Richmond-area pharmacy customers may be surprised to learn that some prescriptions picked up at neighborhood drugstores were never filled on-site. Instead, medications may have been counted, sealed, and packaged by robotic systems operating hundreds of miles away before being shipped to local pharmacies.
That model is becoming standard practice after the Virginia Board of Pharmacy voted earlier this month to permanently allow “central-fill” pharmacies—large-scale facilities that process prescriptions for multiple retail locations. The decision follows an emergency regulation approved in June and still requires a final review before taking effect.
Supporters say the shift reflects mounting pressure on pharmacies across Virginia, where staffing shortages and thin profit margins have driven widespread closures. Since the start of 2025, the number of licensed pharmacies in the state has fallen by 55, according to the Virginia Department of Health Professions.
Pharmacists argue automation is a necessity as their responsibilities expand. “We’re kind of at this tipping point,” Karen Winslow of the Virginia Pharmacy Association told the Richmond Times Dispatch. Pharmacists are increasingly tasked with administering vaccines and diagnostic tests while operating with fewer staff. (RELATED: State AGs Push to Block Virginia AG-Elect Jay Jones From National Prosecutor Groups)
But not everyone is convinced the tradeoff is worth the risk. Kelly Hasty Kale, a pharmacist and board member who voted against the regulation, warned regulators to move cautiously. “I’m willing to listen, but I have lots of concerns about where some of this is headed, and I think we need to tread very carefully,” she said, according to the Richmond Times Dispatch.
The legal groundwork for central-fill pharmacies was laid in 2024, when Gov. Glenn Youngkin signed legislation allowing chains to outsource prescription filling to centralized hubs. These facilities may handle only Schedule VI drugs, which have a low potential for abuse, and are primarily used for routine refills.
Walgreens has operated a pilot central-fill warehouse in Mechanicsville since 2023, employing nearly 250 workers in a $34 million micro-fulfillment center. The company says four out of every 10 prescriptions it sells are filled at similar facilities. At an Arizona site, manager Shauna Peterson described the work in human terms, telling the Richmond Times, “You’re saving lives each and every day.”
Walmart has also expanded the model, opening a 100,000-square-foot prescription processing center in Frederick, Maryland, serving 700 stores across 16 states, including Virginia. CVS Health has signaled plans to follow suit.
Critics worry increased automation could diminish the role of pharmacists. At central-fill sites, one pharmacist may oversee up to 12 technicians, compared with four in retail settings. (RELATED: Investigation Spurs Instacart Pricing Backlash and Regulatory Scrutiny)
Tim Robertson, a Glen Allen pharmacist and board member, said concerns about pharmacies operating without pharmacists are misplaced. “I can’t imagine we’d ever let that happen,” he told the Richmond Times Dispatch.