Pharmacy Deserts Eased by Less-Restrictive Telepharmacy Policies

States that recently adopted less-restrictive policies surrounding the use of telepharmacy had fewer pharmacy deserts in the following year, a cohort study involving a dozen states showed.

Compared with nearby states that made no changes, states that formally implemented or updated pro-telepharmacy policies had a 4.5% relative decrease (95% CI 1.6-7.4) in the percentage of regions defined as pharmacy deserts (P=0.001) and an 11.1% relative decrease (95% CI 2.4-22.6) in the proportion of people living in one of these deserts (P=0.03).

And in general, telepharmacies tended to serve areas of high medical need, reported Jessica Adams, PharmD, of TelePharm in Iowa City, Iowa, and colleagues.

“As pharmacy closures and socioeconomic factors persist, pharmacy deserts are likely to expand unless policies are implemented to ensure continued access to pharmacy services,” the researchers wrote in JAMA Network Open.

Adams and team noted that telepharmacies — actual brick-and-mortar locations staffed with pharmacy technicians but remotely supervised by a pharmacist who can verify prescriptions and offer counseling — are legal in 28 states, but often have “burdensome” restrictions.

“These varied restrictions, including those limiting the geographic location of a telepharmacy, can be arbitrary and capricious, placing an undue burden on Boards of Pharmacy to enforce and pharmacy owners to comply, the consequences of which transfer to the patient,” according to the study authors.

Other restrictions may include maximum prescription counts, the number of telepharmacies a single pharmacist is allowed to supervise, and rules around technician ratios and training.

Adams and colleagues’ study examined pharmacy deserts in 12 U.S. states from 2016 to 2019, including eight that formally adopted less-restrictive policies or regulations on the use of telepharmacy in 2017 or 2018 (Arizona, Idaho, Indiana, Iowa, Nebraska, New Mexico, Texas, and Wyoming) and four nearby control states that made no change in policy during the study period (Kansas, Ohio, Oklahoma, and Utah).

They identified a total of 3,972 pharmacy deserts, which were defined as any area 10 miles or more from a physical pharmacy — including rural and urban regions. Of the 80 pharmacy deserts where a telepharmacy opened during the study period, 37.5% no longer met that definition a year later; of the 3,892 pharmacy deserts where a telepharmacy did not open, only 1.8% no longer had that designation the following year (P<0.001).

“Currently, patients living in pharmacy deserts have few options for pharmacy services that combine medication dispensing and pharmacist interaction,” Adams and co-authors noted. When it comes to options such as physician dispensing, mail-order pharmacy, and pharmacy delivery, “patients may experience a delay in receiving medications and have limited or no interaction with a pharmacist. Studies show when patients have timely access to medication and a pharmacist, outcomes and adherence improve.”

And they pointed out that patients prefer to fill medications at brick-and-mortar locations, especially lower-income patients and those from marginalized groups.

Pharmacy locations in the study came from the National Council of Prescription Drug Plans DataQ database, which was matched against population data from the U.S. Census Bureau.

The average number of telepharmacies increased to 7.25 in states that adopted less-restrictive policies but remained stable at 0.25 in control states.

During the period before implementation of the new policies, 12 of 19 telepharmacies (63.2%) were in areas or among populations considered medically underserved; this grew to 37 of 59 telepharmacies (62.7%) after implementation. For traditional pharmacies, 33.9% of the 17,511 total locations during the pre-implementation period were in these high-medical-need areas, as compared with 33.7% of the 17,800 locations in the post-implementation period.

Study limitations included that the findings may not be generalizable to the entire nation, that urban areas within 10 miles of a pharmacy may still present a barrier to access, and that causality cannot be determined by the study design.

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