The novel coronavirus has upended healthcare in America and pharmacies are no exception. With speed seldom seen among state boards of pharmacy, regulations governing pharmacy operations have been rewritten to respond to the epidemic. Waivers have proliferated; new guidance is issued daily. 

The need to protect both pharmacists and their patients has driven many of the changes. As with most healthcare not directly related to COVID-19, pharmacies have grappled with how to maintain a safe distance from patients while still meeting their needs. With stay-at-home and shelter-in-place orders common and many pharmacists and pharmacy technicians needing to self-isolate following coronavirus exposure or diagnosis, keeping pharmacies running has posed new and growing challenges.

To respond to the rapidly evolving situations, since mid-March many states have issued waivers or otherwise amended regulations to permit the use of remote processing or telepharmacy to oversee a wide range of pharmacy operations. Many of the changes follow recommendations in a joint statement for addressing COVID-19 from leading pharmacy organizations, including the American Society of Health-System Pharmacists, American Pharmacists Association, National Alliance of State Pharmacy Associations (NASPA), National Association of Chain Drug Stores, and National Community Pharmacists Association. 

A sampling of those changes appears below. As the regulations are changing daily, please consult your state’s board of pharmacy website for the details on the current status in your area.  

Alabama has authorized offsite order entry under certain conditions, and Arizona’s board of pharmacy authorized remote work in some situations. Arkansas’ board will consider remote order entry, verification, and other activities on a case-by-case basis, according to the NASPA.

California permits pharmacists to remotely conduct order entry and drug-utilization reviews, interpret clinical data, process insurance claims, and perform therapeutic interventions. Pharmacists cannot remotely dispense a drug, however. Pharmacy technicians can remotely process insurance for prescriptions and do prescription and order entry, if a pharmacist is available for remote supervision. 

Florida’s status is less clear. The state department of health suspended the statutes related to pharmacy operations covering distribution, dispensing, and administration of prescription drugs, which could be interpreted to permit pharmacists to work from home, but specific guidance has not yet been issued, according to the law firm Bass, Berry & Sims, PLC. A pharmacist can remotely supervise a pharmacy technician. 

Kansas authorized pharmacists and pharmacy technicians to work remotely on a temporary basis. Louisiana permits all pharmacy staff to work from home to process prescriptions as long as patient confidentiality is protected. Maryland said it would not enforce technician supervision requirements if technicians are working remotely to perform prescription or data entry, process insurance, or perform other administrative functions.

Minnesota and Nevada permit pharmacy staff to process prescriptions and medication orders remotely. Most functions related to prescriptions, except dispensing, may be done from home or another location.

North Carolina has provided similar flexibility to pharmacists and pharmacy staff and specifically encouraged pharmacies to adopt workflows that limit direct personal contact. Pennsylvania permits remote data entry by technicians under the supervision of a pharmacist.

Ohio issued guidance enabling pharmacies to remotely receive, interpret, evaluate, clarify, and approve medication orders and prescriptions. Pharmacists or technicians may remotely perform order entry, data entry, drug-utilization review, insurance processing, clinical interpretation, therapeutic interventions, and author release of medication. Remote dispensing of a drug is not permitted.

South Carolina permits remote order entry by executive order. Tennessee permits processing of prescriptions at alternative locations, including homes. Wisconsin pharmacy technicians can complete order entry or other activities remotely as long as they are supervised by a pharmacist.  

As the pandemic persists, changes to pharmacy operations will likely continue, so stay tuned to new developments in your state.   
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