The difference between telepharmacy and internet pharmacy

By Mitch Larson

If you are familiar with the terms “telepharmacy” and “internet pharmacy,” chances are good you have heard them used interchangeably. In reality, the only similarity they share is that they are a way for patients to get prescription medications. The way each one works and the impact each one has on patient care and the pharmacy industry are vastly different.

Telepharmacy fully relies on pharmacists, certified pharmacy technicians, brick-and-mortar locations and local patient populations visiting the telepharmacy in-person to function. Telepharmacy allows local pharmacies to stay open, allows pharmacists to serve more patients and makes pharmacy access feasible for underserved areas. 

Let’s talk in more depth about the differences between telepharmacy and internet pharmacy. Today we’ll cover how they are different from one another in three categories: how each one works, the safety concerns surrounding each and the effects each one has on pharmacists and the pharmacy industry as a whole.

Internet Pharmacy

Internet pharmacies are online drug stores that ship medications to patients. The process of filling a prescription on an internet pharmacy goes like this:

The process is overall simple and relatively convenient for patients (assuming they are reasonably technology and internet savvy), but when they do have a phone call with a pharmacist, that pharmacist is located somewhere in one of the internet pharmacy’s many locations where pharmacists spend their days fielding calls from patients all over in a queue based format.

Internet pharmacy safety concerns

As stated, internet pharmacy does provide a level of convenience for patients when executed properly and legally. The issue, however, is internet pharmacy has proven to be an avenue for the illegal and unlicensed selling of medications. Many nefarious websites have been spotted and shut down by the FDA for not being legitimate pharmacies, and they have been accused of dispensing without a prescription, dispensing counterfeit medications, and diagnosing ailments via an online questionnaire instead of requiring actual diagnosis from a healthcare professional. We’ve all typed our symptoms into WebMD before and thought we had a terminal illness when really it was a head cold. Now imagine getting prescribed medications based on how you describe your condition online…that’s a recipe for disaster.

Although there are plenty of cases of internet pharmacies being shady and up to no good, there are many others that are legitimate businesses (here's a list of legitimate internet pharmacies approved by the NABP) which are compliant with the FDA, HIPAA, and the Better Business Bureau.

Even for the legitimate internet pharmacies, there is significant safety risk involved in shipping medications. First, there is the unpredictability of delivery as a whole. When inclement weather, human error along the delivery workflow, and high order volume threaten the arrival of shipments, it places an increased risk on patients who need their medications. For instance, Christy, a telepharmacy patient from a small town in Iowa, experienced this risk first hand. Prior to the telepharmacy opening in her town, she was receiving her medications through a delivery service, and as a diabetic, she needs her insulin every day. “My medications were being delivered, but it was not an ideal solution. They delivered the wrong medication once, and another time my medication was delivered to the wrong house. Luckily the neighbors know me and I got the medication,” said Christy. 

But let’s say the package is delivered to the right address at the right time. What could go wrong then? Well, prescription medications have guidelines for the temperatures at which they should be stored, and when medications are shipped to patients’ mailboxes, they often sit for indefinite amounts of time in both extremely cold and extremely hot weather. Some medications could deteriorate rapidly under high heat or extreme cold. Drugs for asthma, diabetes, thyroid and anxiety could be especially vulnerable. Improper storage of medications, even for a few hours, can impact the efficacy and safety of some of the most common prescription medications used today.

Effect on pharmacists and the pharmacy industry

Internet pharmacies have the potential to pose a threat to independent pharmacists and community pharmacies across the country. Pharmacists and pharmacies provide so much value beyond the prescriptions they dispense. They provide clinical services and give patients and communities a local healthcare professional they can consult about their health.

Internet pharmacy has ultimately come to confirm the fears pharmacists have about their jobs becoming more commoditized and outsourced. When patients in a pharmacist’s community opt to go online to get pharmacy services and obtain counsel from a pharmacist located remotely, it makes it difficult for pharmacists to drive traffic to their brick and mortar location and stay in business.

Internet pharmacies are hurting today’s pharmacists by transitioning pharmacy to a “call center” model, as opposed to the relationship-focused and community-oriented business it has been for so many years.

Telepharmacy

Telepharmacy works just like any traditional pharmacy; the pharmacist’s scope of practice remains exactly the same. Everything a pharmacist does in a traditional pharmacy they do in a telepharmacy The only difference is the pharmacist supervises technicians, verifies prescriptions, and counsels patients from a remote location. I know what you’re thinking at this point, “Hey, don’t internet pharmacies have pharmacists working remotely? What’s the difference?”

Yes, they do. The difference is when telepharmacy is practiced, regardless of whether it is in a retail independent setting, a health system, a hospital, or some other use case, there is a pharmacist dedicated to overseeing the operations of the telepharmacy from a host pharmacy. 

When a patient visits a telepharmacy, they have a nearly identical experience as they do with a traditional pharmacy. They visit a brick-and-mortar location, chat with friendly technicians, and have immediate access to a pharmacist if they have questions or need a consultation. Additionally, pharmacists practicing telepharmacy are often available in-person at the telepharmacy location for clinical services or appointments on a regular basis. 

Now let’s walk through the patient process with telepharmacy. As mentioned before, the process works just like it does with traditional pharmacy:

Telepharmacy safety concerns

Concerns over the safety of telepharmacy began to fade out well over a decade ago when the pilot study for telepharmacy in North Dakota, which lasted six years and ended in 2008 (as a point of reference, this was two years before the first iPad came out), released the results of their experiment. The study found error rates among the telepharmacies were actually lower than the national average error rate among traditional pharmacies (1.3% compared to 1.7%). In the 11 years since the conclusion of that study, the practice of telepharmacy has naturally become far more sophisticated due to advancements in technology, and as a result the safety of it has improved as well.

Effect on pharmacists and the pharmacy industry

Telepharmacy provides pharmacists with an opportunity to serve more patients, increase their prescription volume, and most of all it allows the pharmacist to remain a central pillar of the patient’s healthcare team. It allows pharmacists to open pharmacies in locations where a traditional pharmacy may not be viable, and lets them serve underserved patients in rural and urban areas with the local, friendly connection that pharmacists have always had with their communities.

Implementing telepharmacy in a location that doesn’t have a pharmacy (like a pharmacy desert), allows pharmacists to serve underserved patients and provide them with a local alternative to internet pharmacies. When there is a brick-and-mortar location down the street that is overseen by a pharmacist, patients receive the local, personal touch they’ve come to know and enjoy from their pharmacy.

Telepharmacy also throws a lifeline to struggling pharmacies; instead of selling, closing the pharmacy doors, and sending patient prescriptions to the nearest large town, telepharmacy helps keep pharmacies open. Instead of closing or selling, small-footprint pharmacies can convert to telepharmacy as a way to remain open and serve patients locally with lower operating costs.

Wrapping Up

Internet pharmacy and telepharmacy could not be more different in how they work, how safe they are in practice or in how they affect pharmacists. Driving business to online vendors might lead to another pharmacy closing, and an already underserved population losing yet another healthcare professional. Internet pharmacy removes the local pharmacist from the equation, takes business away from the local economy, and funnels it into the pockets of big businesses located elsewhere.

Telepharmacy is a tool pharmacists can use to ward off the threats posed by internet pharmacy, decreased reimbursement rates, physician dispensing and other threats to pharmacy practice. Telepharmacy preserves the role of the pharmacist and pharmacy technician, keeping business local and allowing pharmacies to stay in business and help underserved patients.