group said the cases showed that “neither the government’s preventive controls nor its post-prescription monitoring system functioned at all.”

“The appropriateness of the prescriptions should be rigorously examined according to medical and legal standards, and the medical community will not shirk its responsibility to address unethical prescribing practices internally,” the association said.

It added that, “However, the fundamental problem is that the telemedicine environment had no institutional safeguards to detect and prevent such aberrant overprescribing in advance.”

Safeguards remained inadequate, including an electronic system that can block duplicate prescriptions from multiple medical institutions and limits on prescription duration for initial consultations, the association said.

“Prescriptions that would never be tolerated in face-to-face care were issued without restriction amid the anonymity of telemedicine and the profit-driven structure of private platforms,”  the association said.

The KAIMP also took issue what it described as an ecosystem in which providers willing to prescribe drugs on demand become popular destinations for patients and compete for ratings, allowing platform competition to influence prescribing instead of physicians’ professional judgment.

“Moving ahead with institutionalizing telemedicine while leaving in place an electronic system that cannot prevent duplicate prescriptions from multiple institutions, and without even minimum clinical safeguards such as limits on prescription duration for first-time patients, constitutes a clear dereliction of duty,”  the association said.

Expanding delivery of prescription drugs is another bone of contention for the association. It argued that the risk of so-called “drug shopping” and medication misuse and abuse could further increase by allowing patients to choose a medical institution, receive a prescription, have it dispensed and obtain the medication entirely through a telemedicine platform.

The group called on the Korean government to immediately stop the current telemedicine pilot program, abandon plans for full implementation, and reconsider the policy from the ground up.

The association also issued other demands, including a thorough investigation into duplicate prescriptions from multiple institutions and the misuse and abuse of narcotics, psychotropic drugs, and other dependence-forming medications during the pilot period. It further called for the withdrawal of plans to expand delivery of drugs prescribed through telemedicine.

“The essence of healthcare is not indiscriminate convenience but safety,” the group said. “If the government pushes ahead with institutionalization without suspending the pilot program, we will respond to this hasty policy that threatens public health.”