Technology and
the benefits
of telepharmacy

Awareness and use of telehealth have grown substantially in recent years, with patients and providers increasingly using it for remote patient monitoring, community healthcare and even to help develop medicines. Among the reasons for the popularity is the ability for people to access specialized medical advice and help without needing to travel. Therefore, it's perhaps not surprising that those same reasons have also led to a growth in virtual pharmaceutical services or telepharmacies.

Telepharmacy is the practice of a pharmacist delivering care and services to a patient at a dispensing site through telecommunication or similar technologies. These services can include dispensing prescriptions, answering questions patients may have about their prescriptions in real time, reviewing patient drug use and monitoring drug therapy adherence.

Patients can interact with pharmacists who are located remotely in two ways:

1. Brick-and-mortar remote sites: These are pharmacies with a physical location where patients can interact with staff who are supervised by a pharmacist at a different location and communicate through real-time computer, video or audio links. This can include telepharmacies at clinics or other healthcare settings.
2. Self-service automatic machines: Similar to a bank ATM, these kiosks contain prescription medication, labeling equipment and telecommunications that connect patients to a remote pharmacist using real-time video and audio. Patients can fill and refill prescriptions through the kiosk.

In late 2021, the Drug Enforcement Administration (DEA) announced it was considering issuing specific regulations regarding telepharmacies, given they're not specifically defined by the Controlled Substances Act (CSA) or DEA regulations. The DEA also said:

• Telepharmacies are under the purview of the CSA and DEA to the extent they dispense controlled substances.
• Since they use the internet to dispense controlled substances, telepharmacies may constitute Online Pharmacies under the Ryan Haight Online Pharmacy Consumer Protection Act and therefore must obtain a modified registration or meet one of the legislative exceptions.

The Health Insurance Portability and Accountability Act (HIPAA) regulations apply to telepharmacy, although certain regulations were relaxed during the pandemic, allowing pharmacies to use free teleconferencing platforms, such as Zoom or Skype, which would have otherwise been noncompliant with privacy standards. Additionally, emergency legislation allowed pharmacists to conduct COVID-19 testing and vaccination and provide other services.

As with other aspects of telehealth, one of the key benefits of telepharmaceutical services is the ability to address the systemic challenges of delivering healthcare to hard-to-reach populations. Telepharmacies can help to minimize burdens associated with travel, cost and time.

Telepharmacies can help address patient and provider-related barriers to accessing healthcare, including communication, lack of 24/7 availability, lack of engagement in treatment decisions, existing medical status (such as infectious disease or high-risk status), substance abuse and mental health conditions. Some examples of positive outcomes include:

• Expanding service hours.
• Diversifying outreach services such as patient education, monitoring and adherence support, and antimicrobial and opioid stewardship programs.
• Increasing the proportion of patients who are 65 years or older and who are non-English speakers.
• Expanding access to Pre-Exposure Prophylaxis (PrEP) medication to people at risk of contracting HIV.

Residents of rural areas are less likely to have access to healthcare providers, less likely to be treated for chronic conditions and likely to pay more for healthcare (with a larger percentage of costs out of pocket). Telepharmacies are helping to restore, retain and establish pharmacy services in remote parts of the country, such as the 80,000 rural citizens who have benefitted from a project in North Dakota.

Hospital pharmacies could decide to outsource tasks to telepharmacies, allowing them to reduce their staffing levels. This, combined with a Just In Time system, would allow hospitals to maintain less stock, which would mean less inventory work and less risk of medicine expiring or being stolen. Finances can also be redeployed elsewhere.

Alternatively, hospitals could use telepharmacies as an opportunity to cost-effectively expand their pharmacy footprint. They could offer 24/7 pharmaceutical coverage for patients or consolidate the number of staff needed to provide those services across a wider system. Beyond hospitals, the medical industry can maximize the benefits of telepharmacy in a few ways.

Examples include:

• After-hours drug approval times can be reduced to as little as 14-20 minutes.
• Telepharmacies improve drug-dispensing practices, including lower rates of medication dispensing errors.
• Pharmacists don't have a risk of viral transmission when consulting with patients.
• Clinical pharmacy specialists can provide patient counseling, consultations and real-time monitoring to a wider range of patients.

There are still several challenges to the widespread adoption of telepharmacy:

• Pharmacy technicians under remote supervision aren't able to undertake the same tasks as those working under direct supervision.
• There isn't a standardized regulatory environment.
• The digital divide, including access to necessary devices and fast and reliable internet, and a lack of digital health literacy limits the impact telehealth can have on certain sectors of the population.
• There's a lack of industry awareness, including patients, of the benefits of telepharmacy.