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Contributing Editor Fred Gebhart works all over the world as a freelance writer and editor, but his home base is in San Francisco.
Arizona joins a growing list of states to adopt telepharmacy legislation. Here’s how it could affect pharmacists.
Arizona is poised to become the 24th state to adopt telepharmacy legislation. The legislation is expected to be signed into law this year with the first outlets scheduled to open in early 2019.
Six other states have authorized pilot programs that could apply to telepharmacy and five states permit waivers of legislative or administrative requirements that could allow for telepharmacy, according to the Rural Policy Research Institute at the University of Iowa College of Public Health.
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As more states adopt telepharmacy legislation, some pharmacists are raising concerns over what it could mean for patients and the pharmacist job outlook. To help address those concerns and others, the Arizona Pharmacy Association, which supports the legislation, negotiated a series of protections for pharmacists and patients.
“The big issue that came up from some of our members and other stakeholders is to ensure that this is a safe practice,” says association CEO Kelly Fine, RPh. “We are equipping and training both technicians and pharmacists, making sure that security and surveillance are sufficient, and requiring HIPAA-compliant high-definition video conferencing for face-to-face interaction with the remote pharmacist.”
Most telepharmacy locations will likely be in rural areas, at least to start, she says. But community health centers and hospitals have also expressed interest. "So have independent pharmacists who want to expand into pharmacy deserts, areas with few or no pharmacies and severely limited local access to pharmacy care."
The potential for urban expansion has raised objections among some pharmacists. “This bill can and will likely be used to lay off hundreds of pharmacists and convert hundreds of ‘underperforming’ pharmacies in urban areas, effectively reducing pharmacist jobs by over 75%,” says P. Charles Zaffrey, RPh, pharmacist at Bashas’ United Drug, a supermarket chain pharmacy in Tempe, AZ, who opposed the legislation.
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The Arizona Pharmacy Association insisted on including language in the telepharmacy legislation that may help prevent such problems from occurring. The legislation limits pharmacists to overseeing one remote location in addition to managing operations in their own physical location. Pharmacists who do not have oversight responsibilities for a physical pharmacy will be allowed to oversee two remote locations.
Adam Chesler, PharmD, director of regulatory affairs for Cardinal Health, which is backing the legislation, says many providers who fear job loss due to telepharmacy may have misconceptions about state-level legislation.
“One of the lessons we have learned is the need for provider education,” he says. “Anything and everything a pharmacist has to do in a physical pharmacy today still has to be done in a telepharmacy. None of the steps of pharmacist involvement in oversight, counseling, and clinical responsibilities is gone with telepharmacy. If anything, you see increasing clinical involvement by pharmacists because they are able to see more patients as telepharmacy expands access.”
Mark J. Hardy, PharmD, executive director of the North Dakota State Board of Pharmacy, says pharmacist employment hasn’t fallen since North Dakota became the first state to authorize telepharmacy in 2002.
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“If anything, telepharmacy has expanded the hiring of pharmacists across the state,” he says. “It has allowed them to focus on clinical duties and interact with more patients than ever before by expanding pharmacy access. If there have been job losses, they are attributable more to economics than to telepharmacy.”
Beyond jobs, telepharmacy is also creating opportunities for patients.
“The big pro for telepharmacy is better access to medications and to pharmacists,” says Mohamed A. Jalloh, PharmD, assistant professor at Touro University California College of Pharmacy, community pharmacist, and a spokesperson for the APhA. “The reality is there are places in every state where access to pharmacy is difficult to impossible. Telepharmacy can increase access.”
Telepharmacy seems to be expanding steadily, if not quickly.
“Pharmacists are learning about it and state boards are taking deliberate approaches to be sure it will work in their state,” says Lisa Schwartz, PharmD, senior director of professional affairs for the NCPA. “And thanks to software advances, you no longer have to come up with technology solutions by yourself. When you have a turnkey package, the business case makes more sense.”