Aetna Ends Cerebral’s In-Network Status, Congress Looks into Digital Health’s Compliance with Ryan Haight Act

The scrutiny around mental health startup Cerebral Inc. following the company’s meteoric rise and subsequent criticism has generated new challenges for the company.

A House committee has launched a review of how the Drug Enforcement Administration (DEA) has enforced the Ryan Haight Act, which dictates how controlled substances are allowed to be prescribed via telehealth. Aetna, the national health insurance arm of CVS Health (NYSE: CVS), has also told Cerebral that it will no longer be in-network.

This comes as the Cerebral faces layoffs and an investigation by the U.S. Justice Department.

Last month, Cerebral said that it would stop prescribing most controlled substances by the fall of this year. Allegations of inappropriate marketing and prescribing of controlled substances for mental health conditions are at the heart of much of the criticism against the company.

The company’s new CEO has acknowledged that Cerebral has made mistakes in the past and is dedicated to improvement.

Founded in 2019 and launched in 2020, Cerebral raised $300 million in a Series C funding round led by SoftBank Vision Fund 2 in December 2021 at a valuation of $4.8 billion. Through Series C, the company has raised $462 million.

Cerebral has not yet responded to a request for comment on the committee letter nor the Aetna decision.

The committee letter

The U.S. House Committee on Oversight and Reform has requested information from the DEA detailing how it has pursued and how it intends to prevent “allegations of bad actors exploiting telehealth prescription authorities during the pandemic.”

The letter, a copy of which was provided to Behavioral Health Business, expresses worry that the rise of telehealth, the loosening of prescribing online and the lack of DEA action around regulating online prescribing could hurt Americans in need.

“Left under-regulated, we risk allowing new, more sophisticated classes of ‘pill mills’ to freely exploit Americans seeking legitimate mental and physical health services,” the letter, signed by Subcommittee on Government Operation Gerald Connolly (D-Va.), states

The DEA loosened the rules governing how telehealth providers may prescribe controlled substances. In response to the pandemic, the DEA temporarily waived the requirement dedicated by the Ryan Haight Act of 2008 that health care providers couldn’t prescribe controlled substances remotely without first conducting an in-person exam. The in-person waiver is still in place.

Cerebral cites the potential end of the in-person waiver as a reason for deciding to not prescribe controlled substances; it will continue to do so for treating patients with opioid-use disorder.

The letter specifically names Cerebral as an example of a company that may have “prioritized investors’ expectations for growth over patient safety.” It also mentions a whistleblower retaliation suit that alleges that Cerebral’s management was aware of duplicate patient accounts, “suggesting customers were setting up multiple accounts to obtain additional medication.”

It also mentions that some major retail pharmacies won’t fill prescriptions from Cerebral providers and uses reports about Cerebral as footnotes to many claims.

Finally, the letter also requests an update on a long-overdue special registration program for telehealth providers

Cerebral and Aetna

Aetna has decided to remove Cerebral from its provider networks, effective August 21, 2022, a CVS Health representative said in an email.

Cerebral CEO David Mou told employees that Aetna terminated its provider contract and will cease coverage “without cause,” according to forbes.com. Aetna reportedly offered in-network coverage of Cerebral’s services in 45 states.

In May, CVS Health and Walmart announced they would no longer fill prescriptions for controlled substances from Cerebral providers.

“This is related to the decision we made regarding controlled substance prescriptions issued by Cerebral,” the representative said, adding that Aetna will help members transfer to new mental health providers. “We are confident our network of in-person, virtual and digital health care providers, partners and resources can meet the needs of our members, and we will continue to provide easy access and navigation to the solutions that help them live healthier lives.”