Pharmacies across the United States operate under a complex web of regulations implemented and enforced by individual state Boards of Pharmacy. These Boards, acting as administrative agencies, are tasked with safeguarding public health by regulating the practice of pharmacy, licensing professionals, and ensuring compliance with state laws. Their rulemaking authority means that any new regulation—proposed or adopted—can materially impact how pharmacies operate on a day-to-day basis.

Texas is no exception. The Texas State Board of Pharmacy (TSBP) has recently introduced a series of proposed and adopted rules in 2025 that Texas pharmacists, technicians, and pharmacy owners should pay close attention to. These regulatory changes, which touch on prescription drug delivery methods and pharmacist-to-technician ratios, signal the Board’s responsiveness to evolving technology, patient safety considerations, and operational realities within the profession.

Proposed Rule: Prescription Delivery by Contract Carrier and Drone

In May 2025, the Texas Board of Pharmacy proposed amendments to Section 291.10 of the Texas Administrative Code concerning the delivery of prescriptions. Most notably, the rule would permit licensed pharmacists and pharmacies to deliver prescription medications via a contract carrier and allow for certain prescription drugs to be delivered using unmanned aircraft systems (UAS), or drones.

The proposed rule represents a forward-looking approach that recognizes how logistical and technological advancements can enhance patient access to medication—particularly in rural or underserved areas. Under this amendment, pharmacies that meet security and tracking requirements may be permitted to use drones to deliver medications directly to patients’ residences or designated delivery points.

However, the proposal also raises several important compliance and safety concerns:

• Controlled Substances: The proposed rule appears to restrict or heavily scrutinize the use of drones for controlled substances, a prudent move given the potential for diversion or misuse. Pharmacies must ensure that any delivery system—including drones—has robust safeguards to verify delivery and maintain chain-of-custody.
• Patient Consent and Notification: The rule may require pharmacies to obtain informed patient consent before using drone delivery and to notify patients of expected delivery windows and procedures in the event of failed delivery attempts.
• Data Security and Tracking: Pharmacies engaging in drone deliveries would likely need to implement secure tracking systems, maintain real-time logs, and potentially update their HIPAA policies to address the use of aerial technology for transmitting sensitive health information.

This proposed rule, if adopted, would not only modernize prescription delivery in Texas but could set a precedent for other states considering the use of unmanned aircraft in pharmacy operations. Pharmacies interested in exploring drone delivery should closely monitor the rule’s progression and begin reviewing vendor agreements, insurance implications, and federal aviation regulations.

Adopted Rule: Technician-to-Pharmacist Ratios in Central Fill Pharmacies

Also in May 2025, the TSBP adopted an important amendment to the rules governing pharmacy technician staffing ratios. Historically, Texas law imposed a maximum ratio of one pharmacist to six pharmacy technicians or technician trainees. This ratio is intended to balance operational efficiency with patient safety, ensuring that pharmacists are not overwhelmed and can appropriately supervise non-pharmacist personnel.

The newly adopted rule carves out a significant exemption: central fill pharmacies that do not engage in direct patient interaction are now excluded from the minimum ratio requirements.

Implications for Central Fill Pharmacies

Central fill pharmacies operate behind the scenes, filling prescriptions on behalf of retail or outpatient pharmacies. These facilities are often highly automated and do not interact directly with patients, which reduces the scope of technician responsibilities involving patient counseling or sensitive communications.

By exempting these pharmacies from the traditional ratio, the TSBP acknowledges the unique structure and workflow of central fill operations. This change allows central fill pharmacies to scale their operations, potentially hiring more technicians per pharmacist without being encumbered by outdated supervisory models. This rule is also particularly beneficial for pharmacies handling high prescription volumes or engaging in contract work with health systems or payors. It may also reduce costs associated with hiring additional pharmacists solely for compliance with technician ratio limits.

However, the rule change does not mean that oversight is optional. Pharmacies will still be expected to ensure that pharmacists have the capacity to verify and review technician work, especially for high-risk medications or sterile compounding tasks.

Compliance Considerations

• Documentation: Central fill pharmacies benefiting from this ratio exemption should document their lack of direct patient interaction and maintain written policies supporting appropriate supervision.
• Quality Assurance Programs: Increased technician staffing must be accompanied by robust QA protocols to detect and prevent medication errors.
• OSHA and Labor Law: Even if not limited by Board ratios, central fill facilities must still comply with occupational safety standards and ensure technicians are adequately trained and not overburdened.

Importance of Staying Compliant with State Board Rules

As these updates demonstrate, the Texas Board of Pharmacy is adapting to the dynamic landscape of healthcare and pharmacy services. Pharmacies must remain vigilant in tracking proposed and adopted rules—particularly those related to new technologies and operational structures.

Failure to comply with TSBP regulations can result in administrative penalties, fines, or even license suspension. Moreover, for pharmacies participating in Medicare, Medicaid, or commercial networks, non-compliance could trigger contractual breaches or audit findings from Pharmacy Benefit Managers (PBMs) or plan sponsors.

Legal and Strategic Recommendations

For pharmacies and pharmacy owners in Texas, the following steps are recommended:

1. Monitor TSBP Meetings and Updates: The TSBP publishes meeting minutes and rule proposals on its website. Assign someone on your compliance team to monitor these developments monthly.
2. Consult Legal Counsel: When implementing new technologies like drone delivery or altering staffing models, consult with counsel experienced in pharmacy law to ensure all federal, state, and contractual obligations are satisfied.
3. Update Policies and Procedures: Pharmacy SOPs should be updated to reflect any rule changes, especially regarding delivery logistics and technician supervision. Staff training should also be documented.
4. Engage with Industry Groups: Texas pharmacies should consider participating in comment periods for proposed rules and joining professional organizations that advocate on behalf of independent and institutional pharmacies.
5. Audit Internal Practices: Regularly auditing your practice against TSBP rules is one of the most effective ways to prevent disciplinary action and improve operational efficiency.

Conclusion

The 2025 rulemaking activity by the Texas Board of Pharmacy reflects the shifting priorities in pharmacy practice—modernization, flexibility, and risk mitigation. While the proposed drone delivery rule opens new doors for innovation, the adopted technician ratio rule gives central fill pharmacies room to operate more efficiently. Texas pharmacists and pharmacy leaders should approach these regulatory changes not only as compliance obligations, but as opportunities to enhance care delivery, streamline operations, and maintain a competitive edge in a highly regulated industry.