New incentives from the Italian Government to promote telemedicine in pharmacies

Thanks to Camilla Garzon and Denise Moretti for collaborating on this article

As was recently demonstrated by the COVID-19 pandemic, the development of telemedicine has been an important tool in the containment of the disease. New and interesting scenarios are emerging for the future of the national health service and its relationship with citizens, especially in the most peripheral areas of the country.

The greatest obstacles to overcome in order to build effective reliance on telemedicine are, among others, a certain level of difficulty in using digital tools, especially among the older segments of the population, and the lack of high-speed internet connections, especially in rural and peripheral areas.

These circumstances represent a challenge for the dissemination of telemedicine among the population, but also represent an opportunity for pharmacies to build an increasingly central role in the field of local health care by supporting patients in the use of these services. Indeed pharmacies, due to their widespread distribution throughout the territory, are the first way in which citizens interact with the SSN (Servizio Sanitario Nazionale[1]), and they can provide important health support services. Since the introduction of the “service pharmacy” model, the quality of the services offered in pharmacies has greatly improved but new advancements can still be achieved thanks to technological evolution and new digital tools.

The regulatory framework and incentives for pharmacies

The new national guidelines on telemedicine, approved in December 2020 by the State-Regions Conference, have expressly provided for the inclusion of pharmacies in the provision of telemedicine services to the public.

In particular, the guidelines specify that, in cases where “the patients did not possess the computer tools necessary for the tele-consultation and struggled to acquire them, appropriate agreements allowing patients to conveniently make use of dedicated stations made available by entities close to their houses will be evaluated”.

In this regard, Decree-Law no. 137/2020 (converted into Law no. 176/2020) has provided that in order to facilitate access to telemedicine services by citizens of small towns, pharmacies operating in municipalities or towns with fewer than 3,000 inhabitants are entitled to a benefit consisting of a tax credit amounting to 50%, up to 3,000 euros for each beneficiary and, in any case, within the spending limits of 10,715 million euros for the year 2021, of the expenses for the purchase and leasing, in the year 2021, of the equipment necessary for the provision of telemedicine services.

This provision delegated to a decree of the Minister of Health the definition of the criteria and the methods for implementing the contribution, in the form of a tax credit. In particular, it aimed to specify the kind of investments that gave access to the benefit, the procedures for granting and using the contribution, the documentation required, the conditions for revocation and the performance of controls.

The implementing decree envisaged was adopted on October 30 2021 (and published in the Official Gazette on December 15 2021). This decree specifies that the expenses incurred in the year 2021 for the purchase and leasing of a list of equipment required for telemedicine services will be eligible for the benefit, such as:

(a) devices for the non-invasive measurement of blood pressure;

b) devices for the measurement of pulmonary capacity by self-spirometry;

c) devices for the non-invasive measurement of the percentage of oxygen saturation;

d) devices for the non-invasive monitoring of blood pressure and cardiac activity in functional connection with cardiology centers accredited by the regions on the basis of specific technical, professional and structural requirements;

e) devices allowing for the performance of electrocardiograms, relying on telecardiology procedures to be carried out in connection with cardiology centers accredited by the regions on the ground of specific technical, professional, and structural requirements.

It is also specified that: (i) pharmacists must verify that their telemedicine devices are compliant with the requirements of current regulations on the quality and safety of the devices, and are responsible for the proper performance and maintenance of the devices themselves; and that (ii) only adequately trained health care personnel and pharmacists are permitted to use telemedicine services.

Trial Projects

In the past months, numerous trial projects were undertaken involving pharmacies in the provision of telemedicine services to patients.

While not mentioning all of these, we cite the project of Ulss 7 Pedemontana Veneta[2], which establishes a network of pharmacies to provide telemedicine services to citizens. In particular, the pharmacies that were part of the project were equipped with artificial intelligence devices for tele-consultations: a patient with a certain disorder goes to the pharmacy and, with the support of the pharmacist, an AI machine is used to obtain images and data that will be sent in real-time to an Ulss doctor. In the Ulss 7 hospital, there will be doctors who will be available during the pharmacy hours to consult with the patient and make the diagnosis, issuing a prescription when required.

Another trial project has been developed in Tuscany[3]. This is based on an agreement between the Region and the territorial pharmacies to monitor drug therapies involving chronic patients and provide telemedicine services. In this project too, there is an attempt to combine the distribution of medications with the offer of professional support to citizens.

Future prospects

Telemedicine represents a new tool through which pharmacies can assert their centrality as providers of local health services, facilitating access to telemedicine and thus, ultimately, facilitating access to health care even in the most difficult contexts.

During the management of the pandemic, pharmacies have already demonstrated their ability to operate as a fundamental local garrison for the provision of essential health services in relation to the diagnosis of Covid and its prevention. As stated in a judgment of the Council of State of January 4 2021 No. 111: “there has been a profound transition in the role of the pharmacy from a more traditional activity consisting simply in distributing pharmaceutical products, towards a role of provider of services and activities (…). The pharmacy in itself is now a multifunctional health center at the service of the community and a point of connection between the hospital and territory and the front-office of the Servizio Sanitario Nazionale“.

Telemedicine is therefore the new challenge that pharmacies will have to face (and benefit from), especially in the post-emergency phase, in order to continue to maintain the role they have earned over time and significantly strengthened in the last months of the pandemic.

[1] Italian National Health Service

[2] https://www.aulss7.veneto.it/telemedicina

[3] https://www.toscana-notizie.it/-/telemedicina-e-terapie-farmacologiche-l-accordo-tra-regione-e-farmacie