Telepharmacy Offers Opportunity Amid Pandemic

In 2020, the worldwide spread of coronavirus disease 2019 (COVID-19) has created major disturbance in the daily life of billions of individuals.

The spread of COVID-19 and the lockdown of major cities have forced people to rethink how to obtain goods and services, including health care. Data clearly indicate a significant decrease in patients’ regular visits to their health care providers and also, as reported, a decrease in medication refills.¹ Although these observations point toward significant threats for appropriate chronic disease management, they also offer tremendous opportunities. Evolving health care systems could allow for increased flexibilities in telehealth practice regulations. Prior to the COVID-19 public health emergency, just 0.1% of Medicare beneficiaries received telehealth services.² By April 2020, Medicare telehealth use soared to 43.5%, according to the US Department of Health & Human Services.2 Rather than requiring patients to risk physical encounters, many health care providers began offering virtual patient outreach for nonemergency conditions and routine care.

Despite these advances and an obvious patient demand for virtual services, pharmacists are not recognized as telehealth service providers by governmental agencies and cannot receive reimbursement outside specific programs. Without considering COVID-19 or any other pandemic, the need for pharmacists to contribute to health care teams as recognized telehealth providers is driven by the alarming predictions for provider shortages within the next decade. A deficit of 122,000 primary care providers is expected in the United States by 2032.³ At the same time, projections show increased life expectancy and an exponential increase in patient demand for telehealth services— putting pharmacists in a unique position to close the gap in their communities and be further recognized as major players in primary care.

Using Digital Applications

Amid the turbulent nature of the COVID-19 pandemic, telepharmacy has shifted the paradigm of patient care by leveraging digital medicine. This is not new; for years, several pharmacy organizations have used telephonic encounters and demonstrated improved adherence and outcomes in patients with polypharmacy. Some pharmacy organizations use mobile health telepharmacy to improve medication adherence through use of smartphone applications designed to inform patients about the process and delivery status of prescription refills.⁴ Near-field communication (NFC) protocols allow mobile devices to communicate with each other using a wireless connection. NFC is used in telepharmacy for patients with poor medication adherence through use of blister packaging or a coded chip that synchronizes with the mobile phone app.⁵

The pharmacy profession also has embraced innovative health technologies, including digital pill bottles, ingestible sensors, remote dispensing machines, and wearable biometric sensor patches designed to measure and improve medication adherence.⁶ Telehealth pharmacists will play a key role in telepharmacy beyond COVID-19, given their breadth and depth of knowledge about national consensus treatment guidelines and their ability to provide chronic medication management through whole patient— based care and precision pharmacotherapy.

Community pharmacy organizations recently deployed drone technology to deliver prescriptions to retirement community residents in Florida and North Carolina.⁷ Drone medication delivery was innovated to help reduce the spread of COVID-19 and comply with social-distancing measures. Other pharmacy organizations give patients to request medication refills and home delivery directly from the company app or website, without phoning the pharmacy. Pharmacies are continuously using technological advances to reduce the number of in-person patient visits and to facilitate social distancing. These innovations allow essential employees, such as pharmacists, more time to pay greater attention to patients who need immediate care.

Community pharmacy is one of the more common telepharmacy practice settings. Through synchronous telehealth technology, pharmacists can remotely verify prescriptions using 2-way audiovisual applications. Another benefit related to community-based telepharmacy is the increased opportunity for telehealth pharmacists to provide uninterrupted patient condition and medication counseling.

Although the benefits of telepharmacy for both community- based pharmacists and patients are clear, only 24 states permit community pharmacists to use telepharmacy models.⁸ Thus, there is an obvious need for increased advocacy for telepharmacy during and beyond the COVID-19 pandemic.

Looking Ahead

Pharmacists will continue to drive paradigm shifts to ensure better patient care and embrace the incorporation of digital clinical pharmacotherapy into their routines.⁹ Through their expertise in pharmaceutical care, pharmacists are equipped to determine the most appropriate medication regimen using whole-patient—based care in tandem with digital applications designed to improve medication appropriateness and adherence. Pharmacists have proven that their telepharmacy efforts improve patient outcomes by increasing patient satisfaction scores and provider acceptance rates.¹⁰ Pharmacists have shown that they are able to fill gaps in care.¹¹ The contributions to patient care through telepharmacy service integration will help legitimize the role of pharmacists in telehealth beyond the COVID-19 pandemic.

Jenny Bingham, PharmD, BCACP, is the director of ambulatory care residency programs and research at Tabula Rasa HealthCare in Tucson, Arizona.Karley Tranchina, PharmD, is a PGY2 ambulatory care pharmacy resident at the University of Arizona College of Pharmacy in Tucson.Jacques Turgeon, PhD, BPharm, is the chief scientific officer at Tabula Rasa HealthCare in Moorestown, New Jersey.

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• HHS issues new report highlighting dramatic trends in Medicare beneficiary telehealth utilization amid COVID-19. News release. US Department of Health & Human Services. July 28, 2020. Accessed October 26, 2020. https://www.hhs.gov/about/news/2020/07/28/hhsissues-new-report-highlighting-dramatic-trends-in-medicare-beneficiary- telehealth-utilization-amid-covid-19.html
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• Hawkins AJ. UPS and CVS will use drones to deliver prescriptions in Florida. The Verge. April 27, 2020. Accessed October 27, 2020. https://www.theverge.com/2020/4/27/21238196/ups-cvs-drone-delivery- medicine-florida-coronavirus
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