For those familiar with the practice, history, and benefits of telepharmacy, it may be hard to imagine that there are still many people out there who oppose it. In fact, almost half of the United States (23 states) still don’t permit telepharmacy. We actually wrote about the same topic a couple of years ago but sadly the misconceptions and unfounded fears remain. It begs the question - Why are there still so many people opposing telepharmacy so strongly?
The truth is, the reasoning typically comes down to misconceptions and unfounded fears about what telepharmacy is and what it’s impact will be. We’ve written extensively about the history of telepharmacy in the U.S., the advantages it provides to patients, and the business benefits it provides to pharmacies. In this article we’re going to talk specifically about some of the most commonly held fears about telepharmacy today, and we’ll work to address them one by one.
1. Telepharmacy is NOT a Threat to Pharmacists’ Jobs
From the time telepharmacy made its first appearance in the U.S. in 2001 to this very day 20 years later, this unfounded fear has always been a fan favorite. The line of thinking is understandable at the surface:
“A telepharmacy is a pharmacy without a pharmacist. Therefore you replace a pharmacist with a telepharmacy location staffed by a technician.”
In a telepharmacy, the scope of practice for the pharmacist and pharmacy technician is unchanged. The managing pharmacist is responsible for the verification of all prescriptions, and in many states a pharmacist must provide patient consultations via a secure video call. Unless on-site, the pharmacist performs all clinical duties from the host pharmacy, and is available for the technician and patients at all times.
North Dakota and Idaho are two states which have allowed telepharmacy for over a decade and pharmacy professionals in those states have provided testimonials with an overwhelming response that telepharmacy poses no risk to pharmacist’s jobs in the state. Mark Hardy, PharmD, Executive Director of the North Dakota Board of Pharmacy, says of telepharmacy:
“If anything, telepharmacy has expanded the hiring of pharmacists across the state. It has allowed them to focus on clinical duties and interact with more patients than ever before by expanding pharmacy access. If there have been job losses, they are attributable more to economics than to telepharmacy.”
Similarly, Nicki Chopski, PharmD, Executive Director of the Idaho State Board of Pharmacy, says:
“Pharmacist job loss due to telepharmacy is not a reality in Idaho that I’m aware of. In fact, there have been some pharmacy owners that put a telepharmacy in place and came to realize there was enough business in a given community to put the pharmacist in the store on certain days of the week and operate as a telepharmacy on the remaining days.”
Dr. Chopski raises a second point in the latter half of her quote about the potential benefit of telepharmacy as a job creator. It is not a rare occurrence for a telepharmacy to pave the way for a future conversion to a traditional pharmacy.
2. Telepharmacy Does NOT Create Unfair Competition for Pharmacies
The second fear about telepharmacy is the issue of creating an unfair advantage for the pharmacies that decide to use it. Essentially the argument is this:
“Someone can just set up a telepharmacy right next to a traditional pharmacy and run them out of business by providing cheaper services and products since their operating costs are lower.”
As with the first unfounded fear, this may seem to make sense upon first glance. However, let’s take a closer look at why this is unfounded.
We’ve said it before, and we’ll say it again: telepharmacy is not intended to be a replacement for traditional pharmacies. Implementing telepharmacy is an option to consider when a traditional pharmacy can’t survive (or is failing to survive).
Telepharmacies are often placed in high-need, low access communities where patients otherwise have to travel long distances to get to their nearest pharmacy or would benefit from access to a pharmacist at the point of care. A traditional pharmacy which is failing to make ends meet and is on the brink of closing down could be converted to a telepharmacy to retain pharmacy access for those patients. A telepharmacy can also be opened in a community that may have never had a pharmacy at all and do not have the population or prescription volume to sustain the traditional model.
Telepharmacy is not a shortcut to providing cheap pharmacy services to compete with the traditional pharmacy next door. Telepharmacy requires all the things required of a traditional pharmacy, and in many states, the regulations are more strict for telepharmacies. The managing pharmacy would still have to rent or buy the brick and mortar retail space for the telepharmacy, staff it with a full-time technician, equip it with all the proper security measures required to be compliant, pay for the electric and water bills, supply the inventory, and of course pay for and implement the telepharmacy software that makes the whole thing work.
As you can see, a telepharmacy isn’t like a kiosk pharmacy. It operates essentially the exact same way as a traditional pharmacy, with the only difference being that the pharmacist is located off-site.
The above description simply addresses the logistical part of the equation. There is, of course, the other aspect of the market simply preferring a traditional pharmacy over a telepharmacy if the option is available close by. When we spoke with Dr. Chopski, she told us about a situation where a pharmacist did try to open a telepharmacy near an existing traditional location:
“We’ve seen situations where a telepharmacy didn’t survive in the marketplace when it attempted to compete with a traditionally staffed pharmacy. From our vantage point, the market seems to be driven by both technology and customer service. Telepharmacies function best when they meet an unmet need and provide access to people who don’t have it.”
Again, Dr. Chopski hits the nail on the head. Telepharmacy isn’t intended to be used as a way to compete with existing nearby pharmacies. There is no additional competitive advantage for telepharmacy, and according to the anecdote from Dr. Chopski above, patients pick a pharmacy location just as they would pick any other service, based on convenience and the customer service available to them.
3. Technicians CAN Manage a Location Alone
Next, let’s address the unfounded fear surrounding technicians bearing the responsibility of managing a telepharmacy location on their own. Often, this fear is presented as:
“It’s not safe for a technician to man the location alone. There’s more possibility for errors, improprieties, and even robbery.”
In order for a pharmacy technician to work in a telepharmacy, many states require a technician to have prior experience in a traditional pharmacy or complete additional continuing education. When a pharmacist looks to open a telepharmacy, they choose a technician who is skilled to manage the location, and it is entirely up to the pharmacist to vet and select the technician they feel will be right for the job, just as they would when hiring in a traditional pharmacy setting.
Many times, the technician hired is one who has worked with the pharmacist for some time, with the skills necessary to manage a location on their own, and has also developed a level of trust with the pharmacist, allowing them to be confident with putting the telepharmacy in their care.
To ensure safety and error mitigation in a telepharmacy, a trained and licensed pharmacist oversees the operations of a telepharmacy at all times. In fact, a telepharmacy cannot operate unless the pharmacist is on duty at the host location. If the pharmacist takes lunch, the telepharmacy closes for the hour. If the pharmacist leaves early for the day, the telepharmacy closes for the day. The technician has some autonomy in a telepharmacy, but they are not free to provide medication or serve patients in any way without the supervision of a pharmacist.
Then there’s the question of robberies. Robberies can happen in any pharmacy location, whether or not a pharmacist is present. There are additional safety measures taken in any pharmacy to prevent loss, theft, or breach in security, and there is no evidence that telepharmacies are more or less vulnerable to theft than traditional pharmacies.
4. Patients DO Know How to Talk to a Pharmacist on Video
The next fear that gets mentioned has, fortunately, faded in recent years. The objection typically goes something like this:
“My elderly patients in rural towns aren’t going to want to talk to a pharmacist on a screen, and in fact they won’t even know how to operate it!”
Let’s start with the technological side of this fear. Prior to COVID, many people would consider themselves to have been familiar with video platforms like Skype, FaceTime, and Zoom. Fast forward to now in the year 2021, after a year of a pandemic which caused lengthy periods of isolation from friends and family, video call technology has been more broadly used than ever before.
In our patient perspective blog post, we interview patients of telepharmacies and ask them about their experiences. The patients (most of whom are elderly) discuss why they prefer the convenience of pharmacy access nearby over having to travel long distances for one of their most basic and essential needs, with the video call portion of the process presenting no issue for them at all.
This leads to the second part of the discussion, which is considering the alternatives available to underserved patients. Across the U.S. there are approximately 1.8 million people (according to our independent research as of 2021) living in what are considered “rural pharmacy deserts,” or areas located 10 or more miles from the nearest pharmacy. In the northern parts of the country and across the upper midwest, which would you rather have your grandmother do? Drive 40 minutes round trip on potentially icy rural highways to get to her nearest pharmacy, or have her simply head to the telepharmacy location a few blocks away to obtain her prescription and receive a short video consultation with her pharmacist? The benefits simply outweigh the cons, and (as you’ll see in the next point), there is no difference in the level of care the patient receives from the telepharmacy.
5. Patients CAN Get the Same Level of Care From a Telepharmacy
We’ve arrived at our final unfounded fear that we’ll address, which is the concern that patients can’t get the same level of care from a telepharmacy as they can from a traditional pharmacy.
“How can a telepharmacy possibly provide the same care as a traditional pharmacy? Nothing can replace those face-to-face interactions with a local pharmacist.”
First let’s start out by saying that we completely agree, interaction with a pharmacist is vital and helps aid in the understanding and adherence to medications. When patients resort to pharmacy options that require no interaction with a pharmacist, such as physician dispensing or internet pharmacies, there can be a decrease in the level of care and customized attention they’re getting. Fortunately, telepharmacy retains the face-to-face interaction between a pharmacist and the patient, but it is conducted through a high definition video call instead of in-person.
Patients are able to get the same level of care from a telepharmacy as they would from a traditional pharmacy. In many cases, patients are able to get both prescription and over the counter medications at a telepharmacy. Patients still speak with a pharmacist regarding their medication regimen and all their specific medication questions, and the pharmacist can recommend over the counter medications, vitamins, or supplements that are sold right there on-site.
There is often the question of other clinical services provided by pharmacists as well, such as immunizations and point of care testing. If there’s no pharmacist on-site, how are patients supposed to acquire these services? Most of the time, the host pharmacist will make at least monthly visits to the telepharmacy site to check inventory and monitor operations (in fact, this is required in many states). When they make their regular visits, they will often notify the community that they’ll be present, and schedule immunizations and perform other in-person clinical services while on-site.
In Conclusion
Whether you opened this article as a fan and advocate for telepharmacy or a staunch opponent, hopefully at this point you have a better grasp on the nuances of the practice of telepharmacy.
As with any topic, it’s easy to jump to conclusions, but when you take a step back and analyze the evidence in practice, it tells a different story. We at TelePharm have worked with several hundred telepharmacies operating across the country, and have had years of experience with pharmacists, pharmacy owners, and even patients who have been able to tell us first hand of all the positive impacts telepharmacy has had for them.
If you want to learn more about implementing telepharmacy for your own practice, feel free to click below to watch a short video to see how telepharmacy works, or you may want to view our regulatory map to see if telepharmacy is legal in your state.
