The potential of telepharmacy isn’t restricted to job creation. Experts say it also gives pharmacists more opportunities to practice at the top of their license.
By design, telepharmacies rely on technicians to fill prescriptions and for other non-clinical tasks. Pharmacists can spend more time on counseling and other patient-focused responsibilities.
“Every time a pharmacist can interact with a patient, there’s a better chance to have an intervention to improve drug therapy, to demonstrate the pharmacist’s value, and to help overall patient care,” Chesler said.
NuCara, a chain of 23 pharmacies primarily in the upper Midwest, operates two telepharmacies in Iowa, and has plans to open a third and one in North Dakota. NuCara also provides all the pharmacy services for four telepharmacies in Illinois, although they don’t own these facilities.
“I definitely think it’s a tool to reach into communities that otherwise would not have access to pharmacist services. That’s really how we look at telepharmacy,” said Brett Barker, PharmD, Vice President of Operations for NuCara.
Ashley Loeffelholz, PharmD, is the Pharmacy Manager of a NuCara hybrid telepharmacy in State Center, IO. Under the hybrid model, Loeffelholz primarily provides telepharmacy services to the State Center location while also working at a regular retail pharmacy in Ames, IO. However, she is on-site at the telepharmacy one day a week to provide immunizations and other clinical services.
Finding time to counsel patients at both stores naturally weaves into her work flow, she said. She spends the same amount of time, if not more time, counseling those patients at the telepharmacy site compared to her traditional pharmacy.
“I think now it’s very user-friendly and patients are pretty happy with it,” Loeffelholz said.
One advantage to working in the telepharmacy is that due to the small- town nature of State Center, Loeffelholz said she’s had more opportunity to work collaboratively with local physicians.
“We’ve launched a couple clinical projects [in Ames] that have been inspired by working closely with the doctors in the towns,” she said. “It’s really helped me grow professionally.”
Expanded patient access
The University of Wisconsin used telepharmacy initially as a way to assist a federally qualified health center that needed help with getting medications at discounted prices for the 340B drug pricing program targeted at the center’s indigent population.
“We got into the telepharmacy realm by trying to figure out how we could get these patients access to medication at their clinic while not incurring the high cost of a pharmacist FTE [full-time equivalent],” said Melissa Ngo, PharmD, BCACP, Manager of Community Pharmacy Services at UW Health in Madison.
The telepharmacy started at about 20 prescriptions a day and has since grown to about 60 prescriptions a day.
UW Health, which has more than 60 clinic locations, now operates two telepharmacy locations. It has plans to provide services at a third site this summer.
“We can also utilize this technology to improve the efficiency that we can have with our pharmacist. So we can free up our pharmacist’s time to focus on the clinical tasks,” said Joe Cesarz, PharmD, MS, Director of Ambulatory Pharmacy Services at UW Health.
Chains, health systems, and independents have seen advantages to the telepharmacy model, but experts acknowledge that there are still obstacles that prevent more widespread adoption of the strategy.
Rickert, who also teaches pharmacy law at the University of Illinois College of Pharmacy, points to legislative and regulatory hurdles that still exist in many states.
“Some states are great. The way their laws are written, the board has the authority to allow pilot projects and other such things to test technology. A lot of states don’t have that,” Rickert said.
Chesler said regulations are fragmented widely across states. Some don’t even have the statutory approval to operate a telepharmacy. He said Cardinal Health is focusing on educating regulators and legislators to try to give more states the opportunity to use telepharmacy as a strategy within their state.
Another challenge is to ensure that high-caliber technicians are employed at these sites since they will be operating at a separate location from the pharmacist who supervise them.
“You really have to go out on a limb and trust them and trust that they are doing everything in a way you would want it to be done,” Loeffelholz said. “We’ve gotten very lucky. We have great staff able to do that.”
Barker said finding physical space to house telepharmacies can also be a challenge in some areas due to limited available retail space.
Finally, Rickert said some automated telepharmacies could face challenges related to the distribution of controlled substances via automated technology. This is less of a concern for brick and mortar telepharmacy buildings, but could be a challenge for those telepharmacies relying on automated dispensing systems.
“It’s something that I think the DEA will eventually come around to, but they move slowly in terms of embracing technology,” he said.
Despite the challenges, those in the industry said they expect telepharmacy to continue to grow, further extending a pharmacist’s reach in patient care.