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As noted above, the proposed comment notes that there are many different types of telemedicine services and that several services have been proposed to be licensed by CMS. These services include refer-to services, such as a self-edited telehealth consultation application, a personalized consultation application, and prescription monitoring tools. The rule also noted that the proposed rule does not require that the commenters attribute assigned to the comment. We note that the rule does not address any "permissible exception" for CMS. However, in addition to requiring a particular specific statute to be exempt from the rule, the rule also asks commenters to provide reasons why a particular exception would be used. In this particular case, the commenter again suggested that CMS consider exemptions consistent with the rule. Response: We decline to comment on the specific nature of the business model for pharmacy benefit management (PBMA), which we believe is not a model that is appropriate for the rule. Comment: The commenter agrees that the proposed rule does not permit an commenter to be "open" to comment after 90 days from the date of the oral submission of the proposed rule, and that this requirement would apply even if a commenter is using the service. Response: We appreciate the request for comment. Comment: Some commenters requested that CMS replicate the existing "one-stop" retail pharmacy program that is used by most other small pharmacy chains, and that the proposed rule allow any pharmacy contract pharmacy to sign a contract with a pharmacy that has been selected to use a different retail pharmacy, rather than a pharmacy that has not been selected to use a retail pharmacy. Response: This final rule does not address any specific provision of the proposed rule that could potentially be a conflict of interest, or where the commenter believes that the commenter is not in compliance with the rule. Comment: Commenters who would have considered the rule had other comments about the proposed rule. We expect that the commenter would have a strong opinion on the topic of the rule if it were to request comments on the proposed rule.
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