Wisconsin Creates Remote-Dispensing Law to Ease Pharmacist Shortage

BETHESDA, MD, 15 May 2008 — As some states struggle with pharmacist shortages, the problem can be especially difficult to resolve for isolated, rural areas.

Wisconsin has created a new law this year aimed at bringing pharmacy services to remote stretches of the state through the practice of remote dispensing.

"The intent here is that pharmacy service can be increased to underserved areas, which right now may be suffering from pharmacy shortage," said Bill Black, legal counsel for the Wisconsin Pharmacy Examining Board.

The details of the law have yet to be written. The pharmacy board will examine a series of pilot programs over the next two years. Specific regulations for the law will be based on the procedures developed during the test programs, Black said.

Parts of northern Wisconsin—and even some urban areas—have little access to pharmacy services. In some cases, the entire health care system consists of a clinic with a physician and a nurse.

Currently, Wisconsin law allows physicians to prescribe and dispense drugs in underserved areas.

"This just provides an additional potential business model instead of a physician-dispensing model," Black said.

A drawback of the physician-dispensing system is that pharmacy-related paperwork can reduce the time available for patients.

"A lot of medical clinics and doctors want to be spending time seeing patients and not necessarily devoting staff time to record keeping as part of the dispensing process," he explained.

The Marshfield Clinic, which has more than 700 physicians, is among the organizations that pushed for a new way to dispense drugs in Wisconsin. The rural health care provider has 43 sites scattered across 40,000 square miles of northern Wisconsin.

"The Marshfield Clinic was very interested in embracing remote supervision of dispensing," said Gary Plank, system director of pharmacy services for the clinic.

The town of Mercer, which sits in northern Wisconsin near Michigan's Upper Peninsula, is a location that could benefit from the new remote dispensing law. In the past few years, the town lost its only community pharmacy after the local pharmacist-owner retired and could not find a buyer, Plank said.

A single clinic, staffed by a physician and a nurse practitioner, served the basic medical needs of the town and surrounding area. The town approached the Marshfield Clinic for help in providing pharmacy services for residents unable to travel to another town that has a pharmacy, Plank said.

Up to 30% of prescriptions go unfilled in some areas, Plank said, often due to the lack of convenient access to a pharmacy. The law should help those patients who may be going without needed drugs due to lack of transportation or rising gas prices.

"We have to be able to remove the barriers to getting" drugs, he said.

Black said technological advances have opened new doors for pharmacies in recent years.

"Through the use of new technology, it is much more possible do a lot of the dispensing functions at a distance," Black said.

Plank said the Marshfield Clinic did some early remote pharmacy work starting in 2003, when pharmacists oversaw the remote creation of antineoplastic drugs at three locations. Now, the group is moving ahead with a wider array of remote services.

Under the Marshfield Clinic's plan, each outlying clinic that participates would include a pharmacy technician with a computer in an examination room stocked with drugs. Video equipment linked to the Internet would connect a pharmacist with the remote technician, he said.

The technician would pull the drugs, create the product label, and enter information into the pharmacy computer system. The pharmacist would view the label, the original prescription, and the contents to approve the transaction.

Patients would then come into the room and communicate with the pharmacist over the video link.

"[A] good feature about this is that the pharmacist will be required to counsel patients regarding their medication before the medication is ultimately dispensed to the patient," Black noted.

An important factor for the Wisconsin Pharmacy Examining Board will be the final stages of the remote dispensing process. There must be security and accountability with the pharmacy technician as he or she finalizes the packaging and the labeling for dispensing, Black said.

"The goal is that the patient will have essentially the same safeguards and protocols applied to them as would happen if they would go to a pharmacy," he said.

Black said the law will help more than Wisconsin's rural residents. There will be opportunities for new partnerships between hospitals with 24-hour pharmacies and those pharmacies operating during limited hours.

"These new rules will also allow partnerships to be formed with other pharmacies that want to pick up some of that work," Black said.

Aurora Health Care, a provider serving southeastern Wisconsin, joined Marshfield Clinic in pushing for the new legislation. The Pharmacy Society of Wisconsin also advocated for the legislative change.

Black said the Wisconsin Pharmacy Examining Board will be watching the various pilot plans for the next two years. The results of the pilot programs will determine the specific rules behind the new law, Black said.

"If it is safe," he said of a proposed plan, "we should be able to find a way to make it work."

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