Telepharmacy governance in Thai community pharmacies: feasibility, fairness and willingness to pay from a nationwide association-based mixed-methods survey

Abstract Background As Thailand moves from professional telepharmacy standards to draft regulatory requirements, implementation success depends on whether community pharmacy operators perceive governance as feasible and fair. We assessed operators’ perceptions of telepharmacy governance and willingness to pay for a shared telepharmacy application, and explored explanations in free-text responses. Methods We conducted a nationwide association-based online survey of community pharmacy operators in Thailand. Structured items measured understanding, perceived safety benefit, feasibility, fairness, pharmacy system role, platform acceptance, and maximum monthly payment. Quantitative data were analysed descriptively and by business characteristics. Open-ended responses were analysed thematically and integrated with quantitative findings. Results Overall, 205 respondents completed the survey; most operated single-outlet pharmacies. Perceived understanding and safety benefit were moderate, whereas feasibility and fairness were lower, especially fairness across pharmacy sizes. A shared professional association application was supported by 71.7%. Usable payment values were available for 188 respondents; the median was 40 Thai baht/month, and 54.3% reported a positive value. Higher daily revenue was associated with greater WTP descriptively, but multivariable estimates varied by WTP outcome and should be interpreted cautiously. Themes explaining low feasibility and fairness included proportionate standards, consistent enforcement, pricing sustainability, platform reliability, interoperability, and workforce/training capacity. Conclusions Community pharmacy operators recognised the potential value of telepharmacy governance but questioned its fair and feasible implementation. Scale-up should avoid uniform requirements that disproportionately burden smaller pharmacies and should prioritise proportionate standards, reliable interoperable platforms, training support, transparent pricing, and predictable enforcement.