Telepharmacy Regulation in Transition: Growing From Sites to Networks

Telepharmacy is increasingly being reshaped from a limited, site-based service into a broader network of connected pharmacy operations. As states respond to persistent pharmacy deserts, workforce challenges, and advances in technology, boards of pharmacy are reexamining telepharmacy regulations – moving away from geographic requirements toward policies that support coordinated, needs-based models while maintaining patient safety and oversight.

These regulatory shifts reflect a broader rethinking of how pharmacy services are organized and delivered, with telepharmacy serving as a backbone for emerging networks that extend pharmacist oversight beyond traditional brick-and-mortar settings. Recent policy changes, such as adjustments in geographic restrictions and oversight models, illustrate how this approach is taking shape in practice.

Research cited by regulators supports this realignment, with states that have adopted less restrictive telepharmacy policies reporting reductions in pharmacy deserts and improved access in underserved areas. In response, state boards of pharmacy are advancing policies that modernize telepharmacy regulations and clarify standards for prescription drug delivery.

Together, these developments illustrate how telepharmacy regulation is evolving to support more coordinated pharmacy networks without compromising patient safety or oversight.

Needs-Based Access to Telepharmacy Outlets and Operational Standards

One of the most significant shifts in telepharmacy regulation is the move away from rigid geographic and mileage requirements toward needs-based access to pharmacy services. Colorado provides a clear example of this shift. In 2022, Colorado enacted a law that eliminated limitations for telepharmacy outlets. Previously, an outlet needed to be located more than 20 miles from the nearest prescription drug outlet or another telepharmacy.

Colorado’s law requires that telepharmacy outlets be registered as “prescription drug outlets” rather than “other outlets” and placed in areas of need, with a pharmacist manager overseeing operations and supervising remotely. According to Colorado’s law, an area of need is “any health facility licensed or certified by the Department of Public Health and Environment or any area where a demonstration of need is approved by the State Board of Pharmacy.”

Although rural areas are often the focus of discussions regarding unequal access to pharmacy services, the NABP task force on telepharmacy also brought up urban pharmacy deserts, in which a pharmacy may not be available within multiple city blocks. Thus, the task force added a footnote to the Model State Pharmacy Act and Model Rules of the National Association of Boards of Pharmacy (Model Act), stating the following: “To allow for emerging practice models, states should not impose volume restrictions, mileage restrictions, or unnecessary limitations that would limit patient access to remote dispensing sites.”

Expanding Point-Of-Care Testing Models

The expansion of telepharmacy networks has sharpened focus on the range of clinical services pharmacists may safely provide within those systems. Remote supervision, shared infrastructure, and coordinated workflows have created new opportunities to integrate point-of care testing and test-to-treat models into telepharmacy-enabled settings. In response, state boards of pharmacy are not only revisiting how telepharmacy outlets are regulated, but also how expanded clinical services can be safely delivered within these practice sites.

State legislatures are continuing to identify opportunities to expand access to quality health care by capitalizing on pharmacists’ clinical expertise, particularly as point-of-care testing and test-to-treat models offer opportunities to improve timely access to care. For example, West Virginia enacted a law that allows pharmacists to test and prescribe medications for certain conditions, such as COVID-19, RSV, and influenza. Controlled substances (CS) are excluded from the list of permitted medications.

Under the law, pharmacists must notify a patient’s primary care physician within 72 hours of receiving test results and prescribing medication, with referral requirements in place if a patient does not have an established provider. This law increases timely and convenient access to health care, particularly in underserved areas.

Prescription Drug Home Delivery Services

Prescription drug home delivery represents another operational dimension of telepharmacy networks that is drawing increased regulatory attention. For instance, the Georgia Board of Pharmacy delineated a rules-based structure for mail-order and prescription medication deliveries. The rules include compliance with manufacturer, United States Pharmacopeia (USP), and Food and Drug Administration (FDA) standards, including temperature control as applicable. The Georgia Board also requires that patients be able to report issues with timeliness of deliveries or compromised quality of prescribed medications. In addition, CS that are delivered to patients’ homes must be signed for on arrival and not left unattended. Also, patient counseling must still be available, and mail-order pharmacy services must retain records of delivery issues for at least two years.

The Missouri Board of Pharmacy also revised its rules addressing mailing and shipping prescription medications to patients’ homes. The rules require that patients be given advance notice when medications are mailed to their homes and that proper packaging, including temperature control, be ensured to safeguard the quality of prescription medications. The Missouri Board developed protocols for notifying patients and managing compromised deliveries.

Staying Current With Emerging Technologies

Looking ahead, emerging delivery technologies may further reshape pharmacy regulation.

As telepharmacy, expanded scope of practice, and new delivery models continue to evolve, state boards of pharmacy are navigating an increasingly complex regulatory landscape. Ensuring patient access while maintaining appropriate safeguards requires regulations that are flexible, data-driven, and responsive to technological change.

Through initiatives such as the Research and Innovation Institute, NABP leadership continues to encourage regulatory bodies to remain current with technological advancements while preserving the pharmacist’s essential role in patient care.

This blog was adapted from an article that originally appeared in the April/May 2026 issue of Innovations.