Telehealth Models for Increasing Access to Pharmacy Services

Rural communities are using telehealth to increase access to pharmacy services. Referred to as telepharmacy, this model helps rural communities overcome common challenges to practicing pharmacy, including financial difficulties related to low volumes of patients and a limited ability to recruit qualified pharmacists. Telepharmacy models can help rural communities retain, restore, or gain access to timely pharmaceutical services. A study of telepharmacy use in the rural Midwest found no differences in the quality of medication use between telepharmacies and traditional pharmacies.

Telepharmacies can be implemented in retail, outpatient, mobile, or hospital settings. A typical telepharmacy involves a fully licensed pharmacist at a remote site who provides consultations and supervision to a pharmacy technician or nursing staff at a rural site. The pharmacist verifies prescriptions, assesses the appropriateness of the dose, and asks for clarifications before approving the order. The technician and pharmacist communicate through telephone, videoconference, electronic health records, or another form of secured electronic connection.

Many programs also use telehealth to record images of the prescription, medication, label, or prepared bottle for additional review by the pharmacist.

Another key component of telepharmacy is patient counseling and education. Many telepharmacy programs require pharmacists to conduct a live-video consultation with the patient prior to releasing a prescription. In some telepharmacy models, especially those located in hospitals, the rural site is equipped with an automated dispensing unit that contains prepackaged doses of medications.

Examples of Rural Telepharmacy Models

• The North Dakota Telepharmacy Project provides pharmacy services to rural and frontier communities across the state. A pharmacy technician prepares prescriptions and obtains approval from a pharmacist through videoconference to dispense the medication. In order to receive the prescription, the patient must first receive patient counseling from the pharmacist through videoconferencing. Telepharmacies have served 80,000 rural residents of North Dakota and contributed to economic development in rural communities.
• The Idaho State University College of Pharmacy has a telepharmacy project that serves rural towns in eastern and northern Idaho. The program engages pharmacy students and pharmacists to counsel patients on their medications. Patients in rural pharmacies can meet with pharmacy students and pharmacists through a live-video feed or over the phone.
• The Nebraska Medical Center Telepharmacy Service connects rural hospitals to remote pharmacists. Rural hospital staff send medication orders to the pharmacists, who review the patient's electronic medical record to verify the prescription and review the patient's medical history before approving hospital staff to dispense the prescription.
• The TelePrEP program is using telepharmacy to expand access to Pre-Exposure Prophylaxis (PrEP) medication to rural Iowans who are at risk of contracting HIV. Patients use an mHealth application on their smartphone or other videoconferencing technology to meet with a pharmacist from the University of Iowa Health Care system. The pharmacist counsels the patient and prescribes a PrEP regimen. Pharmacists hold periodic follow-up calls with patients through telehealth in order to ensure that patients are managing their medication appropriately.
• Rural clinics in North Carolina expanded their telepharmacy service during the COVID-19 pandemic to include support for the social determinants of health (SDOH). The pharmacist helped screen patients for SDOH concerns during telehealth visits and provided information and resources when appropriate. Examples of support included sending patients coupons for their medications and providing resources to help patients search for jobs.

Implementation Considerations

Rural communities should understand regulations and restrictions for telepharmacy in their states:

• Authorization restrictions. As of 2020, 21 states explicitly allow the use of telepharmacy and two additional states have laws or regulations that permit waivers or pilot programs to implement telepharmacies. Other states also permit telepharmacy with restrictions, prohibit telepharmacy, or do not have any laws related to telepharmacy.
• Facility restrictions. Telepharmacies are also commonly restricted to certain geographic locations and types of facilities. For example, telepharmacies in Louisiana must be located at least 20 miles away from another pharmacy.
• Staffing restrictions. States may also strictly regulate staffing and supervisory models for telepharmacies. Rural programs should review pharmacy regulations in their state to assess any requirements that would prevent the use of telepharmacy, including physical supervision of pharmacy technicians.

Telepharmacy models may require substantial investments in health information technology infrastructure. For example, some telepharmacy programs require pharmacists to access electronic health records in order to verify prescriptions and review pertinent medical information. Telepharmacy may also involve digital cameras for capturing images of prescriptions and real-time videoconferencing technology for patient counseling. Rural programs may need to seek grant funding to implement telehealth technologies to conduct telepharmacy. For example, the North Dakota Telepharmacy Project used funding from the Office for the Advancement of Telehealth to purchase telepharmacy equipment for pharmacy sites in rural North Dakota.

The North Dakota Telepharmacy Project offers several resources for rural communities interested in implementing a telepharmacy project, including a consumer satisfaction survey to assess pharmacy services among community members. NDTP also provides a comprehensive technical assistance document with step-by-step guidelines and implementation considerations for rural programs. Other resources include sample policies and procedures for establishing telepharmacy contracts and agreements.

Additional implementation considerations including licensing and reimbursement are discussed in Module 4: Implementation and Module 6: Funding & Sustainability.

Program Clearinghouse Examples

• North Dakota Telepharmacy Project

Resources to Learn More

What is Telepharmacy?
Audio
An interview with Jessica Adams, PharmD, Director of Regulatory Affairs for TelePharm, providing an introduction to telepharmacy, and how it can help rural communities increase access to care. Includes transcript and links to resources identified in discussion.
Organization(s): Upper Midwest Telehealth Resource Center, TelePharm
Date: 4/2021