Telepharmacy, ePrescribing And Prescriptive Authority Explained
A complete guide for telehealth companies and their clinicians.
The pharmaceutical industry began dipping its toes into virtual service delivery nearly 20 years ago, although it was officially legalized in the US in 2007. Since then, increasing patient demand for rapid results and remedies, technology advancements and telehealth usage sparked by the COVID-19 pandemic have all led to wider adoption of virtual pharmacies.
Under the larger umbrella of telepharmacy falls terms like telepharm, e-prescribing and prescriptive authority. If you aren’t yet familiar with that vocabulary, you will be after reading this blog!
What is a telepharmacy
According to the American Society of Health-System Pharmacists (ASHP), telepharmacy “is a method used in pharmacy practice in which a pharmacist utilizes telecommunications technology to oversee aspects of pharmacy operations or provide patient care services”. This growing field allows pharmacists to deliver pharmaceutical care effectively and at a distance for maximum convenience.
Like all other telehealth services, virtual pharmacies have expanded access to rural and underserved communities nationwide, as well as patients struggling with barriers to travel. Let’s get started by diving into the variety of virtual pharmacy services available and the impact each has on patients and providers.
Inpatient or remote order-entry review
Inpatient telepharmacy serves patients who are in need of medication while admitted in a hospital. The pharmacist at a remote location reviews all medication orders before the patient is administered any drugs by the provider. When this happens, the pharmacist is performing a remote order-entry review to ensure safe and seamless continuity of care.
This type of telepharmacy, mainly used in hospitals and healthcare facilities, has been especially helpful during the COVID-19 pandemic as it allows pharmacists to work remotely 24/7 to deliver vital medications to patients whenever needed.
According to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), IV admixture is “the preparation of pharmaceutical products which requires the measured addition of a medication to a 50 mL or greater bag or bottle of IV fluid”. In other words, it is the combining and mixing of an IV solution that is given to patients in a healthcare facility.
It saves hospital pharmacies a ton of time and money. Instead of requiring a pharmacist to suit up, enter the cleanroom (the location where sterile preparation of IV medications is executed) and review the solution, it can be done remotely.
Remote dispensing can be complex due to the variety of services included within it.
Remote dispensing site: A remote dispensing site is an actual pharmacy building, like a CVS or Walgreens. It can also be a smaller retail community pharmacy that is staffed by in-person pharmacy technicians. In this instance, the pharmacy that supervises the technicians and reviews prescriptions is remote. This type of telepharmacy allows healthcare facilities and organizations to save costly resources by sharing one pharmacist across multiple locations.
Remote dispensing machine: Remote dispensing machines aren’t as common. In fact, you likely have never seen one in-person. They act as vending machines for prescribed medications. It is typically used in healthcare environments such as long-term care facilities and correctional institutions where it doesn’t make sense to have an in-house pharmacy. These units are closely controlled by a pharmacist across every interaction. The pharmacist refills medications put into the machine in bulk, reviews the orders needing to be sent there, then directs it to that site to be filled. It’s pretty awesome if you think about it. The machine automatically fills the exact amount of medication the patient is prescribed, labels it and when the patient comes to pick it up, it dispenses the prescription bottle.
Remote counseling is exactly what it sounds like - when pharmacists provide patient counseling in a live video session or by other telehealth technology. This type of telepharmacy has taken off rapidly amidst the COVID-19 pandemic, allowing patients to receive consultations or other pharmacy-care services from the comfort of their own homes, any time.
Virtual counseling has opened many doors and opportunities for specialty counseling for patients with chronic conditions such as HIV, AIDS or diabetes. If a patient is having issues with their medication or wants to speak with a pharmacist more regularly, this is a great option for them to explore.
Advantages and disadvantages of telepharmacy
Everything comes with its advantages and disadvantages. When it comes to healthcare services that directly impact the quality of life for patients, closely examining the pros and cons across each avenue is critical. For patients, it’s important to decide whether or not you feel comfortable pursuing these services, then continuing to make sure they are serving your needs. On the flip-side, pharmacists must weigh all resources needed, efficiencies gained and potential repercussions before putting new measures into place.
Let’s talk about some of the advantages and disadvantages to telepharmacy that patients, pharmacists and pharmacies have pointed out throughout the years.
Let’s start off first with the upsides of telepharmacy.
Reduced operating costs: For hospital pharmacies, they are saving money by utilizing telepharmacy. Hospitals and healthcare facilities that don’t have internal pharmacies are finding it hard to provide 24/7 medication services and consultations. With telepharmacy, they are able to deliver those consultations and services at a lower cost because they don’t need to have the staff onsite.
Improved patient satisfaction: With the extended reach that telepharmacy has given pharmacists, they are able to follow up with a patient more regularly and provide counseling in near real-time. This is especially vital for patients who have just been discharged from the hospital, who are located in rural areas or are experiencing negative side effects of a medication. Patients having 24/7 access to a pharmacy if they have questions or concerns about their medication increases patient satisfaction and quality of care, while decreasing unnecessary hospital visits.
Now let’s look at the disadvantages that come with telepharmacy.
Not offered nationwide: Currently, 48 states allow telepharmacy services to operate in their state. Michigan and Georgia are the only two who do not. So, even though it is widely available in the United States, it is not nationwide which is a huge disadvantage for patients, pharmacists and health systems in those two states.
Finding qualified pharmacists: Telepharmacy is a fairly new service that is continuing to gain traction. The rules and regulations that go into operating telepharmacy and all the technology it uses are strict (and for good reason). That makes finding a pharmacist that is tech-savvy, licensed and experienced tricky.
Now that we’ve covered all things telepharmacy, let’s hit on another term that comes into play here. Electronic prescribing, commonly referred to as ePrescribing, is used every day in the healthcare industry. It’s the term that explains the process healthcare providers take to securely transmit a prescription to pharmacists using technology like a computer or tablet.
This was first introduced in the early 2000s when the healthcare industry flagged medication and prescribing errors as the most common type of medical error. It was estimated that thousands of deaths occurred as a result each year. As you may be aware, clinicians’ handwriting can be illegible at times, which isn’t surprising given the number of patients they see in a day. One of the primary reasons for the push towards ePrescribing is to eliminate potential errors that could come with misreading traditional writing.
The benefits of ePrescribing are endless, there’s a reason why it’s the main way, if not the only way, that providers send a prescription over to pharmacies. Just to name a few…
Reduce prescribing errors: This is an obvious one based on the history of ePrescribing. With everything typed out, it reduces the errors of prescribing medication greatly.
Decrease the work needed to send a prescription: With everything organized and readily available on the ePrescribing system for the provider, it makes it easy to send over a prescription as soon as they are done seeing the patient. Not only does this make it easier for the clinician but it gets the patient their medication faster. This also makes it a simpler process to refill prescriptions. The technology allows prescribers to easily review, approve and send a refill prescription over to the pharmacist in no time.
Avoid bad drug reactions: With patient prescription histories stored in prescribing systems, providers can see all allergies and medications issued easily. This helps ensure that the patient won’t have a bad reaction to what they are being prescribed.
Monitor controlled substance prescriptions: Providers can track the number of controlled substance prescriptions a patient has received in the past. This allows them to monitor how much the patient is taking and reduce the risk of over-prescribing.
Keeping on the topic of ePrescribing, prescriptive authority is becoming a hot topic in healthcare. Prescriptive authority is the ability for clinicians who don’t typically have prescribing power to be able to prescribe, without limitation, prescription and controlled drugs. Providers that have prescriptive authority use ePrescribing to carry out these tasks.
So, who has prescriptive authority? That’s where it gets tricky. There are only select states that allow this, with different levels for different providers. Let’s break it down by provider type.
Certain states allow pharmacists to prescribe medications. The states that allow pharmacists to prescribe or require them to get an advanced license to carry out the tasks have limited allowances.
Limited prescribing: Prescribing is still limited for pharmacists but there is a growing number of states that are allowing pharmacists to prescribe a small list of medications such as birth control, tobacco cessation products, etc. Currently, this is the breakdown of the limited prescribing for pharmacists:
12 states allow pharmacists to prescribe birth control
50 states allow pharmacists to prescribe naloxone
seven states allow pharmacists to prescribe smoking cessation products
two states allow pharmacists to prescribe pre and post-exposure prophylaxis for HIV prevention
Expanded prescribing: In some states, pharmacists have been given more authority to prescribe medications. In total, there are seven states that have given pharmacists this authority and four of them require an advanced license to do so. The expanded prescribing authority refers to medications that treat minor conditions. Those states include:
New Mexico (require an advanced license)
California (require an advanced license)
North Carolina (require an advanced license)
Montana (require an advanced license)
Like pharmacist prescriptive authority, each state has its own rules and regulations around nurse practitioners writing prescriptions. All states allow nurse practitioners to write prescriptions to some degree but many states require physician oversight or a transition period.
Full prescriptive authority: 20 states and Washington DC allow nurse practitioners to prescribe medications without a physician overseeing them. Most states that allow this also grant them full independent prescriptive authority. Other states, including Nevada and Minnesota, require a physician’s oversight for certain tasks.
Transition period to independent prescriptive authority: Some states, such as Colorado and West Virginia, grant independent prescriptive authority for nurse practitioners after a transition period. To gain full prescriptive authority, they must operate under a physician’s oversight for a set period of time.
Physician oversight required: Most states, about 30, require nurse practitioners to be overseen by a physician when prescribing medication. This looks different for each state. For example, Colorado can prescribe medication in their area of specialty, but to prescribe Schedule II or III controlled substances, a physician must supervise.
The laws surrounding prescriptive authority are constantly changing and many states are pursuing increased prescriptive authority for pharmacists and nurse practitioners. With the shortage of physicians in the United States currently, we may see these laws changing in the near future.
Powering Retailers & Pharmacies
As experts in the virtual care world, we’d be remiss not to highlight what we’re doing here at OpenLoop and how it’s impacting telehealth delivery.
We are a telehealth company that powers other telehealth companies by removing the roadblocks that come with launching and scaling telehealth services. Partnering with us gives you access to our network of over 6,500 fully-vetted clinicians (with full prescriptive authority) ready to serve your patient needs. Not only do we give you access to our network, but we match your organization with clinicians that align to your values, culture and patient needs for seamless continuity of care.
On top of staffing your telehealth services, we take any additional telehealth headaches and back-office challenges off your plate. This includes MSO & PC groups, managed services agreements, payer contracts, telehealth consulting, support and so much more. Interested in what we can do for your telehealth organization? Let’s connect!
Now that we’ve introduced ourselves and filled your brain with all things telepharmacy, it’s time to wrap up this week’s blog! Virtual prescribing is constantly evolving and growing with the new age of technology. With this constantly evolving space, it’s important to continually educate yourself on the trends. As new information becomes available on telepharmacy, ePrescribing and prescriptive authority, we will update this blog to ensure we have all the information compiled for you in one place. Be sure to check back in a couple of months to see how these topics have evolved!
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