Telepharmacy and Safety Outcomes: What Recent Studies Reveal

Telepharmacy isn’t just about convenience-it’s changing how people get their meds, especially in places where pharmacies have vanished.

In rural towns across the U.S., driving 40 miles just to pick up a prescription used to be normal. For older adults, people without cars, or those with mobility issues, that trip wasn’t just inconvenient-it was a barrier to health. Telepharmacy emerged as a real solution: pharmacists providing services remotely via video, secure systems, and automated dispensers. But the big question isn’t whether it’s possible-it’s whether it’s safe.

Studies from the last five years show something surprising: telepharmacy matches traditional pharmacies in accuracy, and in some cases, beats them at preventing dangerous errors. But it’s not perfect. The tech can glitch. The training can be inconsistent. And sometimes, a pharmacist misses a subtle sign because they can’t see the patient’s hands shaking or their skin pale.

How telepharmacy actually works

Most telepharmacy setups follow a hub-and-spoke model. A central pharmacy-often in a city-has licensed pharmacists who oversee multiple remote locations, like small clinics or rural drugstores. These remote sites have automated dispensing machines, video cameras, and secure connections to electronic health records. When a patient walks in, a pharmacy technician takes their information, the prescription is sent digitally to the remote hub, and a pharmacist reviews it live via video. If everything checks out, the pharmacist approves the fill and the machine dispenses the meds.

Some services skip the physical site entirely. Patients in remote areas video-call a pharmacist directly for counseling, refill requests, or even medication reviews. These direct-to-patient models are growing fast, especially since Medicare started covering them in late 2022.

It’s not sci-fi. It’s regulated. Most states require video quality to be at least 720p, encrypted connections, and backup systems in case the internet drops. The American Society of Health-System Pharmacists (ASHP) says pharmacists need 16 to 24 hours of special training before they can do this work. That includes learning how to assess patients remotely, how to handle emergencies, and how to spot red flags without physical cues.

Is telepharmacy as safe as the corner pharmacy?

A 2021 systematic review by Pathak et al., analyzing six major studies, found that telepharmacy medication dispensing accuracy hovered between 99.2% and 99.8%. Traditional pharmacies? 99.3% to 99.9%. The difference? Statistically meaningless.

But safety isn’t just about getting the right pill. It’s about catching mistakes before they hurt someone. In one study, telepharmacy sites caught 1.2 medication errors per 100 prescriptions-same as traditional pharmacies. But here’s the twist: telepharmacy reduced after-hours approval times from hours down to 14-20 minutes. That means fewer delays in critical meds like insulin or blood thinners, which can prevent hospital visits.

A 2021 study in Telemedicine and e-Health tracked 3,782 patients. Those with telepharmacy access had a 12.9% increase in hospitalizations over a year. Those without? 40.2%. That’s not because telepharmacy caused harm-it’s because it prevented worse outcomes. People got their meds faster, got better counseling, and avoided complications.

And then there’s the access angle. A 2023 study by Urick showed that states with strong telepharmacy laws saw a 4.5% drop in pharmacy deserts-areas with no pharmacy within 10 miles. In some places, that number jumped to 11.1%. That’s not just convenience. That’s life or death.

Where things go wrong

Telepharmacy isn’t magic. It’s only as good as its weakest link.

One Reddit user from North Dakota shared how a poor video connection led to a missed insulin allergy. The technician couldn’t see the patient’s skin reaction during the initial consult. The patient ended up in the ER. That’s not a flaw in the system-it’s a flaw in execution. Poor lighting, bad internet, rushed interactions-these aren’t theoretical risks. They’re documented.

A 2022 survey by the National Community Pharmacists Association found that 35% of telepharmacy sites had ongoing issues with stable video connections. In rural areas with spotty broadband, that’s a dealbreaker.

Another concern? Training. Not all remote sites invest in it. Studies show telepharmacy sites with strong technician training had 22% fewer dispensing errors than those without. Some sites still use unlicensed staff to handle basic tasks, with pharmacists reviewing remotely. That’s legal in some states-but risky if the technician doesn’t know what to look for.

And then there’s the human factor. Dr. Jerry Fahrni pointed out in the Journal of the American Pharmacists Association that pharmacists lose the ability to read body language. A patient who says they’re fine but won’t make eye contact? A trembling hand? A slow, slurred speech? Those are signs of something serious. In person, a pharmacist sees them. On video? They might miss it.

What’s working-and what’s being fixed

The Indian Health Service’s telepharmacy program for Navajo Nation communities is a model. They require dual verification for high-risk drugs like warfarin and opioids. If something’s unclear, the patient is immediately referred to an in-person pharmacist. Their error rate? 0.45%. The national average? 0.67%. That’s not luck. That’s protocol.

Some companies are using AI to help. MedsAI, a startup that raised $22 million in early 2023, built an algorithm that flags potential drug interactions or dosage errors before a pharmacist even reviews the script. In early trials, it cut adverse drug events by 18.7%. It’s not replacing pharmacists-it’s giving them better tools.

The FDA launched its Sentinel Initiative in January 2023 to track adverse events linked to telepharmacy. The Patient-Centered Outcomes Research Institute (PCORI) is funding a $3.2 million, three-year randomized trial comparing telepharmacy and traditional pharmacy safety across 12 rural communities. Results are expected by 2026.

And in November 2022, Medicare expanded reimbursement for telepharmacy services. That’s a big deal. It means more clinics can afford the tech, more pharmacists can get paid to do this work, and more patients can access it.

What patients really think

A 2022 survey of 450 telepharmacy users found 76.4% were highly satisfied. But 28.7% still worried the pharmacist couldn’t fully understand their condition without being there in person.

One patient in rural Montana said video chats about her warfarin dose had likely prevented two ER visits. Another in Arizona said she finally got her pain meds on time after her local pharmacy closed. But then there’s the counterpoint: a nurse in South Dakota told Pharmacy Today that complex cases-like someone with five chronic conditions and a new drug reaction-still need an in-person visit. Telepharmacy works best for refills, basic counseling, and routine checks. It’s not a full replacement for face-to-face care… yet.

The future: better tech, better standards

By 2026, experts predict telepharmacy will match traditional pharmacy safety levels across the board. But that’s only if we fix the gaps.

States need consistent rules. Right now, 28 states have clear telepharmacy laws. 22 don’t. That’s a mess for pharmacists who work across borders. The American Pharmacists Association has set a goal to establish national safety standards by 2025. That’s the next big step.

Broadband access remains the biggest barrier. No amount of AI or video tech helps if the internet cuts out during a medication review. Federal funding for rural broadband is now tied to telehealth expansion-something that could change the game.

Training will improve, too. Pharmacy schools are starting to include telepharmacy simulations in their curricula. Students are learning how to conduct remote consultations, spot red flags on screen, and communicate clearly without body language.

Telepharmacy isn’t the future of pharmacy. It’s the present. And it’s working-when done right.