The year is now 2020, which means 2000 was officially 20 years ago… 20 years ago! Think about yourself in 2000 - Were your clothes baggier? Was your cell phone bulkier and far less capable than what you have today? Did you still purchase an entire CD so you could listen to the one song from the album you actually liked?
Things sure have changed in 20 years, and much of that change is due to the advancement of technology. For instance, no one in 2000 was streaming movies on Netflix or music on Spotify, and they certainly weren’t practicing telepharmacy as we know it today (that came a year later). At the time, it was not legal to practice telepharmacy in any state, but thanks to the safety and efficiency that technology affords, pharmacists can now use telepharmacy to provide access to patients across the country. Today there are 23 states that permit telepharmacy, with several others in the process of passing telepharmacy rules of their own.
Because the last 20 years have progressed from zero states permitting telepharmacy to nearly half of them permitting it today, it seemed fitting for us to take some time to reflect on the progress and recap how we’ve gotten here. With that, let’s start at the beginning:
2000 - 2009: The Boom of Technology, Telepharmacy, and Innovation
The 2000s were a pivotal time for new technology. Many of us rang in Y2K with a sigh of relief, clinking glasses of sparkling grape juice, watching a Blockbuster movie and waiting for our family member to hang up the phone so we could “dial-up” to surf the web. Throughout the decade, broadband internet and eventually wireless internet, smartphones, social media, and other technologies became widely available and popular, allowing people to connect with each other and content like never before.
In 2006, as you made your last trip to Sam Goody to purchase that new CD before they closed their doors, a startup in Stockholm, Sweden was launched called Spotify. This music startup would go on to essentially deliver the final blow to the age of CD’s, and would completely change the landscape of how people listen to music because they made it accessible and highly convenient for their customers to stream albums or single songs on their computers and smartphones.
A year later, a movie rental delivery company began offering its online streaming service, allowing customers to watch movies online and bypass the hassles of dealing with DVD’s, keeping track of returns, and of course paying exorbitant late fees. It was in 2007 when Netflix disrupted the entertainment industry, altering the way people consume movies and shows. Netflix was a success because it removed barriers for its customers, making the service they demanded accessible and convenient. Noticing a trend?
Before these innovations came about, back in 2000, the world was a cold, dark, and technology-less place. Okay that’s not totally true, but in rural North Dakota, it probably felt like that at times, especially for those patients who were without pharmacy access. In North Dakota, pharmacy closures were plaguing the state, and more and more patients were finding themselves in “pharmacy deserts” without the accessibility and convenience of a local pharmacy.
This left patients with no option but to travel long distances to get their medications, and often patients simply wouldn’t fill or refill their prescriptions due to the barriers they had to navigate just to get to their pharmacy. Because the lack of pharmacies was placing an undue burden on North Dakota residents, the state decided to take action. In 2001, North Dakota permitted the practice of telepharmacy, a concept which at that point had not been utilized in the U.S.
When North Dakota put their telepharmacy rules in place it allowed for telepharmacy sites, also known as “remote sites,” to be staffed by a pharmacy technician who would dispense medications to patients on-site, all the while a supervising pharmacist at the host location was supervising the technicians, verifying prescriptions, and counseling patients via two-way audio-visual communication.
North Dakota’s first stint with telepharmacy proved very successful, even though the mechanisms used to deliver the service were rather clunky. At the time, the process consisted of a one-to-one video solution in which the pharmacist and technician joined a live video call using bulky convex computer monitors for the video, and regular telephones for the audio connection. In addition to the overall clunkiness of the solution, the system had inefficiencies because the pharmacist was unable to optimize the workflow or perform any additional clinical activities. To top it off, there was essentially no documentation of any part of the process; from the verification to the dispensing to the patient-pharmacist consultation.
However, despite the technology limitations they faced at the time, a telepharmacy study conducted by North Dakota State University from 2002-2008 went a long way in documenting and proving the safety and effectiveness of the practice. Because this trial run in North Dakota was so successful, other states began looking at telepharmacy as a viable option to help restore access to their own residents who were without accessible or convenient pharmacy care.
Between 2001-2007, five more states and the US Navy adopted telepharmacy rules, but the highlight of the bunch is Illinois. When Illinois wrote their telepharmacy rules in 2007, they did it in the most empowering way possible for pharmacists, placing very few restrictions on the practice and affording maximum flexibility and freedom in regards to where telepharmacy locations could be placed, while the language also maintained patient safety as a top priority.
For this reason, Illinois is the most telepharmacy-populated state to date, with the 60+ telepharmacies in the state distributed evenly between rural regions and dense urban settings such as inner-city Chicago. Illinois serves as an excellent model for how to implement telepharmacy rules that present maximum benefit for both pharmacists and patients, and many states have followed their example since.
In 2009, Nevada, a state with vast swaths of sparsely populated desert land decided that telepharmacy could benefit patients across the state. Unfortunately, they took the opposite approach to that of Illinois. Included in Nevada’s telepharmacy statutes is a mandate that any telepharmacy location must be at least 50 miles from the nearest pharmacy, and additionally, it stated that the population of the area being served by the telepharmacy must not exceed 2,000 people. With such restricting language, the state of Nevada has only successfully implemented two telepharmacy locations to this day.
The progression of states' adoption of telepharmacy from 2000-2019
2010 - 2019: Telepharmacy Continues to Grow
The second decade of our recap begins in 2010, the year in which Blockbuster Video formally ceased operations, due primarily to its inability to compete with Netflix. When customers began opting to stay in and explore the titles on Netflix instead of going to their local Blockbuster location, the company simply couldn’t survive. Their failure to innovate and keep their eyes on industry and consumer changes led to their demise, and it serves as a warning to any industry about the dangers of lacking foresight and innovation.
One year after Blockbuster was closing up shop, a wildly successful company was just getting started. In 2011, the ride sharing app Uber was launched, quickly finding success due to - you guessed it - the increased accessibility and convenience it provided its customers. Uber quickly posed a big threat to the taxi industry, not only because of the ease of use, but because it provided an increased level of accountability for the drivers and safety for riders. Riders using Uber and its competitors today feel safer knowing that their location is being tracked and the ride is being documented so that they will get to their destination safely and efficiently.
In the telepharmacy world, the 2010’s brought continued innovation and growth as well, as the mechanisms through which the service of telepharmacy is delivered began to drastically advance. Along with the technological growth in telepharmacy came the growth of states’ adoption of the practice, as 13 states implemented telepharmacy language through the 2010’s.
But what was the catalyst for the innovation and advancement of the practice of telepharmacy in the 2010’s? The answer is in 2012, the worlds of industry-disrupting companies and telepharmacy collided with the founding of TelePharm.
It was at this time that TelePharm launched its flagship telepharmacy software which made the connection between host pharmacies and their telepharmacy sites seamless, allowing pharmacists to make pharmacy services accessible and convenient for patients in underserved areas. Much like Uber provided for the transportation industry, TelePharm provided a way to implement and practice telepharmacy in a more efficient way while facilitating transparency and accountability for all pharmacists and technicians involved, ensuring utmost safety for patients.
As opposed to the pieced-together telepharmacy solutions utilized in the early 2000’s, with TelePharm, host pharmacies and their telepharmacy sites can now operate as a connected web, with priority queues in place that allow for optimization of the workflow. Pharmacists are able to counsel patients and perform clinical activities, all the while documenting each step of the process, keeping detailed audit logs, and upholding patient safety with the various safety features built into the technology.
While the introduction of a safe and secure telepharmacy system made the practice more manageable and attainable for pharmacists across the U.S., this was not the only important contribution TelePharm made to the advancement of telepharmacy.
A couple years after launching, TelePharm assembled an in-house Regulatory Affairs staff. This highly experienced team of pharmacists-turned-regulatory experts make the navigation of state legislation and regulation a much less daunting task for pharmacists and organizations looking to get telepharmacy permitted in their state. The Regulatory team has been instrumental in getting telepharmacy language passed in 12 states so far, and continues to work hard to move legislation forward in the remaining states.
Idaho implemented telepharmacy years ago starting with a pilot project, but in 2019, after observing the safe and successful implementation of telepharmacy in Idaho and other states, the board removed the regulatory barriers, allowing it to be practiced by pharmacists statewide. Idaho board of pharmacy member Nicki Chopski states about telepharmacy’s impact in Idaho:
“For the state, the impact has been a sense of overall improved healthcare for the citizens of Idaho. The reason I say that is because when you provide access to a pharmacist, it provides an increased level of healthcare service to patients. Pharmacists not only dispense prescriptions, but they educate and counsel patients on their regimens and therapies, which is an extremely important part of the process.”
To round out the 2010’s, there were two more states that implemented restriction-free language for telepharmacy. Arizona did so in 2018, and in 2019, Utah reworked its original telepharmacy language (initially introduced back in 2001) to reduce restrictions and make the practice more viable for pharmacists across the state. Once the language was passed in both states, there was no time wasted in getting the first telepharmacies up and running in Utah or Arizona.
2020 and Beyond: More Innovation Will Come - Where Will You Be?
As telehealth continues to gain traction across America, it is reasonable to predict telepharmacy will also be permitted by all 50 states within this next decade. The status-quo of roadblocks for patients without access to pharmacy care cannot survive.
Time rolls along, and innovation keeps coming. If we’ve learned anything from CD’s, Blockbuster, and taxis, it’s that when you fail to adapt, alternative companies and solutions will arise and find a way to meet customers’ needs. In the pharmacy industry, if the pharmacist wants to remain a central pillar in the patient care process, then pharmacists are going to have to adapt as a whole. If pharmacists aren’t accessible and convenient, patients see this as a reason to find other solutions, many of which in existence today require little to no pharmacist interaction that patients are historically used to.
We can’t be sure what the next 10 or 20 years will bring us. In 2000, no one could have imagined we’d be carrying around little computers in our pockets that give us access to almost any information we could want. Today, it is crazy to think about a future where flying cars are driving themselves, or where hyper-speed trains transport us around the country at the speed of light, but the fact is, these things are already here. Innovation and growth waits for no one, so the choice we have to make is whether to get on board or get left behind.
Pharmacists are one of the most vital components of the healthcare system, yet unless they improve their accessibility, their future is dim. Patients see pharmacists on average almost nine times more per year than their other healthcare providers, but the dispensing piece of the pharmacy industry is moving more toward online, impersonal, transaction-based models as opposed to the personal, human touch that has made pharmacists such crucial healthcare providers and members of their communities for so long. Telepharmacy keeps this vital role intact, allowing pharmacists to keep their doors open, maintain human interaction and relationship with patients, and extend their reach to serve more people in need.
Telepharmacy gives pharmacists the ability to compete with mail order, physician dispensing, drone delivery, and other technologies which are gaining traction to improve patient access. Don’t let other threats diminish your ability to adapt, stay competitive, and serve your patients as well as you can. If telepharmacy is not available in your state yet, please get involved! Reach out and advocate for telepharmacy with our Regulatory Affairs team as they work to get telepharmacy permitted in your state.
Not sure whether telepharmacy is permitted in your state? Click above to view the regulations map to see what states allow telepharmacy, as well as their specific rules:
If you have questions, or want to help get telepharmacy moving forward in your state, contact our Regulatory Affairs team for help:
Just curious how the modern-day telepharmacy process works? Watch this short video which outlines the whole process from start to finish: