When North Dakota opened the nation’s first community-pharmacy-based remote dispensing site in 2001, the case was simple. The state pharmacy association, board of pharmacy, and pharmacists wanted to reverse the tide of rural communities losing pharmacy services. The pilot program brought pharmacy services to 80,000 rural North Dakotans who were without a pharmacy.
Nearly two decades later, the case for telepharmacy is more inclusive. The goal is to bring pharmacy services to underserved areas. Telepharmacy can work in rural or urban settings, specialty clinics, hospitals, or anywhere else that needs but does not have ready access to pharmacist care.
That led Heather L. Bibeau, PharmD, director of outpatient pharmacy services at Bigfork Valley Hospital in Minnesota to open telepharmacies in three Federally Qualified Health Center clinics in Bigfalls, Floodwood, and Northome, MN, which had no community pharmacies in 2017. The state’s newest telepharmacies join 19 other remote dispensing facilities.
The latest move is bringing telepharmacy to underserved urban areas that lack a conventional brick-and-mortar pharmacy.
Meeting Unmet Needs
“There is a shift of telepharmacies for strictly rural areas to telepharmacies for medically underserved areas in urban settings, where patients may have transportation issues, may be low income, and not have a convenient pharmacy,” said Adam Chesler, PharmD, director of regulatory affairs for Telepharm, a telepharmacy software provider owned by Cardinal Health.
Cardinal Health has identified multiple areas where a patient might need to take two or more buses to get to their doctor, then another two or three more to get to the nearest pharmacy, he said. The focus is increasingly on providing access wherever it is needed.
Pharmacists are identifying other needs that telepharmacy can meet. In West Texas, Micah Pratt, PharmD, needed a way to ease the skyrocketing costs of delivering medications to patients in Olton, about 30 miles from his pharmacy in Littlefield. He gained patients after a national chain bought out the sole pharmacy in Olton, closed the store, and moved prescriptions to an existing pharmacy another 30 miles away that did not offer delivery. With up to 25 deliveries to Olton daily, Pratt saw profits falling as delivery costs climbed.
In 2016, Pratt opened the first telepharmacy in Texas to give his Olton patients a local pharmacy outlet and provide a base for local deliveries. And to discourage potential expansion by the chain that had closed Olton’s brick and mortar pharmacy.
In Driggs, ID, Sally Myler, PharmD, wanted to expand to Victor, a nearby town that is small but growing as a bedroom community to nearby Jackson Hole, WY. And she wanted to deter an aggressive chain had already tried to buy out her third-generation Corner Drug, then threatened to undercut her prices and hire her employees when she declined to sell.
Telepharmacy helped Pratt and Myler move ahead of the competition. Both use Telepharm as their telepharmacy software provider, but their business models differ.
Pratt set up shop in what had been a large closet in a medical clinic in Olton, about 150 square feet. Existing Texas legislation allowed telepharmacy, but requirements were so onerous that no one had successfully opened a remote dispensing location. He spent months working with the Texas Board of Pharmacy to obtain waivers to open the remote location, then more months with the state legislature to create a more workable legislative framework for telepharmacy.
With more favorable regulation in place, Pratt purchased a second brick and mortar pharmacy and opened a second telepharmacy. Texas allows up to two remote dispensing locations for each brick and mortar pharmacy and he is actively looking for two more telepharmacy locations.
Myler considered moving into the existing medical clinic in Victor, in a converted modular home. Instead, she worked with the clinic to build Victor’s first purpose-built medical facility. The clinic is her primary tenant and the building includes pharmacy space.
Victor is growing, like much of rural Idaho, which could improve prescription volume as well as front-end sales. At some point, it could make sense to convert the telepharmacy to a second brick and mortar pharmacy. Myler told Drug Topics that local real estate brokers warned that other operators were looking for pharmacy space, including Victor’s one grocery store.
“If we hadn’t come into Victor, it was clear that somebody else would,” she said, “either as a telepharmacy or a brick and mortar pharmacy. Either way, we would have lost the customers that are keeping our Victor outlet going.”
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