Telepharmacy becoming more of a reality

     The profession of pharmacy is an ever changing concept.   The role of a pharmacist now is quite different from our place in the healthcare system a couple of decades ago.  Nowhere is that change more evident than with the fusion of technology and pharmaceutical services that results in the emerging field called telepharmacy.  But what does this mean for pharmacists going forward? 

    First, a bit of an introduction on the topic of telepharmacy.  Telepharmacy is the use of video conference technology by pharmacists to provide pharmacy services to remote locations.   Pharmacists now have the ability to perform traditional oversight of functions like drug dispensing, as well as patient counseling duties, from remote locations using teleconferencing equipment.   This merger of our profession with technology has no limits to what is possible.  But is it a good thing for pharmacists?  What can we expect out of the coming years? 

     Although in certain parts of the country telepharmacy has been around for a few years, for most of the country the concept of telepharmacy is a relatively new idea.  North Dakota took the lead in this field a decade ago out of necessity.  The pharmacist shortages of 2000-2001 really hit the state hard and they had a lot of under-served rural communities that needed pharmaceutical care services.   The board of pharmacy thought that telepharmacy would be a possible solution to some of the problems so they started their Telepharmacy Project, which has now expanded greatly and serves thousands of patients across the state. 

     Other states have also addressed telepharmacy rules and regulations in an attempt to incorporate those kinds of services into their healthcare systems.   But regulations can vary from state to state with some states not addressing the concept of telepharmacy directly at all.  As this field of pharmacy continues to develop, expect more and more states to write rules and regulations regarding these kinds of services.  There is opportunity for great growth in the field going forward. 

    The benefits to this kind of pharmaceutical care delivery system are almost undeniable.  The ability to operate pharmacies from a remote location can potentially serve many under-served areas of the country and the world.  The United States military has already realized that telepharmacy services can provide the ability to provide care across borders.   Rural communities across the country could also tap into major pharmacy services, such as medication therapy management (MTM) that often is unavailable in their area. 

     The opportunity for pharmacists with a entrepreneurial spirit is also great.  Creating a pharmaceutical consulting job could include some kind of video conferencing aspect with patients.  Pharmacist could manage patients without the need to actually meet them in person for a consultation.  It would allow more patients access to a licensed pharmacist who can manage their treatment plan and improve outcomes.

     But there is a downside to this technological push from within the profession.  What if this technology could be used to phase out pharmacist jobs?  The ability to connect patients with pharmacists in this manner, coupled with regulatory changes, could allow one pharmacist to oversee more than one brick and mortar pharmacy.  The overall demand for community pharmacists could decrease.  The only real roadblock to keep this from happening now is regulatory restrictions that are currently in place.  But that could change in the future.

    I’ve read lots of recent articles on the subject of telepharmacy, including the articles in the February 15th, 2011 issue of Drug Topics magazine that all tend to focus on the positives and the opportunities surrounding implementing telepharmacyon a widespread level.   The problem with that optimism is that it should be tempered with concerns over some very real negative consequences resulting from the expansion of telepharmacy services.  Jobs could be lost as pharmacist positions are simply phased out and the technology involving connecting people remotely becomes more advanced and affordable. 

    I can’t help but think that a large chain like Walgreens or CVS won’t take the first chance they get to change the regulations involving the requirement to have a pharmacist at each pharmacy.  They will use this technology not to “free up the pharmacist’s time” to counsel and provide services, which is how they will inevitably promote the idea.  Instead, they will simply cut out the pharmacist position and use technicians to check medications and have as few pharmacists on staff as legally possible.  Telepharmacy won’t be the beginning of a new era in pharmacy as it is being promoted.  It will be the beginning of the end for community pharmacy. 

     Having said that, I think that telepharmacy has a very vital role in the profession going forward.  The ability to remotely enter orders for hospitals that don’t currently have 24 hour in house pharmacy services is invaluable to provide care for hospitals or clinics on nights or weekends or during holidays.  The ability to provide pharmaceutical services like medication management counseling to rural areas can help bridge the gap between what patients have access to in those rural locations compared to the extensive services offered in many larger cities.

      But in the end the critical step for the widespread implementation of telepharmacy services will involve regulatory changes at the state level to allow for those services to be delivered to patients via technology.    My concerns about the chains phasing out retail pharmacists can’t happen until more and more states address telepharmacy by changing regulations in order to clarify what is legal and what isn’t.   Having legal clarification would allow a chain like a CVS to at least test pilot programs in certain states and then expand those programs as other states changed their own regulations to allow for telepharmacy services.  But will that be a good thing? 

      So I caution anyone who is being swept up in the wave of excitement surrounding telepharmacy and all of the possibilities involved in delivering that kind of care to temper that excitement.   Because as promising as this emerging field of telepharmacy is to our profession, there is also a dangerous possibility that it will be used to destroy pharmacy positions as much as it could potentially create opportunities. 

     The profession of pharmacy must adapt to meet the ever evolving needs of patients.  It would be in our best interests as a profession to embrace the technologies that are available to us to better do our jobs and serve the public.  But there is also a danger that those same technologies could be used to simply phase us out as the ability to connect pharmacists with more patients could lead to fewer pharmacists being required. 

      So going forward I would hope that each state board of pharmacy would officially define and describe what telepharmacy services are allowed and under what restrictions.  I also hope that the resulting field of telepharmacy expands our ability to serve patients and creates opportunities.    We can’t ignore our future as a profession.  The question though is what that future holds for pharmacists and what role telepharmacy will play.   I think we will all find out the answer to that question soon enough.  I just hope it’s the answer I am looking for and not the answer I fear.  What do you think?

The Redheaded Pharmacist

3 Comments to “Telepharmacy becoming more of a reality”

  1. By Jay Bird, February 21, 2011 @ 1:23 am

    The topic of telepharmacy is a hot topic and one that could make a real impact in the future. Look at Caremark, Medco, UnitedHealth, and Humana…these are some of the largest PBMs in the United States and all of them are creating phoned based MTM services. They do not want to pay the community pharmacists to do this, they want to do it themselves to save cost on their end. Next, Caremark may decide to try and do pilot studies for the majority of counseling at their CVS stores to be done in this fashion….who knows. Need to stand up and fight.

    PBMs are stepping up and creating MTM services that work for them, remember they are the payors and if they decide they are going to do it themselves that will leave community pharmacists out to dry when it comes to being able to bill for these services. Community pharmacists need to step up in the community and advocate for their roles.

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  2. By Jay Bird, February 21, 2011 @ 7:52 pm

    This is just a generalization and my opinion but I would say from my experience the big difference in pharmacists these days who pursue residency versus those who go straight into retail is: Those who pursue residency want to advocate for the profession and see the professional duties/services expand and those in retail want to go to work/help a few patients and then go home and forget about pharmacy altogether.

    I may catch flack for this and I know it is not true across the board. I have worked with great community pharmacists and poor managed care/hospital/amb care pharmacists. But overwhelming so, the pharmacists outside of retail seem to advocate much more for the profession and seem happier with their careers.

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  3. By WrongAid, February 21, 2011 @ 11:07 pm

    Someone answer me this question. What if the pharmacy you work at were to be converted to some telepharmacy remote location where only the techs ran the pharmacy and some pharmacist working from home or maybe India was checking the techs work by computer. Everything is exactly the same as you left, same techs, same usual customers, same layout. Would you let your child take a prescription filled from that pharmacy? Don’t forget, this is the very pharmacy you were running and the techs you were training.

    I would not.

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