Pharmacy's secret weapon: Pharmacy technicians step up to support clinical services, patient health
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.
Hannah Fish, associate director of strategic initiatives at the National Community Pharmacists Association, said that as many pharmacies are no longer able to survive from dispensing prescriptions alone, they are turning their attention to offering such enhanced services as diabetes education, chronic disease management, MTM, and medication synchronization.
“As the pharmacy is transitioning to fit the model for success, that’s requiring technicians to evolve as well,” she said. “As pharmacies are getting more involved in enhanced and counseling services and comprehensive health management, technicians play a role above and beyond the typical dispensing model.”
Echoing Fish’s sentiments, Darem Dughri, Walgreens’ senior director of pharmacy operations, sees the growing role of the pharmacy technicians.
“The role of the technician is evolving before our eyes. At Walgreens, they are an integral part of the patient care team, supporting both pharmacists and patients, and will continue to help deliver positive patient outcomes as we move forward,” Dughri said. “Pharmacy technicians play an important role in collecting medication and health condition history information, as well as communicating with pharmacists if care plans are needed once adherence barriers are identified. Technicians also take on more of the administrative tasks so that our pharmacists can focus on patient care.”
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
and employees.
— 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.
Increasing Responsibility
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?”
Education Is Key
While fostering the enhanced role of the pharmacy tech appears to be a no-brainer, those who carry out these growing responsibilities must be trained and educated in order to assume their varied responsibilities.
NCPA is among the organizations providing training and education, creating a three hour continuing education program to give pharmacists and techs a general baseline as to what they need to know, what they’ll likely be exposed to, and the concepts involved in working as a CHW.
Elise Damman, NCPA associate director of education programs, said that in putting together education for its members and staff, NCPA provides information and resources that they need to be successful.
“A lot of the programs may seem more specific for pharmacists, but it also applies to pharmacy techs. It allows them to be better team members to support the pharmacist and the pharmacy’s goals,” Fish said. “Every state regulates how many credits they require of their techs. We try to make sure we’re putting out education, such as monthly webinars that are CE accredited for pharmacists and techs, and sessions during our annual convention in October.”
Retailers also are stepping up to the plate when it comes to training and educating technicians.
In addition to in-pharmacy training, Hy-Vee offers designated training classes, a technician training program and various other technician-driven programs.
“At Hy-Vee, we have developed a training program to allow our technicians to be engaged in MTM, which helps our technicians to understand the value they can bring in assisting our pharmacists in the MTM workflow,” Wiese said.
Heath Mart also has taken steps to provide increased access to high-quality training programs for pharmacy technicians, including an option to become an approved training site within Health Mart’s ASHP/ACPE Accredited Technician Training program.
“Earlier this month, we announced a partnership with TRC Healthcare that provides more than 5,000 community pharmacies in the Health Mart family comprehensive training options,” Lyons said. “Each of the solutions leverage comprehensive Pharmacy Technicians University curriculum from TRC Healthcare via the Health Mart’s Basic 127-hour PTU 101 program or 402-hour National Standards Entry-Level training curriculum that is a part of the accredited program. Access to both of these training programs is an exclusive advantage for Health Mart pharmacies.”
The curriculum Health Mart offers also meets the training prerequisite for the Pharmacy Technician Certification Board exam application. The Pharmacy Technician Certification Board provides credentialing for pharmacy technicians, and is continually launching new certificate programs. PTCB has 282,271 active PTCB Certified Pharmacy Technicians as of Aug. 1.
Ryan Burke, PTCB’s director of professional affairs, said these programs enable technicians to assume roles and to demonstrate their specialty skills to employers.
In September, PTCB launched an Assessment-Based Certificate Program in Controlled Substances Diversion Prevention. The program is the fifth to be launched of PTCB’s suite of specialty certificates that include Technician Product Verification, Medication History, Hazardous Drug Management, and Billing and Reimbursement. PTCB will develop certificate programs in immunization, point of care testing and the CHW role in the future.
“As you think about advanced roles of technicians, looking at the certificate programs we currently offer or are planning to offer, those are all areas where we know technicians are currently fulfilling those roles, or it’s something we hear from our stakeholders, which means boards of pharmacy, individual technicians or large employers that these are future roles they see for their technicians,” Burke said. “We’re trying to ready the workforce for these roles that will allow technicians to build a career ladder in the health system world, as well as in the community world. That’s ultimately the goal of these credentials, not only to recognize the knowledge and skills, but to make sure this provides a pathway for technicians to feel like they have a home within the pharmacy team.”
With all of the advanced responsibilities that techs are assuming, it appears that as pharmacy techs continue to evolve, so too will the practice of pharmacy.
“Many of our Hy-Vee pharmacy technicians are engaged in technician product verification programs, expanding their roles and responsibilities, which allows our pharmacists to focus on clinical services and provide the best health outcomes for our patients,” Hy-Vee’s Wiese said.
He also pointed out that Hy-Vee recently was approved by the Iowa Board of Pharmacy to participate in a pilot project that allows pharmacy technicians to administer immunizations to patients. “In addition to providing more time for our pharmacists to assess immunization statuses of our patients, the pilot will allow our technicians the opportunity to expand upon their skill sets and responsibilities,” he said.
Burke said he sees the glass as half full. He pointed to several states, including Washington, Idaho, Utah, Rhode Island and Nevada that are permitting technicians to administer immunizations.
“Some other states are looking to accelerate the idea of allowing pharmacy technicians to administer vaccines, and it’s being talked about within the boards of pharmacy,” he said. “The pandemic is accelerating talks about expanding the role of pharmacy technicians in community pharmacies.” The question facing states is whether these expanded opportunities require legislation, a rule change or whether existing language allows technician immunization, Burke said.
Whether or not more states will shortly permit technicians to immunize is yet to be seen, but PTCB executive fellow Rhea Angeles said many retailers are supporting technician certification and investing in the cost of recertification.
Angeles, who was previously a pharmacy technician and was certified prior to becoming a pharmacy intern, said that she is now completing a fellowship with PTCB, where she sees the growth pharmacy technicians are able to make in the community or other pharmacy settings.
“There’s definitely room for growth for pharmacy technicians in the pharmacy world, and even roles for technicians to move up the career ladder and take on more leadership and management roles,” she said.
Lyons also expressed optimism. “As more demands are placed on the healthcare system and pharmacy practice, the future for pharmacy technicians is bright, especially when employers see the potential in investing in careers of high-talent pharmacy technicians.”
Community pharmacies need to continue to develop and promote technicians to do more within the industry, Walgreens’ Dughri said.
“From administering immunizations to other advanced technician practice opportunities, there are many ways for pharmacy technicians to have greater responsibility in the larger healthcare team, helping care for patients’ health and well-being,” he said. “With the appropriate training and experience, pharmacy technicians may be promoted to supervisory roles, seek specialized skills, or pursue further education and training to become a pharmacist.”
Logan said that his company long ago realized the benefit of having well-trained technicians on the team, and that he incentivizes techs to become certified with PTCB. “It’s like any professional. You can’t do it by yourself,” he said. “You have to have the support behind you. If my techs didn’t show up, I’d go home.”