At Towncrest Pharmacy in Iowa City, Iowa, a pharmacy technician has completed the order entry for a prescription and is about to fill the prescription. After that, another technician will perform product verification, a task formerly done by the pharmacist.
Inside L&S Pharmacy in Charleston, Mo., a pharmacy technician, who has earned the professional designation of community health worker, is connecting one patient with Meals on Wheels and helping a second patient access transportation to a doctor’s appointment.
At any one of the many Health Mart pharmacy franchises nationwide, a pharmacy technician can be found performing prescription processing functions, including collecting and documenting patient profile information, processing and packaging prescriptions, resolving third-party billing issues, and ordering products.
Scenes similar to these are playing out daily in independent community pharmacies and retail chains. From order entry and dispensing of medications to prescription verification, point-of-care testing, administration of immunizations, and serving as community health workers, pharmacy techs are freeing retail pharmacists to provide more clinical services and boost revenues from these services. They also are assisting retailers in attracting new pharmacy customers, ensuring patient satisfaction and retention, and differentiating their store from the competition.
The enhanced roles for technicians could not have come at a better time for pharmacy, what with the enormous impact COVID-19 has had on pharmacists’ daily workload as they seek to fill a greater volume of 30- and 90-day scripts, provide delivery of prescriptions and OTC items, perform COVID-19 tests, administer a backlog of immunizations, and prepare for a potential COVID-19 vaccine.
Pandemic lets techs step up
With all of their responsibilities, pharmacy technicians have been particularly instrumental in helping patients amid the COVID-19 pandemic.
At Towncrest Pharmacy in Iowa City, Iowa, student pharmacy technicians are performing curbside COVID-19 testing decked out in personal protective equipment, while regular pharmacy technicians are managing dispensing functions.
“With this surge of COVID-19, they are doing 20 to 25 tests a day. That frees up our pharmacists, too,” said Randy McDonough, Towncrest Pharmacy co-owner and director of clinical services.
Nancy Lyons, vice president and chief pharmacist at Health Mart, said that amid the COVID-19 pandemic, many technicians are involved in setting up and maintaining new curbside pickup options for their patients, assisting with the higher demand for home deliveries and managing the enhanced cleaning practices needed. “We also had technicians assisting with COVID-19 test collections as part of Health Mart’s partnership with eTrue North in the Department of Health and Human Services COVID-19 testing program,” she said.
Richard Logan, owner of L&S Pharmacy in Charleston, Mo., said that COVID-19 recently began to hit the rural area hard, and one of his technicians, a certified community health worker, saw that patients were facing challenges accessing groceries, which led to patient outreach. “We reached out to 140 patients over the phone just to check on them to make sure they had plenty to eat, to find out if they had trouble getting to the grocery stores, or if they lost their job due to COVID, if they needed Meals on Wheels or a food bank,” Logan said. “That resulted in seven high-quality referrals to agencies just from that one technician who saw that as a COVID issue.”
At Hy-Vee, COVID-19 has led to new shifts in the way pharmacies operate and serve their patients, which has added responsibilities for both Hy-Vee’s technicians and pharmacists.
“Since the start of the pandemic, our technicians have become even more integral to our operations, taking on added responsibilities to meet the needs of patients,” said Aaron
Wiese, Hy-Vee’s senior vice president and chief health officer. “Our technicians were key during times when we were seeing unprecedented demand in prescriptions earlier this year, and have continued to play an important role in ensuring our pharmacies are following a strict cleaning and sanitization regimen to provide a safe and clean space for our patients
— Sandra Levy
Aaron Wiese, senior vice president and chief health officer at Hy-Vee, which employs more than 1,200 certified technicians across eight states, agreed that the role of pharmacy technicians has evolved.
“We encourage our pharmacy technicians to operate at the top of their license, which in turn, allows our pharmacists to practice at the top of theirs,” Wiese said. “Combined with Hy-Vee’s strong focus on patient care and employee job satisfaction, Hy-Vee pharmacy technicians have had opportunities to expand upon their responsibilities and gain new experiences.”
Randy McDonough, a board member of the American Pharmacists Association and co-owner and director of clinical services of Towncrest, Solon Towncrest and Towncrest Compounding Pharmacies in Iowa, which employ regular career techs and student pharmacist techs, is no stranger to enabling technicians to exercise their full abilities. Towncrest Pharmacy was one of the initial sites in Iowa that studied how to implement technician product verification in community pharmacy.
The process, already widely used in health systems and hospitals, involves a technician checking medications after the prescription has been filled by another technician to ensure accuracy.
The pilot turned into a multiyear process with additional pharmacies, in which data was collected to determine the safety and the effectiveness of the “tech check tech” process in community pharmacy.
“What we found was that technicians, because they can focus on product distribution, were very accurate in checking each other and making sure it was the right product in the right bottle and the right directions,” McDonough said. “The tech is now really managing more of the dispensing functions. It helps to bring more revenue, and that’s the reason we went this route and why we call it a new practice model in Iowa. We can’t have pharmacists be tied down to dispensing functions because that is not where the future of health care is or the future of pharmacy.”
Beyond product verification, pharmacy techs also are assuming a wide range of critical and expanded responsibilities, as Nancy Lyons, vice president and chief pharmacist at Health Mart pointed out.
“As with many small businesses, technician employees often take on any role that is needed by the business, including marketing, community relations and HR functions,” Lyons said. “Because Health Mart pharmacies also are offering additional clinical services, you’ll also see technicians in advanced clinical positions.”
These positions include collecting assessment information before an immunization or other clinical interventions, documenting and billing patient interventions, performing finger sticks, taking blood pressure measurements and other point-of-care test collections, as well as administering immunizations under the direction of the pharmacist, where permitted by their states, Lyons said.
Pharmacy techs also are taking the lead in helping pharmacists address the challenges of social determinants of health by training for and assuming the role of community health worker, or CHW.
“Techs often serve as additional eyes and ears for flagging some issues the pharmacist may need to go counsel on,” said NCPA’s Fish.
Fish explained the role of CHWs as one in which techs are serving as health liaisons in the community, connecting patients with resources. They are focused on all of the social determinants of health, including health literacy, transportation, housing and food security.
“Especially with COVID and folks losing their job, pharmacy techs serving as CHWs have been able to identify and connect individuals with resources that maybe they never have needed before or don’t know where to look, such as local food banks and Meals on Wheels,” she said. “These resources aren’t necessarily medically related, but they take priority over the medical side of things when trying to manage a patient with hypertension or diabetes. The patient will worry about the next meal more than the next insulin dose. These CHWs play an enormous role to help focus on those social determinants of health, so the pharmacist and pharmacy team can then manage the patient’s chronic disease.”
SEMO Rx Pharmacies, which employs a total of 16 techs between its two Missouri locations — Medical Arts Pharmacy and L&S Pharmacy — has cross-trained seven technicians as CHWs. SEMO’s founder, Richard Logan, is working with the University of Buffalo in New York as advisors on a grant project developing CHWs in the world of pharmacy.
“The state of Missouri seems to be at the forefront of embracing the CHW movement, and there are state regulations, guidelines and a curriculum that all of our CHWs are required to go through to use the CHW initials after their name,” Logan said. “You’ll see CHWs working within health systems, in clinics and in hospitals doing patient outreach and ombudsman-type activities. They are new to the world of pharmacy,” Logan said.
Logan said that when the pharmacy trained its technicians as CHWs, it has had a dramatic influence on the tone of the practice in that it is not so much focused on providing medication as it is on providing more holistic access to health care. He said that the result is more filled prescriptions and better customer loyalty based on the care received from the technicians, who he called “pharmacy extenders” As an example of the work CHWs do, Logan used a Medicare member who goes to pick up a prescription, but didn’t know his Part D plan had dropped him.
“Instead of a monthly bill of $4 or $5, he was faced with a $600 bill. That’s a significant social determinant health issue and a barrier to care — 99.9% of community pharmacies will look into that and try to figure a resolution to the problem,” Logan said. “We have formalized it into a process where it’s passed off to a CHW. They have experience in how to solve that problem. They know who to call and how to cut through red tape,” Logan said.
CHWs also visit patients at home, which affords the ability to get referrals back to the pharmacy so the pharmacist can intervene.
“They can observe things that you might not get in your five-minute patient encounter when they walk in the door,” NCPA’s Fish said. They can see if the patient has acceptable transportation to get to their medical appointments. They also can tell if the patient is smoking, or if there is second-hand smoke so we can address smoking cessation. They can see how medications are stored. Are they on the counter, in a shoebox or are they in the fridge? Does it seem like the patient has enough food?”