“Reimbursement is the main issue in pharmacy closures that contribute to pharmacy deserts,” Hauser says. “States are making it more obvious that they want to help pharmacies succeed and continue to stay open in these underserved areas.”
Telepharmacy is a faster fix. About half of states allow telepharmacy and more are moving toward implementation.
“We are seeing a major shift in states adapting regulations to work with telepharmacy,” says Jennifer Bingham, PharmD, clinical pharmacy specialist in Tucson and former chair of the APhA’s telehealth special interest group. “In the next five years or so you we will see telehealth as an additional credential that we can offer.”
Norman Schlecht, PharmD, opened one of the nation’s first community-based telepharmacies in 2001 in Gwinner, ND, a town of about 500. He turned a pharmacy desert into a profitable pharmacy.
“They had a medical clinic, but no pharmacy,” Schlecht says. “Telepharmacy was a big improvement over having to drive 20 to 25 miles each way to get to a pharmacy.”
What began as a rural solution works just as well in urban pharmacy deserts. Tushar Mehta, RPh, opened the Broadway Medical Clinic Pharmacy in suburban Chicago in 2016. His telepharmacy is in a medical clinic in a blue-collar neighborhood with large Medicare/Medicaid populations and no brick-and-mortar pharmacy.
Mehta already owned two brick-and-mortar pharmacies a few miles away.
“Most of our telepharmacy patients are walk-ins, without working cars,” he says. “Too many times they never filled prescriptions because the nearest pharmacy was a mile or two away from the doctor. Patients got frustrated and never filled their scripts. Putting a pharmacy inside the clinic made those access issues go away.”
Low reimbursement from public insurance programs made a traditional pharmacy financially impossible, he adds. At 400 scripts per week, the telepharmacy turns a small profit.
“We have Medicare, Medicaid, a few private insurance patients. If I put everything together, I can afford to stay open because I don’t have a dedicated pharmacist salary. If this was a traditional pharmacy, it would be a money loser,” Mehta said.
Dale Colee, RPh, took a slightly different approach in Decatur, IL. He partnered with a FHQC to open Colee’s Community inside Crossing Healthcare. He also owns two brick-and-mortar pharmacies in Decatur.
“Reimbursement rates are low in public aid managed care programs in Illinois, like they are in every state,” Colee says. “The only economically feasible route was to open a telepharmacy. When patients walk in, they can see a physician or nurse practitioner and get their script filled without ever leaving the building. And because we are part of a 340B program, we get a dispensing fee on brand name products that actually covers our costs. And we don’t lose nearly as much on generics.
“We can do okay on 125 to 150 scripts a day because our biggest expense, a $150,000 pharmacist, is gone. If we had to run The Crossing as a brick-and-mortar pharmacy like our other stores, we’d be in big time financial trouble.”