According to The Model State Pharmacy Act and Model Rules of the National Association of Boards of Pharmacy (Model Act), the “‘Practice of Telepharmacy’ means the Practice of Pharmacy by registered Pharmacies and Pharmacists located within US jurisdictions through the use of Telepharmacy Technologies between a licensee and patients or their agents at distances that are located within US jurisdictions.”1 The Model Act defines “Telepharmacy Technologies” as “secure electronic communications, information exchange, or other methods that meet applicable state and federal requirements.”2
The American Society of Health-System Pharmacists (ASHP) defines telepharmacy as “a method used in pharmacy practice in which a pharmacist utilizes telecommunications technology to oversee aspects of pharmacy operations or provide patient care services. Telepharmacy operations and services may include, but are not limited to, drug review and monitoring, dispensing, sterile and nonsterile compounding verification, medication therapy management (MTM), patient assessment, patient counseling, clinical consultation, outcomes assessment, decision support, and drug information.”3
A more succinct definition of telepharmacy is provided in an article in the American Journal of Medical Research, which states that telepharmacy is “the delivery of pharmaceutical care to outpatients at a distance through the use of telecommunication and other advanced technologies.”4
Current technology includes the following: facsimile or fax machine, binary and text messaging, telephone or audio conferencing, and video conferencing. The latter is usually software or browser-based, and may include a mobile application, or app, as state-of-the-art technology on the pharmacist and/or patient end. Telepharmacy technology can be proprietary or non-proprietary, e.g., Zoom integration, and in some countries, telepharmacy technology is provided by a government agency, like the Ontario Telemedicine Network in Canada.
The first use of video telepharmacy in the United States occurred in 2002 with the North Dakota Telepharmacy Project. Funded by a federal grant from the Office for the Advancement of Telehealth at the US Department of Health and Human Services, its purpose was to provide remote, underserved areas with access to a pharmacist following the closure of many rural community pharmacies in the state.5 A shortage of hospital pharmacists in Canada prompted the establishment of Northwest Telepharmacy Solutions in 2004 to serve a small hospital in northern Ontario and two remote nursing stations in fly-in Native communities.6 A worldwide telepharmacy project was initiated by the US Navy in 2010 when it partnered with ScriptPro, LLC, from Mission, Kansas, to alleviate the shortage of pharmacists in the service.7 “By 2010, Montana, South Dakota, Texas, and Idaho had also enacted laws and regulations specifically authorizing the use of telepharmacy, while Utah, Washington, Arkansas, Minnesota, and Oklahoma permitted the use of telepharmacy on a limited basis. …Little research is available to evaluate the progression of telepharmacy initiatives throughout the states since 2010.”8
Since 2010 several telepharmacy companies have emerged with each advancement in technology, but the 2020 COVID-19 global pandemic is the seminal event that rapidly accelerated industry growth. Regulatory hurdles were loosened as governments required citizens to stay at home in order to “flatten the curve.” For example, the Centers for Disease Control and Prevention issued a “Guidance for Pharmacists and Pharmacy Technicians in Community Pharmacies during the COVID-19 Response,” which stated the following: “[p]harmacists who are providing patients with chronic disease management services, medication management services, and other services that do not require face-to-face encounters should make every effort to use telephone, telehealth, or tele-pharmacy strategies.”9 The Drug Enforcement Administration “issued guidelines intended to make it easier for prescribers to get patients controlled substances through telemedicine. Many states loosened rules concerning the delivery of telehealth services, including those provided by pharmacists.”10,11
At ASHP’s second Pharmacy Executive Leadership Alliance virtual conference on May 11, 2021, Mark McClellan, a former head of the Centers for Medicare and Medicaid Services and the Food and Drug Administration, stated that “there’s a ‘huge amount’ of support for continuing the regulatory flexibilities that have allowed pharmacists and other healthcare providers to deliver remote care during the pandemic.”12 At the same forum, ASHP President Thomas J. Johnson “called telehealth ‘a topic of strategic importance to healthcare in this country.’”13
Even though federal legislation enacting Provider Status for pharmacists under Medicare Part B has not yet occurred, dozens, if not hundreds, of new startup companies have already entered the telepharmacy industry. Polaris Market Research forecasts the global telepharmacy industry to be $71.43 billion US by 2027 due to the COVID-19 pandemic, the increase in internet penetration to remote and rural areas where pharmacists are in short supply, and pressures to reduce labor costs and hospital length of stays.14
Tin Le, Michael Toscani, and John Colaizzi, Telepharmacy: A New Paradigm for Our Profession, Journal of Pharmacy Practice, Volume 33, Number 2, April 2020, pp. 176–182, https://doi.org/10.1177/0897190018791060.