Rx online reaches out to rural towns

IOWA CITY — In 2012, high costs and a low patient population forced Roby Miller's family to close a pharmacy in eastern rural Iowa.

The community was very upset over the pharmacy's closure, Miller recalled. And he understood why — pharmacies, along with health clinics and banks, are key pieces of their communities, he said, and are necessary to maintain a high quality of life.

'You need to have those core things in your community,' he said.

That experience led him to create software that would allow a pharmacist essentially to work in multiple places at once, bringing down operation costs, he said. And his idea is gaining speed.

Miller secured initial funding from family and friends, and the company, TelePharm, took off, pushing Miller to leave his job at Pearson.

The Iowa City-based company has seen substantial growth since it started in 2012, receiving an additional $2.5 million in funding last summer, acquiring Custom Data Inc., which does business as Telepharmacy Concepts, in May. It now operates 122 pharmacies in nine states.

Miller attributes part of the company's growth to the growing acceptance of telemedicine in general. Telemedicine is an easy and efficient way to expand access to patients in rural communities, many of which are facing physician shortages or are unable to recruit specialists.

But its adoption has been slow, with some health care experts believing that the technology has outpaced the regulatory environment.

'The conversation was completely different in 2012 than it is today,' Miller said. 'The conversation in 2012 was almost more of an argument.'

But the adoption of telemedicine has quickened in 2015, with rural and urban hospitals alike implementing the technology, major health systems such as UnityPoint Health and the University of Iowa launching telehealth clinics, and the Iowa Board of Medicine issuing new rules to regulate its use in April.

How it works

TelePharm's technology lets pharmacy technicians take pictures of the drugs being dispensed, their labels and the prescription, which they send to a pharmacist off-site. The pharmacist reviews the images and either approves the prescription or rejects it.

Prescriptions only can be dispensed to patients if they are approved by a pharmacist. If the prescription is rejected, the technician must fix the problem and resubmit the information.

Miller said because of the cataloging process, telepharmacies actually have a better accuracy rate — that is, getting the correct drug and correct amount of each drug to the correct patient — than traditional pharmacies.

The software also allows pharmacy technicians and patients the ability to communicate with pharmacists through a secure teleconferencing system.

Miller said the majority of virtual pharmacies that it operates are located in the Midwest. But TelePharm also works with pharmacies as far south as Texas, as far west as Montana and as far north as North Dakota.

The company has developed partnerships with independent pharmacies, small chains and, more recently, the University of Wisconsin health system.

'That was a milestone for us,' Miller said, calling the partnership 'big level.'

But that growth also presents complications as each state has its own pharmacy board, which in turn regulates pharmacists and pharmacy technicians. That means as TelePharm continues to expand, it also has to build relationships with those boards and meet the standards and regulations the boards set forward.

Underserved communities

Early adopters of the TelePharm model mostly were independent pharmacy owners with stores already in operation, Miller said, adding many were repeat customers and have opened additional locations.

But TelePharm is starting to max out that customer base and needs to adjust its focus.

'The community without a pharmacy is really our customer,' Miller said.

As with other aspects of health care, pharmacies can be difficult to operate due to low patient populations, high costs and challenges recruiting health care professionals.

This has forced many small-town pharmacies to close. According to a 2013 University of Iowa study, more than 119 community pharmacies — including three in Iowa — closed between May 2006 and October 2010. Of those 119 pharmacies, 31 were located in rural communities that had no other health professionals, the study found.

It also concluded those residents have to travel an average of almost 30 minutes to the nearest pharmacy.

What's more, TelePharm estimates that 46 Iowa pharmacies closed from 2010 to 2012, leaving about 220,000 residents underserved.

To help correct this problem, TelePharm is working to open pharmacies in communities without one. The company asks for a $50,000 commitment form the town's economic development board or city council, Miller said. But in return TelePharm also invests its own capital into the community to open the virtual pharmacy.

Miller said the company started this investment initiative two months ago and already has 12 communities in Illinois signed up. It's now bringing the concept to Iowa, working with the Iowa Economic Development Authority, the Iowa Area Development Group and the Farm Bureau.

Miller said establishing a pharmacy in communities without one not only brings essential health care services, but also can create jobs, pointing to one telepharmacy that since has hired a nurse practitioner and several nurses.

'It really has a ripple effect,' he said.