Ohio Board of Pharmacy Proposes Expansion of Technology-Enabled Pharmacy Practice

The Ohio Board of Pharmacy is considering a significant modernization of its rules governing how pharmacy services may be performed, verified and delivered through technology.

On August 14, 2026, the Board released a package of eight proposed rules addressing shared pharmacy services, remote prescription processing, central fill, electronic product verification, automated pharmacy systems, automated drug storage systems and self-service prescription kiosks. Stakeholder comments are due September 30, 2026.

The Ohio Board of Pharmacy’s proposal is notable for a few reasons. First, Ohio already permits several technology-enabled pharmacy practices. However, this package of proposals would establish a more comprehensive framework for separating certain pharmacy functions from the traditional model in which virtually every component of the dispensing process occurs inside a single brick-and-mortar pharmacy.

For pharmacies confronting staffing challenges, rising operating costs and increasing demand for convenient patient access, several provisions deserve attention.

Remote Pharmacy Functions Could Become More Flexible

Proposed Rule 4729:5-3-25.2 would consolidate and expand Ohio’s framework for remote prescription and medication-order processing.

The proposal expressly contemplates pharmacists, pharmacy interns and pharmacy technicians performing authorized functions remotely, including from their residences or other locations where patient information can be appropriately protected.

Permissible remote activities could include prescription receipt and interpretation, prescription or order entry, data entry, prospective drug utilization review, evaluation of clinical information, therapeutic interventions and drug-information services, depending on the individual’s scope of practice. Importantly, the proposal also contemplates work performed outside Ohio.

A pharmacist working outside the state, for example, could process prescriptions or medication orders dispensed in or into Ohio if the pharmacist is appropriately licensed or registered where the work occurs and satisfies the proposed employment and pharmacy-licensure requirements. Similar provisions address pharmacy interns and technicians.

That flexibility could have significant operational consequences. Pharmacies increasingly rely on centralized or remote workforces to manage prescription volume, after-hours workloads and administrative functions. The proposed rules could provide a clearer pathway for Ohio pharmacies to deploy those models.

The flexibility, however, comes with compliance obligations. Pharmacies would need to address training, secure system access, personnel and work-location records, auditing capabilities, policies and procedures and annual competency reviews. When processing is outsourced to an unrelated remote pharmacy, the parties would also need a written agreement allocating their respective responsibilities.

In other words, Ohio appears willing to separate certain pharmacy functions geographically, but not accountability for those functions.

Central Fill Moves Further Toward a Distributed Pharmacy Model

Proposed Rule 4729:5-3-25.1 would establish a consolidated framework for central fill pharmacies.

An originating pharmacy could use a commonly owned or contracted central fill pharmacy to fill or refill prescriptions or medication orders, subject to requirements governing electronic records, patient profiles, quality assurance and allocation of responsibilities between the pharmacies.

One noteworthy provision would permit a central fill pharmacy, for outpatient dispensing, to dispense a prescription directly to the patient if the required prospective drug utilization review and patient counseling obligations are addressed through written agreements and other applicable requirements are satisfied.

Central fill historically has been viewed primarily as a back-end fulfillment mechanism supporting the originating pharmacy. Direct-to-patient dispensing creates the potential for more integrated centralized fulfillment models while preserving responsibility for clinical review, counseling and regulatory compliance.

Pharmacies considering such arrangements should pay particular attention to their contracts. Under the proposal, responsibilities not assumed in writing by the central fill pharmacy generally remain with the originating pharmacy.

Automation Could Assume More of the Physical Dispensing Process

The proposed automated pharmacy system rule may ultimately have some of the greatest operational significance.

Proposed Rule 4729:5-3-17.1 defines an automated pharmacy system broadly to include mechanical systems performing functions involving the storage, packaging, compounding, dispensing or distribution of dangerous drugs.

Most notably, the proposal addresses systems capable of dispensing dangerous drugs without the final association being physically performed by a pharmacist. That does not mean the pharmacist disappears from the process.

Before such a system could operate under the proposed framework, the Board would review it, and approval would be site-specific. The system would also undergo a 45-day period during which a pharmacist verifies the accuracy of all drugs dispensed. The proposed minimum accuracy threshold during that period is 99.985%.

After implementation, pharmacies would be required to maintain an ongoing quality assurance program. Depending upon dispensing volume, the program would require review of a percentage of prescriptions dispensed by the automated system. If the system selects an incorrect drug, the pharmacy would immediately return to 100% pharmacist verification until the cause is identified and corrected.

This is an important regulatory approach: rather than prohibiting automation from performing functions traditionally associated with dispensing, the Board is proposing measurable validation and quality-control standards governing when automation may do so.

Prescription Kiosks Could Expand Access — But With Geographic Guardrails

The proposal would also establish detailed requirements for self-service prescription kiosks.

The kiosks could facilitate pickup of new and refill prescriptions at appropriately licensed locations, but the Board is not proposing unrestricted deployment.

Generally, a kiosk could not be located within ten miles of an existing outpatient pharmacy serving the public. There are exceptions, however, including federally qualified health centers, certain institutional facilities and Board-approved locations demonstrating need.

The proposal expressly ties one pathway for Board approval to Ohio’s Social Vulnerability Index data. A kiosk proposed within a ten-mile radius could seek approval if located in a census block meeting specified medium-high or high vulnerability thresholds.

That creates an interesting intersection between pharmacy technology and access policy. The Board is not simply asking whether a kiosk is technologically safe; it is considering where automated access should supplement the existing pharmacy infrastructure.

The kiosks would also be subject to substantial patient-protection requirements, including two-factor authentication, patient consent, counseling availability, security and video monitoring, patient eligibility criteria, system validation and quality assurance. Controlled substances could not be dispensed through the kiosks.

Electronic Product Verification Remains Part of the Broader Technology Framework

The package also includes a proposed electronic product verification rule allowing pharmacists to perform a nonphysical final check using electronic images and verification technology.

The Board specifically notes that this portion of the package does not represent a significant substantive change from its existing rule. Nevertheless, its placement alongside the remote-processing and automation provisions illustrates the broader direction of the proposal.

Technology may increasingly mediate the pharmacist’s interaction with the physical prescription, but the Board continues to impose detailed standards regarding image quality, barcode verification, system validation, pharmacist overrides, record retention and quality assurance.

What Ohio Pharmacies Should Be Watching

Taken together, these rules suggest a continued shift away from regulating pharmacy practice based primarily upon where a particular task occurs and toward regulating how the task is performed, documented, supervised and validated.

That could be significant for independent pharmacies, health systems, long-term care pharmacies, central-fill operators and other pharmacy organizations.

Technology cannot solve every challenge facing pharmacy practice. But regulatory structures designed around older operating models can prevent pharmacies from adopting technology, even when it could improve efficiency or expand access without compromising patient safety.

Through these proposals, Ohio appears to be attempting to strike a different balance: allowing greater use of remote personnel, centralized operations and automation while maintaining pharmacist responsibility, measurable quality standards and patient protections.

The details will matter. Several provisions—including geographic restrictions on kiosks, licensing requirements for remote personnel, contractual allocation of responsibility and the validation standards for automated systems—could materially affect which business models are practical.

For that reason, pharmacies and other stakeholders that may be affected should review the proposals now rather than waiting for final rules.

As noted above, the Board is accepting stakeholder comments through September 30, 2026. Organizations operating in Ohio—or considering technology-enabled pharmacy models in the state—should evaluate how the proposed rules would affect their current operations and future plans and consider participating in the stakeholder-comment process.

For pharmacies willing to invest in compliant technology, the proposal may ultimately create something increasingly valuable in pharmacy regulation: additional operational flexibility without abandoning professional accountability.

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