Telehealth Models for Increasing Access to Pharmacy Services
Rural communities are using telehealth to increase access to pharmacy services. Referred to as telepharmacy,
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
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
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 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.
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.
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
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
Resources to Learn More
What is Telepharmacy?
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