Aim <p>The COVID-19 pandemic has accelerated the digitization of healthcare, emphasizing the need for online medication counseling. While this service offers convenience, challenges remain regarding patient understanding, technical issues, and pharmacists’ preparedness. Adoption of online counseling remains limited. This explorative cross-sectional study aimed to identify factors associated with pharmacists’ readiness to introduce telepharmacy services.</p> Subject and methods <p>A cross-sectional survey was conducted with 481 pharmacists from 100 pharmacies in Shizuoka Prefecture, Japan, between August and September 2023. Data were collected via Google Forms, focusing on demographics, willingness to provide online counseling, prior experience, job satisfaction, and perceived importance of management skills. Logistic regression analysis was used to explore factors associated with willingness to provide online counseling.</p> Results <p>Among 257 valid responses (53.4% response rate), 57% of pharmacists expressed willingness to provide online counseling, while 43% were reluctant. Willingness was significantly associated with having prior experience, working in community pharmacies, higher job satisfaction, and prioritizing management skills. Despite these factors, only 12.8% showed strong interest in adopting the service, with patient understanding being a major concern.</p> Conclusions <p>Pharmacists’ adoption of online medication counseling is influenced by multiple factors, including prior experience and job satisfaction. Addressing barriers through comprehensive education, technical support, and motivational strategies is essential. Although the study is region-specific, the findings offer insights that may guide global efforts to integrate online counseling into healthcare practice.</p>