Texas Telehealth Pharmacy Rule Signals A New Compliance Era: What Every Pharmacy Should Know About The Board’s Proposed Informed Consent Requirements

Telehealth is no longer an emerging service for pharmacies—it has become a routine part of patient care. Whether counseling patients after discharge, managing chronic diseases, supporting remote clinical services or providing medication therapy management, pharmacists increasingly interact with patients without being physically present.

Recognizing this reality, the Texas State Board of Pharmacy has proposed a new rule that would, for the first time, establish specific documentation requirements for telehealth services provided by pharmacists. While the proposal is relatively concise, pharmacies should not underestimate its potential significance.

If adopted, proposed 22 Texas Administrative Code §291.13 would create affirmative obligations surrounding informed consent, documentation, and record retention for pharmacist-provided telehealth services. Although the proposal is directed at Texas pharmacies, its practical implications extend well beyond the state’s borders. Many multi-state pharmacy organizations already maintain uniform compliance programs, and Texas may become one of several states adopting increasingly detailed telehealth pharmacy regulations.

Why This Rule Matters

Many pharmacies already obtain patient consent before providing clinical services. What makes this proposal noteworthy is that it would transform what has often been considered a best practice into an express regulatory requirement.

Importantly, the rule does not distinguish between sophisticated telehealth platforms and more traditional remote communications. It expressly applies whether the interaction occurs through (1) video conferencing and (2) audio-only telephone communications. This means a pharmacist providing clinical services during a scheduled phone consultation could trigger the same documentation obligations as a pharmacist using a dedicated telehealth platform.

For many pharmacies, this may require revisiting workflows that have existed for years.

What the Proposed Rule Requires

Before providing a telehealth service, the pharmacist must obtain informed consent from the patient or another individual legally authorized to make healthcare treatment decisions for the patient. Importantly, the proposal would allow patient consent to be obtained either in writing or verbally.

Regardless of how consent is obtained, the documentation must reflect patient agreement regarding three distinct areas: (1) treatment; (2) collection of data; and (3) sharing of data.

This three-part consent requirement deserves attention. Some existing pharmacy consent forms address treatment authorization but may not explicitly discuss data collection and data sharing in sufficient detail. Organizations should review existing consent language rather than assume current forms satisfy the proposed rule – even if the rule is not enacted as drafted, this presents an opportunity to review and enhance standard operating procedures in this area.

Documentation Requirements

The proposed rule provides flexibility regarding where consent may be documented. Acceptable locations for consent documentation include the pharmacy data processing system, an electronic logbook, or a hard-copy log. If verbal consent is obtained, documentation must also identify the pharmacist or authorized individual who obtained the patient’s consent through initials or another identification code.

Although these requirements appear straightforward, implementation often becomes more complicated than anticipated. Large pharmacy organizations operating across multiple locations may need software modifications to ensure documentation fields are consistently captured. Independent pharmacies should likewise verify that existing workflow processes allow staff to quickly document consent before telehealth services begin.

Record Retention Requirements

The proposal also creates clear recordkeeping obligations. Consent documentation must (i) remain at the licensed pharmacy location; (ii) be retained for at least two years; and (iii) be available for inspection and copying by the Board or other authorized governmental agencies.

Perhaps the provision most likely to attract attention is the production requirement. If requested by an authorized Board representative, the pharmacy must produce the records within 72 hours. Failure to produce the documentation on-site or within that timeframe would constitute prima facie evidence that the pharmacy failed to maintain required records under the Texas Pharmacy Act. However, this 72-hour requirement is consistent with other document production requirements in Texas under current Texas BOP rules. 

Although pharmacies routinely respond to Board inspections, this proposal reinforces the importance of ensuring telehealth consent documentation can be quickly and easily retrieved quickly, rather than simply existing somewhere within an electronic system.

Which Pharmacies Should Be Paying Attention?

This proposal extends considerably beyond traditional community pharmacies. Stakeholders that should evaluate the proposed rule include:

• Independent community pharmacies;
• Chain pharmacies;
• Specialty pharmacies;
• Health-system pharmacies;
• Ambulatory care pharmacies;
• Long-term care pharmacies;
• Mail-order pharmacies providing pharmacist consultations;
• Central fill operations conducting pharmacist counseling;
• Telepharmacy providers;
• Pharmacists performing remote medication therapy management (MTM); and
• Pharmacists participating in collaborative practice or chronic disease management programs.

Any pharmacist routinely providing patient care remotely should also carefully consider whether existing documentation processes satisfy the proposed requirements.

A Broader Regulatory Trend

The Texas proposal also reflects something larger occurring across the country.

State boards of pharmacy continue to expand their regulatory focus beyond traditional dispensing functions and into clinical pharmacy services. As pharmacists assume larger roles in patient care, regulators increasingly expect documentation standards comparable to those historically applied in other healthcare settings.

We expect additional states to continue refining telehealth requirements as the pharmacist's scope of practice evolves. Organizations operating nationally may wish to view this proposal not simply as a Texas issue, but as another indication that telehealth compliance programs deserve periodic review.

Opportunity to Submit Comments

The Board is accepting public comments through July 26, 2026. Stakeholders, including pharmacies, pharmacy associations, health systems, telehealth providers, software vendors and pharmacists, should consider whether practical implementation issues warrant clarification before the rule becomes final.

Questions surrounding documentation workflows, electronic record systems, and operational flexibility may be particularly appropriate subjects for stakeholder feedback.

Key Takeaways

The proposed rule is not lengthy, but its operational impact could be meaningful.

If adopted, Texas pharmacists providing telehealth services would need to ensure informed consent is obtained and documented before services are rendered, maintain those records for at least two years, and be prepared to produce them within 72 hours upon request.

For pharmacies already expanding virtual care offerings, now is an ideal time to review consent forms, documentation procedures, staff training, and record retention practices. Early preparation will be far easier—and less costly—than reacting if and when the rule becomes effective.

As pharmacy practice continues evolving, telehealth compliance is becoming another essential component of modern pharmacy operations rather than merely an administrative exercise.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.