Background <p>Fecal immunochemical tests (FIT) are recommended for routine colorectal cancer (CRC) screening because they are cost-effective, non-invasive, and convenient. Pharmacy-based CRC screening using FIT kits could be effective to improve screening rates, particularly in medically underserved communities. However, data on follow-up procedures and barriers after positive FIT results in this context remain sparse.</p> Methods <p>We conducted a national survey of 1,045 US adults aged 45–75 to assess preferences for follow-up care in a pharmacy-based CRC screening program we call PharmFIT™ and identify perceived barriers to follow-up colonoscopy after positive FIT results. We evaluated patient preferences and barriers using descriptive statistics. We used multinomial logistic regressions to identify correlates of patient preferences for follow-up and multiple logistic regressions to identify correlates of perceived psychosocial and structural barriers to follow-up colonoscopy.</p> Results <p>Participants showed a strong preference for digital communication for negative FIT results and reminders, but favored direct, interpersonal communication from healthcare providers for positive results and follow-up. Psychosocial barriers, such as fear of colonoscopy or cancer diagnosis, were more prevalent than structural barriers like cost and transportation. Older adults, those with a regular healthcare provider, and higher-income individuals were less likely to report barriers, while non-white and Medicaid patients showed lower preferences for automated notifications.</p> Conclusion <p>PharmFIT should use tailored, multimodal communication strategies to address patient preferences and include strategies, like patient navigation, to address potential barriers to follow-up colonoscopy. This study reinforces the potential of pharmacy-based CRC screening programs to increase screening access and opportunities, particularly in medically underserved communities.</p>