As the title indicates, we'll be discussing telepharmacy benefits and drawbacks in this blog. While one might expect the argument about whether the benefits outweigh the potential obstacles and drawbacks (or vice versa) to appear in the conclusion of this piece, we're going to lead with it instead. The reason: While there are a few noteworthy drawbacks that will be highlighted, we don't want them to dissuade you from pursuing a telepharmacy program. Many organizations are already leveraging telepharmacy to improve quality and access to care while reducing costs, and there is significant potential for the service to grow and deliver even greater benefits. The obstacles are important to understand and take into consideration when determining how to proceed with launching a program, regardless of the approach you take to do so (i.e., "build versus buy," which will be briefly discussed in the conclusion), but we believe none are so significant to overshadow the benefits. In addition, the drawbacks will eventually become nonfactors as further innovations are developed.
6 Telepharmacy Benefits and Drawbacks
Here are six telepharmacy benefits and drawbacks — three of each — that you should know.
Benefit: Expanded access to care
We already referenced this above. One of the most significant benefits of telepharmacy is that it, like other telehealth services, can help make healthcare more accessible to those who live in rural or isolated communities and makes pharmacy services more readily available and convenient for those with limited mobility, time, or transportation options. Telepharmacy services are typically delivered via an interactive communication platform that uses audio and/or video to connect pharmacists and patients in real time. Nearly all consumers already own mobile phones and computers. Most mobile phones can access the internet and include a camera, and consumers have become more comfortable with videotelephony programs (e.g., Zoom, Skype, Facebook Messenger) thanks, in part, to the COVID-19 pandemic. Such technology, together with broadband (i.e., high-speed) internet, is largely what is required for patients to receive telepharmacy services.
Drawback: Some Americans still lack broadband access
While not necessary for the delivery of telehealth services, broadband internet greatly improves the speed and convenience, and, in turn, adoption of telepharmacy. Among the benefits of broadband is that it provides a higher speed for data transmission, which is needed for quality videoconferencing and the exchange of large quantities of healthcare information; access is constant, so there's no need to reconnect to the Internet, as is required for dial-up internet; and it does not impede phone lines. Unfortunately, millions of Americans do not have broadband access. A BroadbandNow Research report estimates that 42 million Americans lack the ability to purchase broadband internet. While telepharmacy can be conducted with the use of phones, greater access to broadband internet will greatly improve the quality of telepharmacy interventions.
That's the bad news. The good news is that this figure should decline. As the Federal Communications Commission's latest annual Broadband Deployment Report notes, the number of Americans without access to fixed broadband decreased 30% during 2017 and 2018. Lawmakers are also aggressively pushing for the expansion of broadband access. As the number of Americans lacking broadband access drops, the number of consumers who can benefit from telepharmacy will increase.
Benefit: Substantial increase to services and patient satisfaction
For those with the ability to access and receive telepharmacy services, there are many beneficial services that telepharmacists may be in a position to offer and deliver. Common services provided via telepharmacy include comprehensive medication management (CMM); medication therapy management (MTM); medication reconciliation post-discharge (MRP); drug information, review, and monitoring; and patient assessment and counseling.
These and other telepharmacy services can help patients in a wide variety of ways, including:
- Improving medication adherence
- More timely access to pharmacists and their services
- Reduced need for emergency or urgent care services
- Improved satisfaction, as a study in the Journal of Pharmacy Technology showed
- Increased engagement and participation in care
- Enhanced convenience
- Reduced costs by eliminating expenses, such as gas, tolls, public transportation fees, and babysitting, that may be required to travel for an in-person pharmacy visit
Drawback: Lack of federal provider status for pharmacists
Unfortunately, pharmacists currently lack national provider status. As the American Society of Health-System Pharmacists (ASHP) states, "Achieving provider status is about giving patients access to the valuable care that you provide. Becoming a 'provider' in the Social Security Act means that pharmacists can participate in Part B of the Medicare program and bill Medicare for services that are allowed under their state scope of practice."
Furthermore, as the Academy of Managed Care Pharmacy (AMCP) notes, "Although the current Medicare Part D program reimburses pharmacies for pharmacists providing medication therapy management to a select subset of patients, the program is limited and encompasses only a small set of the services pharmacists provide."
Without national provider status, pharmacists, including those filling telepharmacy roles, will need to be more selective of the services they offer and provide to Medicare beneficiaries to better ensure services are covered (i.e., reimbursable). To learn more about the value of granting pharmacists with provider status, read this blog and then this blog.
While the lack of national provider status is frustrating and can reduce the benefits of telepharmacy for patients and organizations that offer telepharmacy services, there is a significant effort underway aimed at educating lawmakers about the importance of granting pharmacists provider status. The Patient Access to Pharmacists' Care Coalition (PAPCC) is a multi-stakeholder and interdisciplinary initiative aimed at developing and helping enact a federal policy proposal that would enable Medicare beneficiary access to, and pay for, Medicare Part B services by state-licensed pharmacists in medically underserved communities. In addition, there's bipartisan federal legislation — H.R. 592/S. 109 — that, as PAPCC notes, would "… amend Medicare and increase medically underserved seniors' access to healthcare through pharmacist-provided care."
Hopefully, it's only a matter of time before we can remove this "con" from the list.
Benefit: Many benefits for other stakeholders – patients, pharmacies, providers and payers
Patients aren't the only group that benefits from telepharmacy. Strong arguments can be made that telepharmacy helps pharmacies, providers with telepharmacy programs, payers, and the healthcare system as a whole. Here are just a few ways that telepharmacy helps each of them:
- Pharmacies that leverage telepharmacists gain the ability to cost-effectively expand the hours they can provide services to patients without needing to keep the physical pharmacy location open, reach even more patients thanks to these expanded hours, and support more patients since there will be more pharmacists available to deliver services. Furthermore, since physical In addition, telepharmacists can perform a bulk of the clinical services that are typically performed by on site pharmacists. This leaves the dispensing pharmacists less distracted and better able to meet Rx fulfillment demands during the pharmacy’s operating hours. help patients better adhere to their medication regimen, which should translate to more filled prescriptions with the pharmacy.
- Provider organizations with telepharmacy programs can provide the aforementioned enhanced convenience for patients; reduce overall costs, decrease readmissions, and drive better outcomes, which are critical to achieving the goals of value-based care; boost their Healthcare Effectiveness Data and Information Set (HEDIS) and Medicare Star ratings; and improve collaboration across the patient care team, including physicians and specialists.
- Payers migrating toward value-based care or considering doing so are likely looking for provider organizations to offer programs that help achieve proactive management of patient health and keep patients healthy, while reducing total cost of care — all of which telepharmacy delivers.
- The healthcare system benefits because telepharmacy helps reduce the number of patients who need to go to the emergency room and require in-person care — which will remain particularly beneficial as long as we're battling the novel coronavirus; improves patient health and wellness, which further reduces the need for healthcare services; and drives down the overall cost of care, to name a few.
Drawback: Inconsistent state rules
Lack of national provider status isn't the only hindrance to the delivery of telepharmacy services. State rules represent another significant barrier. Rules vary from state to state concerning the services pharmacists are permitted to provide and what services are permissible via telehealth.
As Drug Topics notes, "Pharmacists are already classified as providers in most states … But what that means depends on just where in state law pharmacists are classified as providers. It depends on pharmacists' scope of practice under state law. And most importantly, it also depends on what states do or do not require in terms of reimbursement for pharmacist services." Concerning telepharmacy services, in our "Telepharmacy Update: Past, Present, Future" blog, we noted that 45 states allowed telepharmacy, but rules and requirements for operation vary widely.
The primary takeaway from this information is that there exist unnecessary barriers on the state level limiting the ability of pharmacists and telepharmacy to do the most good. A secondary takeaway is that when rules lack uniformity, confusion emerges. Organizations launching telepharmacy programs will need to ensure they understand the rules for their state(s) and will also need to put an increased emphasis on patient education concerning available and covered services. Patients who attempt to conduct internet research into telepharmacy services may come away with a misunderstanding of the services available to them.
Continuing the theme of sharing some good news with each drawback is that there are efforts on the state level to have all states recognize pharmacists as providers, and the push for national provider status should only help with these endeavors. When it comes to telepharmacy services, the number of states permitting them have nearly doubled since 2016, and it wouldn't be surprising to see the remaining outlier states coming on board in the near future. In addition, the appreciation for telehealth has never been higher (thanks to the pandemic), which should serve to motivate the federal government and state governments to loosen unnecessary restrictions on services delivered via telehealth, including telepharmacy.
Options for Launching a Program
Now that you hopefully have a better understanding of some of the more significant telepharmacy benefits and obstacles, you also hopefully have a greater appreciation for telepharmacy in general and why launching a program would be worthwhile. Now we'll just briefly review the two most common ways of proceeding with doing so: build or buy.
- Build: If your organization already has 1) a majority of the components and resources (e.g., physical space for telepharmacists, available pharmacists and technicians) and 2) the information technology (IT) infrastructure (e.g., HIPAA-compliant telecommunications platform and a platform to support patient care team collaboration, CPOE, pharmacy information system, software to support telepharmacy services) available and/or already in place, proceeding with an in-house offering is worth considering.
- Buy: If your organization lacks the essential components, resources, IT infrastructure, and time necessary to develop and support a telepharmacy program, you can "buy" a program by contracting with a third party that will provide board-certified clinical pharmacists to deliver telepharmacy services.
If you want to discuss these options and how Cureatr can support your efforts to proceed with tech-enabled telepharmacy program plans, we invite you to contact us. One of our telepharmacy experts will gladly answer your questions about starting a telepharmacy program and how we help organizations add and effective leverage telepharmacy services.