By NextBestFitMail-order and telepharmacy
Allow remote pharmacist supervision and expand mail delivery.
Cheap rural access now.
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This path
Mail-order and telepharmacy
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Allow remote pharmacist supervision in all states
- Cover mail delivery
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Pharmacy closures and pharmacy deserts
Remote pharmacist supervision and mail delivery can restore pharmacy access in towns without a pharmacist and are cheap and quick to expand.
What it creates or worsens
- Solves only part of the problem
Mail delivery and remote pharmacist supervision are poorly suited to urgent medications or patients needing counseling.
- Medical errors and poor care coordination
Mail delivery can be unreliable for temperature-sensitive drugs.
7 paths soften this
Mandatory error reporting and learning systemMedical errors and poor care coordinationChosenEvery person registered with a primary care homeMedical errors and poor care coordinationChosenStandby payments to keep labor units openMaternity care desertsChosenMinimum nurse staffing ratiosNursing and direct-care shortages and burnoutChosenEvidence-based coverage decisionsLow-value care and overtreatmentChosenShift to small homes and home careNursing home understaffing and qualityChosenNational health record and patient IDRecords don't follow patientsChosen
Who's affected
Who gains
- Rural residents
- Pharmacy closures and pharmacy deserts: Pharmacy closures reduce access to medicines, especially without transportation.
- Older adults
- Pharmacy closures and pharmacy deserts: Pharmacy closures reduce access to medicines, especially without transportation.
- Hospitals, clinics, and care organizations
- Medical errors and poor care coordination: Fee-for-service providers are paid for treating complications.
Who loses
- Pharmacy benefit managers and their pharmacies
- Pharmacy closures and pharmacy deserts: Affiliated mail and specialty pharmacies benefit as local pharmacies close.
- Community pharmacies
- Solves only part of the problem: Mail delivery and remote pharmacist supervision are poorly suited to urgent medications or patients needing counseling.
- People with ongoing or specialist care needs
- Medical errors and poor care coordination: Delivery and coordination failures cause preventable harm.
Where it has been tried
- North Dakota: Telepharmacy since 2001 restored service to rural towns.
- North Dakota, United States: A 2015–2016 survey covered North Dakota's telepharmacy network of 24 remote community pharmacy sites and 14 central sites.