TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING

BOARD OF PHARMACY

Proposed Regulation

Title of Regulation: 18VAC110-20. Regulations Governing the Practice of Pharmacy (amending 18VAC110-20-112, 18VAC110-20-276; adding 18VAC110-20-277).

Statutory Authority: §§ 54.1-2400 and 54.1-3307 of the Code of Virginia.

Public Hearing Information:

December 8, 2026 - 9:01 a.m. - Department of Health Professions, 9960 Mayland Drive, Suite 201, Board Room Four, Henrico, VA 23233.

Public Comment Deadline: December 18, 2026.

Agency Contact: Caroline Juran, RPh, Executive Director, Board of Pharmacy, 9960 Mayland Drive, Suite 300, Richmond, VA 23233-1463, telephone (804) 367-4456, fax (804) 527-4472, or email caroline.juran@dhp.virginia.gov.

Basis: Regulations of the Board of Pharmacy are promulgated under the general authority of § 54.1-2400 of the Code of Virginia, which states that the general powers and duties of health regulatory boards shall be to promulgate regulations that are reasonable and necessary to administer effectively the regulatory system.

Purpose: This action is essential to protect the health, safety, and welfare of citizens because it broadens accessibility of pharmacy services to the public.

Substance: The proposed amendments (i) ensure that pharmacy technicians and pharmacy interns performing the duties of pharmacy technicians are able to access remote databases of the pharmacy employer to perform functions listed in 18VAC110-20-276 A and (ii) provide a framework for use of central fill pharmacies, including requirements for operation and dispensing at a central fill pharmacy.

Issues: The primary advantage to the public is faster refilling of prescriptions that may be outsourced to a central fill pharmacy or for which tasks may be completed remotely prior to dispensing the prescription. There are no disadvantages to the public. There are no advantages or disadvantages to the agency or the Commonwealth.

Department of Planning and Budget Economic Impact Analysis:

The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Code of Virginia and Executive Order 19. The analysis presented represents DPB's best estimate of the potential economic impacts as of the date of this analysis.¹

Summary of the Proposed Amendments to Regulation. In response to two pilot programs and 2024 legislation, the Board of Pharmacy (board) proposes a permanent regulation to replace an emergency regulation that amended provisions related to central fill pharmacies and pharmacy technician remote database access.²

Background. Chapter 407 of the 2024 Acts of Assembly directs the board to promulgate regulations authorizing a pharmacy to outsource tasks associated with dispensing a prescription drug, including verification for accuracy by a pharmacist and alternate delivery to the pharmacy that received the prescription, to a central fill pharmacy permitted as a pharmacy or registered as a nonresident pharmacy. Chapter 407 further specified that the regulation would allow central fill pharmacies to (i) operate when sufficient automation is employed to safely support the work and limit distractions for pharmacy personnel, (ii) prohibit central fill pharmacies from accepting prescriptions or communications directly from patients or providers, and (iii) restrict the type of drugs being dispensed by central fill pharmacies to Schedule VI drugs, which have the lowest potential for abuse or dependency of all scheduled drugs. Other specific elements to be addressed in the proposed regulation include: (i) the maximum number of persons performing the duties of a pharmacy technician and support personnel a pharmacist may supervise at one time; (ii) pharmacist verification of a drug canister after filling but prior to being placed on a barcoded automated robotic dispenser, in lieu of pharmacist verification of each prescription product; (iii) a one-time written notification or sign of the dispensing and delivery process at the initiating pharmacy receiving the prescription; (iv) allowance for an unregistered and unlicensed person to assist in non-dispensing functions such as inventory, delivery, receiving, or packing of completed prescription orders when supported by barcode scanning or other technology; and (v) delivery of the dispensed drug to the patient's residence or originating pharmacy that received the prescription. The transfer of the prescriptions shall not be required if the pharmacies share a common electronic file or have technology that allows sufficient information necessary for dispensing the prescription. Chapter 407 also directed the board to promulgate regulations that would allow pharmacy technicians to access the pharmacy database from a remote location to perform certain prescription processing functions. Lastly, Chapter 407 stated that the board shall promulgate regulations to implement the provisions of this act to be effective within 280 days of its enactment. Accordingly, an emergency regulation was promulgated on June 16, 2025, and is currently set to expire on December 15, 2026.³ The Department of Health Professions (DHP) reports that the legislation, emergency regulation, and proposed regulation are all based on existing board pilot programs. The pilot programs were authorized at the Leesburg Pharmacy, also known as The Compounding Center (now Strive Compounding Pharmacy), and at Walgreens Central Fill #21420. The programs were approved through orders signed by the Executive Director of the board on October 27, 2023, and May 22, 2023, respectively.⁴ The proposed changes, which are identical to the emergency regulation except for a few grammatical corrections and minor clarifications, would implement the legislative mandate by making the following amendments: 18VAC110-20-112 currently specifies that a pharmacist can supervise a maximum of four technicians and 18VAC110-20-276 currently only allows licensed pharmacists to have remote access to the pharmacy database. The board proposes to amend 18VAC110-20-276 to expand remote access to the pharmacy database to registered pharmacy technicians and pharmacy interns performing the duties of a pharmacy technician. Further, pharmacists would be allowed to supervise up to six pharmacy technicians as long as a maximum of four of the six would be onsite at the pharmacy, and the rest were working remotely. 18VAC110-20-277 would be newly added to incorporate all of the other requirements of the legislation specific to central fill pharmacies. While most of the proposed text is identical to the legislation, some details that would be specified in the proposed text include (i) the tasks that may be performed by unlicensed or unregistered persons, (ii) the number of individuals supervised by a single pharmacist to be capped at 12 licensed or registered persons (pharmacy techs, pharmacy tech trainees, pharmacy interns) and 12 unlicensed or unregistered persons, (iii) the information to be provided to the pharmacy receiving and dispensing the prescription to the customer, (iv) the written policies to be maintained at the central fill pharmacy, and (v) the specific allowances, exemptions, and requirements so that pharmacists would not have to verify every prescription product for accuracy.

Estimated Benefits and Costs. The proposed amendments would benefit pharmacies, especially large pharmacy chains, by allowing them to use central fill pharmacy locations to more efficiently fill prescriptions, without having to specifically approach the board and obtain approval for a pilot program to do so. Applying for a pilot program costs $325, so pharmacies that choose to utilize a central fill model under the proposed changes would be saving at least that amount. In practice, the increased supervision ratios, the ability for pharmacy technicians and interns to work remotely, and the use of robotics and barcodes would allow pharmacy chains to centralize their prescription filling operations and thereby increase the volume of prescriptions that can be filled in a given day. These steps could, in turn, lead to reductions in overall operating costs and an increase in revenue. Customers (or payors) may also benefit to the extent that any cost savings to pharmacies are passed on via lower prices.

Businesses and Other Entities Affected. The proposed amendments would primarily benefit pharmacy chains operating in Virginia. There were 1,683 licensed pharmacies as of December 2025.⁵ Based on data previously provided by DHP, roughly 60% of pharmacy licenses are held by retail pharmacy chains and retail grocery chains with onsite pharmacies, which would be most likely to benefit from the proposed changes. The Code of Virginia requires DPB to assess whether an adverse impact may result from the proposed regulation.⁶ An adverse impact is indicated if there is any increase in net cost or reduction in net benefit for any entity, even if the benefits exceed the costs for all entities combined.⁷ The proposed amendments would not create any mandatory new costs for pharmacies, nor require any additional registration or fees for pharmacy chains that choose to operate a central fill facility. The proposed changes would only affect pharmacies that choose to open a central fill location. Thus, an adverse impact is not indicated.

Small Businesses⁸ Affected.⁹ The proposed changes are not expected to impact small independent pharmacies.

Localities¹⁰ Affected.¹¹ No locality would be disproportionately affected. Local governments would not be affected.

Projected Impact on Employment. The proposed amendments may increase the employment of pharmacy technicians and interns at central fill pharmacy locations, but pharmacies may reduce their employment of pharmacy technicians and interns at regular pharmacy locations if their work can be moved to a central fill location; such impacts would vary depending on the density of pharmacy locations.

Effects on the Use and Value of Private Property. The value of private pharmacy chains would increase to the extent that they choose to use central fill pharmacy locations to optimize their operations and experience cost savings and/or revenue growth as a result. Real estate development costs would not be affected.

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¹ Section 2.2-4007.04 of the Code of Virginia requires that such economic impact analyses determine the public benefits and costs of the proposed amendments. Further the analysis should include but not be limited to: (1) the projected number of businesses or other entities to whom the proposed regulatory action would apply, (2) the identity of any localities and types of businesses or other entities particularly affected, (3) the projected number of persons and employment positions to be affected, (4) the projected costs to affected businesses or entities to implement or comply with the regulation, and (5) the impact on the use and value of private property.

² More information about the legislative mandate is available on the Virginia Regulatory Town Hall at https://townhall.virginia.gov/l/viewmandate.cfm?mandateid=1399.

³ See the Emergency stage at https://townhall.virginia.gov/L/ViewStage.cfm?stageid=10383.

⁴ Details of the orders and allowances in the pilot programs can be found in pages 38-50 of board June 20th, 2024 meeting agenda: https://townhall.virginia.gov/L/GetFile.cfm?File=meeting\30\38590\Agenda_DHP_38590_v3.pdf

⁵ Data source: https://www.dhp.virginia.gov/about/stats/2026Q2/04CurrentLicenseCountQ2FY2026.pdf.

⁶ Pursuant to § 2.2-4007.04 D: In the event this economic impact analysis reveals that the proposed regulation would have an adverse economic impact on businesses or would impose a significant adverse economic impact on a locality, business, or entity particularly affected, the Department of Planning and Budget shall advise the Joint Commission on Administrative Rules, the House Committee on Appropriations, and the Senate Committee on Finance. Statute does not define "adverse impact," state whether only Virginia entities should be considered, nor indicate whether an adverse impact results from regulatory requirements mandated by legislation.

⁷ Statute does not define "adverse impact," state whether only Virginia entities should be considered, nor indicate whether an adverse impact results from regulatory requirements mandated by legislation. As a result, DPB has adopted a definition of adverse impact that assesses changes in net costs and benefits for each affected Virginia entity that directly results from discretionary changes to the regulation.

⁸ Pursuant to § 2.2-4007.04, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

⁹ If the proposed regulatory action may have an adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include: (1) an identification and estimate of the number of small businesses subject to the proposed regulation, (2) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the proposed regulation, including the type of professional skills necessary for preparing required reports and other documents, (3) a statement of the probable effect of the proposed regulation on affected small businesses, and (4) a description of any less intrusive or less costly alternative methods of achieving the purpose of the proposed regulation. Additionally, pursuant to § 2.2-4007.1 of the Code of Virginia, if there is a finding that a proposed regulation may have an adverse impact on small business, the Joint Commission on Administrative Rules shall be notified.

¹⁰ "Locality" can refer to either local governments or the locations in the Commonwealth where the activities relevant to the regulatory change are most likely to occur.

¹¹ Section 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

Agency Response to Economic Impact Analysis: The Board of Pharmacy concurs with the economic impact analysis prepared by the Department of Planning and Budget.

Summary:

Pursuant to Chapter 407 of the 2024 Acts of Assembly, the proposed amendments allow the use of central fill pharmacies and remote database access on a case-by-case basis as part of pilot programs approved by the board. The proposed amendments establish the terms of those pilot programs, including requirements for operation and dispensing, which include (i) automation requirements; (ii) requirements for acceptance of prescriptions, recordkeeping, patient notification, verification and accuracy, quarterly auditing, policies and procedures, and packaging and labeling; (iii) limitation of dispensing to Schedule VI drugs; (iv) supervision allowances and limitations for pharmacy technicians and unlicensed personnel; (v) allowances for delivery of drugs and returns; (vi) nondispensing functions that may be performed by unlicensed personnel; and (vii) an exemption for the requirement to transfer prescriptions between pharmacies when the pharmacies are a recipient pharmacy and a central fill pharmacy.

18VAC110-20-112. Supervision of pharmacy technicians.

A. A pharmacist shall determine the number of pharmacy interns, pharmacy technicians, and pharmacy technician trainees he the pharmacist can safely and competently supervise at one time; however, no pharmacist shall supervise more than four persons performing the duties of a pharmacy technician at one time, except as provided in 18VAC110-20-276 and 18VAC110-20-277.

B. In addition to the acts restricted to a pharmacist in § 54.1-3320 A of the Code of Virginia, a pharmacist shall provide personal supervision of compounding of extemporaneous preparations by pharmacy technicians.

18VAC110-20-276. Central or remote processing.

A. Centralized or remote processing of a prescription does not include the dispensing of a drug, but does include any of the following activities related to the dispensing process:

1. Receiving, interpreting, analyzing, or clarifying prescriptions;

2. Entering prescription and patient data into a data processing system;

3. Transferring prescription information;

4. Performing a prospective drug review as set forth in § 54.1-3319 of the Code of Virginia;

5. Obtaining refill or substitution authorizations, or otherwise communicating with the prescriber concerning a patient's prescription;

6. Interpreting clinical data for prior authorization for dispensing;

7. Performing therapeutic interventions; or

8. Providing drug information or counseling concerning a patient's prescription to the patient or patient's agent.

B. A pharmacy may outsource certain prescription processing functions as described in subsection A of this section to another pharmacy in Virginia or a registered nonresident pharmacy under the following conditions:

1. The pharmacies shall either have the same owner or have a written contract describing the scope of services to be provided and the responsibilities and accountabilities of each pharmacy in compliance with all federal and state laws and regulations related to the practice of pharmacy;

2. Any central or remote pharmacy shall comply with Virginia law and regulation with respect to requirements for supervision of pharmacy technicians and the duties that are restricted to pharmacists and pharmacy technicians. Pharmacy technicians at the remote pharmacy shall either be registered in Virginia or possess credentials substantially equivalent to those required for a technician registered in Virginia;

3. A pharmacist licensed in Virginia, whether at the remote pharmacy or the dispensing pharmacy, shall perform a check for accuracy on all processing done by the remote processor; and

4. The pharmacies shall share a common electronic file or have technology that allows sufficient information necessary to process a nondispensing function.

C. Any pharmacy that outsources prescription processing to another pharmacy shall provide notification of such to patients. A one-time written notification or a sign posted in the pharmacy in a location that is readily visible to the public will satisfy this notification requirement. The notice shall state the name of any contract pharmacy providing central or remote prescription processing. If the pharmacy uses a network of pharmacies under common ownership, this fact shall be disclosed in the notice.

D. A policy and procedure manual that relates to central or remote processing shall be maintained at each pharmacy involved in the processing of a prescription and available for inspection. The manual shall at a minimum include the following:

1. The responsibilities of each pharmacy;

2. A list of the name, address, telephone numbers, and permit/registration permit or registration numbers of all pharmacies involved in central or remote processing;

3. Procedures for protecting the confidentiality and integrity of patient information;

4. Procedures for ensuring that pharmacists performing prospective drug reviews have access to appropriate drug information resources;

5. Procedures for maintaining required records;

6. Procedures for complying with all applicable laws and regulations to include counseling;

7. Procedures for objectively and systematically monitoring and evaluating the quality of the program to resolve problems and improve services; and

8. Procedures for annually reviewing the written policies and procedures for needed modifications and documenting such review.

E. In addition to any other required records, pharmacies engaged in central or remote processing shall maintain retrievable records that show, for each prescription processed, each individual processing function and identity of the pharmacist or pharmacy technician who performs a processing function and the pharmacist who checked the processing function, if applicable.

1. The records may be maintained separately by each pharmacy, or in a common electronic file shared by both pharmacies provided the system can produce a record showing each processing task, the identity of the person performing each task, and the location where each task was performed.

2. The record shall be readily retrievable for at least the past two years through the primary dispensing pharmacy, and shall be available for inspection by the board.

F. Nothing in this section shall prohibit an individual employee licensed as a pharmacist or registered as a pharmacy technician or pharmacy intern performing the duties of a pharmacy technician in Virginia from accessing the employer pharmacy's database from a remote location for the purpose of performing certain prescription processing functions as described in subsection A of this section, provided the pharmacy establishes controls to protect the privacy and security of confidential records.

G. A pharmacist may only supervise a maximum of six pharmacy technicians and pharmacy interns performing the duties of pharmacy technicians accessing the employer pharmacy's database from a remote location as provided in subsection F of this section, with a maximum of four of the six on site at the employer pharmacy. The supervising pharmacist shall be readily available to the pharmacy technicians and pharmacy interns, and technology shall be available for adequate supervision of pharmacy technicians and pharmacy interns performing the duties of pharmacy technicians.

18VAC110-20-277. Central fill pharmacy.

A. Notwithstanding activities authorized in 18VAC110-20-275, 18VAC110-20-276, and 18VAC110-20-515, a pharmacy located in the Commonwealth or out of state may outsource tasks associated with dispensing a prescription drug, including verification for accuracy by a pharmacist and alternate delivery to the originating pharmacy that received the prescription, to a central fill pharmacy permitted in the Commonwealth as a pharmacy or registered as a nonresident pharmacy.

B. A central fill pharmacy may operate if:

1. Sufficient automation is employed to safely support the practice of pharmacy and limit distractions for pharmacy personnel;

2. The central fill pharmacy does not accept prescriptions or communications directly from patients or providers; and

3. Dispensing is restricted to Schedule VI drugs.

C. Notwithstanding § 54.1-3321 of the Code of Virginia, an unregistered or unlicensed person may perform the following non-dispensing functions at a central fill pharmacy:

1. The movement of sealed manufacturer bottles from an inventory shelf to a pharmacy technician's workspace for the purpose of filling a canister when the filling of the canister is completed by a pharmacist, pharmacy intern, pharmacy technician, or pharmacy technician trainee who barcode scans or uses other technology to verify each individual bottle or package of medication prior to filling the canister.

2. Manually bagging prepared prescriptions when barcode scanning or use of other technology is used to verify the prescription product vial, prescription medication leaflet, and prescription bag label.

3. Loading an automated robotic dispenser with the pharmacist-verified and sealed canister when barcode scanning or other technology is used to verify accurate placement of each canister.

4. Performing monthly cycle counts of sealed manufacturer-packaged products and sealed canisters; however, the opening of a sealed manufacturer-packaged product or canister and the counting of an unsealed manufacturer-packaged product or canister is not permitted.

D. A pharmacist practicing at a central fill pharmacy may supervise up to 12 licensed or registered persons, to include pharmacy technicians, pharmacy technician trainees, and pharmacy interns, and may supervise up to 12 unregistered or unlicensed persons performing non-dispensing functions authorized in this subsection. Each pharmacist shall determine the number of persons the pharmacist can safely and competently supervise at one time.

E. Notwithstanding 18VAC110-20-270 B, pharmacist verification of a canister of medication after it is filled and sealed but prior to being loaded into a barcoded automated robotic dispenser serves as the final product verification of a prescription. Pharmacists shall verify and check for the accuracy of all drugs packaged or repackaged for use by the robot by a visual check of the contents prior to stocking the drugs in the robotic pharmacy system. A repackaging record shall be maintained in accordance with 18VAC110-20-355 A, and the verifying pharmacist shall initial the record. Packaging and labeling, including the appropriate beyond-use date, shall conform to requirements of this chapter and current USP-NF standards. This provision shall not constitute a waiver of the requirement for a pharmacist to verify the accuracy of data entry of the prescription.

F. A central fill pharmacy shall ensure that each pharmacy receiving dispensed drugs from the central fill pharmacy shall provide a one-time written notification or a sign posted in the pharmacy in a location that is readily visible to the public as its notification of the dispensing and delivery process. 18VAC110-20-275 B 2 h shall not apply to central fill pharmacies and those pharmacies receiving dispensed drugs from central fill pharmacies.

G. A written policy and procedure must be maintained by the central fill pharmacy and complied with and shall include, at minimum, procedures for ensuring:

1. Accurate packaging and repackaging of all drugs for use in the robotic pharmacy system, to include properly labeled barcodes and the method for ensuring pharmacist verification of all packaged and repackaged drugs compliant with this section and assigned barcodes;

2. Accurate stocking and restocking of the robotic pharmacy system;

3. Removing expired drugs;

4. Proper handling of drugs that may be dropped by the robotic pharmacy system;

5. Performing routine maintenance of the robotic pharmacy system as indicated by manufacturer's schedules and recommendations;

6. Appropriately performing an analysis to investigate, identify, and correct sources of discrepancies or errors associated with the robotic pharmacy system; and

7. Maintaining quality assurance reports.

H. All manual picks for dispensing at a central fill pharmacy shall be verified for accuracy by a pharmacist.

I. If it is identified that the robot at a central fill pharmacy selected an incorrect medication, the pharmacy shall identify and correct the source of discrepancy or error in compliance with the pharmacy's policies and procedures prior to resuming full operation of the robot. An investigation of the cause of the event shall be completed, and the outcome of the corrective action plan shall be summarized and documented in a readily retrievable format.

J. One prescription per automated dispensing device per quarter shall be redirected to a pharmacist to audit for prescription product accuracy in all components. Quarterly quality assurance records related to these audits shall be maintained for two years from the date the audit is performed.

K. A central fill pharmacy may deliver the dispensed drug to the patient's residence or the originating pharmacy that received the prescription pursuant to § 54.1-3420.2 of the Code of Virginia and 18VAC110-20-275.

L. An out-of-state pharmacy solely returning a drug that was not delivered to the patient to the central fill pharmacy that dispensed the drug as authorized in § 54.1-3411.1 of the Code of Virginia shall be exempt from obtaining registration as a nonresident pharmacy.

M. The transfer of the prescription between the originating pharmacy that received the prescription and the central fill pharmacy shall not be required if the pharmacies share a common electronic file or have technology that allows sufficient information necessary for dispensing the prescription.