Motivated by the persistent decline of independently owned retail pharmacies in rural communities, this policy brief updates previous research surveying the legislative and administrative activity authorizing community-based telepharmacy. After investigating all administrative rules and legislative statutes governing each state's pharmacy practice, states were comparatively analyzed for the following telepharmacy regulatory features: geographic restrictions, permitted providers, staffing requirements, and inter-state accessibility.

Compared to the growth between 2010 and 2016, recent telepharmacy diffusion has been modest. As of January 31, 2020, telepharmacy was authorized in 21 states. Ten states regulate telepharmacy through legislation, while 11 state Board of Pharmacists regulate telepharmacy by administrative code. While the growth in states authorizing telepharmacy has slowed, regulatory activity within states permitting telepharmacy has increased. Among states authorizing telepharmacy, 15 states impose a geographic restriction on licensed telepharmacies, 20 states place restrictions on permitted providers, and 16 states regulate inter-state accessibility of telepharmacy practice. As more states implement and adapt telepharmacy programs, identifying the telepharmacy regulatory variation will assist policymakers developing a portfolio of solutions in states confronting continued rural pharmacy closures.