Expanding The Role of Pharmacy Technicians

How Advanced Skills are Moving the Industry Forward

It’s no surprise that the dynamics of healthcare have shifted in recent years. Patient demand for convenient, cost-effective healthcare continues to increase. Large health systems and pharmacy organizations are increasingly looking for new ways to meet these needs, which has led to a rise in convenient care clinics and the popularity of telemedicine. Among this growing body of innovative healthcare delivery methods is the increased use of pharmacists in clinical, direct patient care roles in both inpatient and community pharmacy settings. This shift in the role of pharmacists has support from both governmental organizations and patients.^1-6

As the most accessible healthcare provider, it’s not hard to imagine how pharmacists can serve as clinicians in both hospital and community pharmacy settings. Yet, this shift in focus from pharmaceutical product to patient care has been fraught with challenges. To continue moving forward, the profession has looked back at its history—as well as to its colleagues overseas for solutions. One resounding answer continues to echo: advancing the role of the pharmacy technician allows for the profession’s advancement in providing patient care.

The pharmacy technician’s role has seen almost constant evolution over the past century, both in the U.S. and abroad.^7,8 In the early part of the century, delegated tasks included simple roles such as running cash registers, answering phones, and providing customer service to patients. With the integration of computers into pharmacy workflow in the 1960s and 1970s, pharmacists began delegating more responsibilities as well as new medication dispensing tasks to technicians, which allowed pharmacists to focus on managing and evaluating “prescription profiles”— something often taken for granted in today’s high-tech pharmacy. Throughout the 1970s-1990s, significant changes occurred in the pharmacist’s role, which embedded them directly in the provision of patient care and away from their more traditional medication dispensing roles. Again, pharmacy technicians rose to the challenge and embraced their new roles, which included early versions of tech-check-tech (a.k.a. technician product verification) and medication reconciliation, among other responsibilities.

Today, future opportunities for pharmacy technicians seem almost limitless. The rapid expansion of clinical pharmacist services across outpatient and inpatient settings has ushered in a new era for pharmacy technician role advancement. Although these opportunities vary across organizations and states, one thing is consistent—advanced technician skills mean better patient care.

Technician Product Verification (TPV)

What is the Skill?

A certified pharmacy technician with advanced training in product verification delivers the final verification of medication product selection after the medication data entry has been verified by a licensed pharmacist (typically excluding compounds and controlled substances).^9,10

Why are pharmacies now looking at technicians to take on this specific skill?

Community pharmacists are increasingly responsible for providing direct patient care services, including medication therapy management (MTM), acute diagnosing of influenza and strep throat via point-of-care testing (POCT), treatment of minor ailments (e.g., allergic rhinitis treatment, anaphylaxis, headaches [including prescribing triptans], human/canine and feline bite prophylaxis). Because of this added responsibility on the pharmacist, technicians are now taking on product verification.

What does the research say about it?

There is consensus that TPV is safe and effective based on several large prospective studies.^10,11 Questions that remain include which pharmacies are best suited for TPV and what is the ideal training and credentialing for technicians providing TPV. Also, since TPV has been largely experimental at this point, a corresponding TPV-technician pay rate increase has not occurred, though this is anticipated as TPV spreads across the country.

Are there any barriers standing in the way of technicians performing the skill?

State regulatory oversight has created the largest barrier to TPV. Boards of pharmacy regulate pharmacy practice from the state level, and so the technician scope of practice can vary widely from one state to another—even if the states border one another.

What are the positive outcomes the industry is experiencing from technicians taking on these duties?

The data is clear: Increasing delivery of patient-care services results in improved quality of work-life (QOWL) for both technicians and pharmacists and improved medication delivery workflow.^10-14 In other words, TPV makes for happier pharmacy technicians and pharmacists, providing higher level clinical services, and quicker medication filling.

Medication Therapy Management (MTM)

What is the Skill?

Medication therapy management (MTM) involves a range of services to optimize patients’ medication regimen while detecting and preventing potentially costly medication errors.¹⁵ MTM is now commonplace in most U.S. community pharmacies—although the number of MTM services delivered varies widely.¹⁶

Why are pharmacies now looking at technicians to take on this specific skill?

A recent report from the Centers for Medicare and Medicaid Services (CMS) noted lower than expected MTM completion rates across the country.¹⁵ As CMS is the largest payer of MTM services, this report was alarming to pharmacies and the industry as a whole. MTM represents a major departure from traditional workflows, and new approaches that involve technicians must be considered to boost the lagging adoption.

What does the research say about it?

Research supports technicians taking on advanced roles as a way to increase MTM delivery rates and as a means to improve technician job satisfaction.^17,18 This represents a win-win for the industry. As one technician framed it in a recent study published in the Journal of the American Pharmacists Association, “… just being a part of [MTM] and seeing how beneficial it can be, I mean, [the patient] was nonfunctional because of all the medications she was on … it’s such a blessing to see what a small service can do to absolutely change somebody’s life.”¹⁷

Are there any barriers standing in the way of technicians performing the skill?

Implementation of MTM into pharmacy workflow and patient awareness of MTM are the two largest factors impacting the adoption of MTM. Busy patients who have never received MTM sessions do not understand the value of the unfamiliar offer and see it as time-intensive and unnecessary. Consequently, many patients decline MTM without realizing how much it can positively impact their care.

What are the positive outcomes the industry is experiencing from technicians taking on these duties?

As MTM is a new service for pharmacy, its implementation has been sporadic and inconsistent. Integrating MTM into traditional pharmacy workflow has been a challenge. Technician involvement may improve some of the workflow constraints, which have hindered widespread availability of these services. Moreover, as technicians are the face of community pharmacies, the strong relationships they have with patients may increase patients’ willingness to agree to MTM session(s).

Vaccinations

What is the Skill?

Pharmacy technicians administer vaccinations after pharmacists provide patient screening, counseling, and vaccine verification.¹⁹

Why are pharmacies now looking at technicians to take on this specific skill?

The increasing demand for clinical services, especially vaccinations from community pharmacists, has created unforeseen workflow problems. The physical act of administering a vaccine does not require clinical judgment, and with appropriate training and credentialing, a pharmacy technician who is skilled and knowledgeable on the vaccines available at their pharmacy can safely administer them, thereby helping to improve public health.

What does the research say about it?

Nearly 1,000 vaccinations were administered in the first six months after a pilot training program in Idaho involving 25 technicians. Since the completion of the pilot, more than 500 pharmacy technicians have received training to administer vaccinations.²⁰

Are there any barriers standing in the way of technicians performing the skill?

Currently, Boards of Pharmacy and other regulatory bodies determine the scope of work for technicians. As of March 2020, only Idaho, Rhode Island, and the federal pharmacy system (i.e., Indian Health Services) permit technicians to administer vaccines. Pharmacy technicians should stay tuned to this rapidly developing story. With support from both large employers and professional organizations as well as continued pressure for pharmacies to provide more clinical services, permission to administer vaccines may be right around the corner.

What are the positive outcomes the industry is experiencing from technicians taking on these duties?

Pharmacy’s entry into vaccination services not only provided more convenient access for patients, but also importantly increased vaccinations for patients who do not have a physician and who otherwise would not become vaccinated. As technician-administered vaccinations increase, we expect the pharmacy to have an even greater impact in reducing preventable diseases for those who do not routinely see a medical provider (e.g., the uninsured, young adults, those with high-deductible insurance plans).

Medication History Collection

What is the Skill?

Medical history collection involves gathering and compiling all current medications a patient is taking, including prescription, over-the-counter, herbal supplements, and vaccinations, with corresponding dose, strength, directions, quantity, length of treatment, and reason for treatment, among other pertinent medication details.

Why are pharmacies now looking at technicians to take on this specific skill?

Medication history collection is an important first step prior to MTM or medication reconciliation—two evidence-based practices proven to improve patient outcomes. When pharmacy technicians collect medication history, they can give time back to pharmacists, allowing them to provide these services to more patients.

What does the research say about it?

Of all the advanced skills technicians are taking on, this skill has the most evidence to support it. The American Society of Health-system Pharmacists (ASHP) specifically advocates for technician involvement in medication history collection and has even produced a toolkit compiling research, case studies, and best practices.²¹

Are there any barriers standing in the way of technicians performing the skill?

State regulatory bodies largely defer to individual pharmacy organizations regarding what “technical” skills to delegate (those who do not involve the exercise of professional judgment). At this point employers, primarily, make the determination as to whether to allow technicians to perform medication history collection. 

What are the positive outcomes the industry is experiencing from technicians taking on these duties?

Medical history collection is fundamental to providing clinical, direct patient care services. As this responsibility is increasingly delegated to pharmacy technicians, pharmacies will play a growing role in ensuring the highest level of patient outcomes—and thereby will improve access to high-quality healthcare services for patients.

References

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2. National Association of Chain Drug Stores. Face-to-face with community pharmacies. Available at: https://www.nacds.org/pdfs/about/rximpact- leavebehind.pdf. Accessed February 4, 2019.
3. Barlas S. CMS to test enhanced medication therapy management model: aims for greater use of pharmacists, cost savings, and better outcomes. P T. 2016;41(7):423.
4. Cardosi L, Hohmeier KC, Fisher C, et al. Patient satisfaction with a comprehensive medication review provided by a community pharmacist. J Pharm Technol. 2018;34(2):48e53.
5. Gibson ML, Hohmeier KC, Smith CT. Pharmacogenomics testing in a community pharmacy: patient perceptions and willingness-to-pay. Pharmacogenomics. 2017;18(3):227e233.
6. Hohmeier KC, Loomis B, Gatwood J. Consumer perceptions of and willingness-to-pay for point-of-care testing services in the community pharmacy. Res Social Adm Pharm. 2018;14(4):360e366.
7. KeresztesJM. Role of pharmacy technicians in the development of clinical pharmacy. Ann Pharmacother. 2006;40(11):2015e2019.
8. American Society of Health-System Pharmacists. The consensus of the pharmacy practice model summit. Am J Health Syst Pharm. 2011;68(12): 1148e1152.
9. Adams AJ, Martin SJ, Stolpe SF. “Tech-check-tech”: a review of the evidence on its safety and benefits. American Journal of Health-System Pharmacy. 2011 Oct 1;68(19):1824-33.
10. Hohmeier KC, Garst A, Adkins L, Yu X, Desselle SP, Cost M. The Optimizing Care Model: A novel community pharmacy approach to enhance patient care delivery by leveraging the technician workforce through technician product verification. Journal of the American Pharmacists Association. 2019 Nov 1;59(6):880-5.
11. Andreski M, Myers M, Gainer K, Pudlo A. The Iowa new practice model: Advancing technician roles to increase pharmacists’ time to provide patient care services. Journal of the American Pharmacists Association. 2018 May 1;58(3):268-74.
12. Hohmeier KC, Desselle SP. Exploring the implementation of a novel optimizing care model in the community pharmacy setting. Journal of the American Pharmacists Association. 2019 May 1;59(3):310-8.
13. Desselle SP, Holmes ER. Structural model of certified pharmacy technicians’ job satisfaction. Journal of the American Pharmacists Association. 2007 Jan 1;47(1):58-72.
14. Desselle SP. An in-depth examination into pharmacy technician worklife through an organizational behavior framework. Research in Social and Administrative Pharmacy. 2016 Sep 1;12(5):722-32.
15. Medication Therapy Management. Centers for Medicare & Medicaid Services. 2019. https://www.cms.gov/medicare/prescription-drug- coverage/prescriptiondrugcovcontra/mtm.html. Accessed 8 Dec 2019.
16. National Community Pharmacists Association. 2016 NCPA Digest. Available at: http://www.ncpa.co/pdf/digest/2016/2016-ncpa-digest-spon-cardinal.pdf. Accessed March 24, 2018.
17. Mattingly AN, Mattingly II TJ. Advancing the role of the pharmacy technician: A systematic review. Journal of the American Pharmacists Association. 2018 Jan 1;58(1):94-108.
18. Hohmeier KC, McDonough SL, Rein LJ, Brookhart AL, Gibson ML, Powers MF. Exploring the expanded role of the pharmacy technician in medication therapy management service implementation in the community pharmacy. Journal of the American Pharmacists Association. 2019 Mar 1;59(2):187-94.
19. McKeirnan KC, Frazier KR, Nguyen M, MacLean LG. Training pharmacy technicians to administer immunizations. Journal of the American Pharmacists Association. 2018 Mar 1;58(2):174-8.
20. McKeirnan KC. An Update on Technicians as Immunizers. Pharmacy Times. 2019 Mar 19. Available at: https://www.pharmacytimes.com/publications/supplements/2019/march2019/an-update-on-technicians-as-immunizers. Accessed 2020 January 17.
21. Medication History Technician Toolkit. American Society of Health-System Pharmacists. Available at: https://www.ashp.org/Pharmacy-Technician/About-Pharmacy-Technicians-Advanced-Pharmacy-Technician-Roles-Toolkits/Medication-History-Technician-Toolkit. Accessed 2020 January 17.
22. National Healthcareer Association. (2020). 2020 Industry Outlook.