1. Advancing the Roles for Pharmacy Technicians in an Evolving Health Care Environment (Part 1):
Maine Pharmacy Association and Maine Society of Health-System Pharmacists Sesquicentennial Anniversary Meeting
October 14, 2017
Presenters:
Miriam A. Mobley Smith, PharmD, FASHP

2. CPE Information and Disclosures
Miriam A. Mobley Smith is employed by the Pharmacy Technician Certification Board. She “declare(s) no conflicts of interest, real or apparent, and no other financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.”

3. A competent pharmacy technician workforce will be fundamental to advancing the patient care role of pharmacists in the FUTURE.
Response to 20/20 shows we still have a long way to go with the rest of the pharmacy family
To meet societal needs for safe and optimal medication therapy management, the profession must set the direction for quality and consistency in pharmacy technician roles, educational preparation, credentialing and regulation.

4. Learning Objectives
Describe the evolving national health care landscape and how it serves as the framework for pharmacy technician role/responsibilities expansion.
Describe examples of expanded roles and responsibilities for pharmacy technicians and how they may provide opportunities for patient care services advancement, patient safety initiatives enhancement, and pharmacist/pharmacy technician job satisfaction.
Explain how state pharmacy regulatory variations in pharmacy technician education, training, certification and licensure may support or suppress advanced roles creation for pharmacy technicians.
Contrast and compare possible pharmacy technician education, training, and certification requirements to assume advanced roles and responsibilities.

5. Transitions of the Profession
PHARMACY
Access to Care
Reimburse-ment Rates
Medically Underserved
Affordable Care Act
Accountable Care Organization
Medical Home Model
Medicaid Expansion
Collaborative Practice
Provider Status
The pharmacy profession is under pressure to change.
Access
Affordable Care Act
Mergers
Collaborations
Reimbursements
Star Ratings
Access to Care
Reimbursement Rates
Medically Underserved
Affordable Care Act
Accountable Care Organization
Medical Home model
Medicaid expansion
Collaborative practice
Provider status

6. Emerging Pharmacy Technician Roles and Responsibilities
Medication reconciliation
Medication therapy management
Immunization
Indigent care prescription programs
Sterile & non-sterile compounding
Clinical technicians (e.g., chronic care, appt. scheduling, medication adherence, smoking cessation, vital signs measurements, data management, etc.)
Tech-check-tech
Point of Care Testing
Prescription clarification
Quality assurance and quality improvement initiatives
OTC Counseling
Community outreach programs
DUE/ADR monitoring
Informatics
Purchasing
Medication safety initiatives
Telepharmacy
Refill counseling screening
Prescription transfers
Board of Pharmacy
Education/Educator
Determine the difference between clinical and technical roles/responsibilities.
We all want provider status to allow pharmacists to be reimbursed by insurance
-Increasing pharmacist access to public increases care.
-Telepharmacy is allowing pharmacist access to rural areas, pharmacists are rounding as part of the clinical team
-Immunization percentage of the public has increased significantly since pharmacists started giving shots
-Pharmacists are doing increased clinical tasks, Flu testing, strep testing pilots, MTM growing
In order for this to happen, all non-clinical tasks must be delegated
-Iowa piloting Tech-check-tech, successful with pharmacists doing more clinical tasks and = or less errors/Idaho less errors than pharmacists
In order to delegate, to keep our patients safe, we need to have a standard minimally competent technican.
Provider status recognition for pharmacists will provide increasing opportunities for roles & responsibilities delegation
-technicians also serve as members of boards of pharmacy and board of pharmacy field inspectors
-teachers/educators

7. Increased demand for prescription medications and interprofessional team-based care will lead to more demand for pharmacy services and advanced roles for pharmacists and technicians.
Advanced roles require moving technicians from unskilled labor to certification for protection of patient safety.
Response to 20/20 shows we still have a long way to go with the rest of the pharmacy family
To meet societal needs for safe and optimal medication therapy management, the profession must set the direction for quality and consistency in pharmacy technician roles, educational preparation, credentialing and regulation.
Pharmacy Times,

8. Pharmacists Entry into the Profession
State Board Requirements
Multistate Pharmacy Jurisprudence Exam (MPJE)
North American Pharmacist Licensure Exam (NAPLEX)
ACPE Accredited Pharmacy School

9. PHARMACY TECHNICIAN ENTRY
Pharmacy technicians do not experience the same linear path into the profession
There is no national educational requirement
Pharmacy board regulations vary among 50 states + D.C.
45 states regulate pharmacy technicians
23 states include national certification in their regulations
Basic stats

10. What do this ketchup bottle and the current U. S
What do this ketchup bottle and the current U.S. pharmacy state board regulations on pharmacy technician education and certification have in common?
50 different sets of regulations
57 varieties of tomatoes

11. State Regulations Vary Widely
45 states and DC regulate pharmacy technicians
24 states include national certification in regulations
3 states accept only the PTCE for national certification
19 states require a background check
22 states require CE
10 states have a pharmacy technician serving on the state Board of Pharmacy
5 states do not regulate pharmacy technicians
Many states have pending legislation or regulations
2017 NABP Survey of Pharmacy Law
Regulatory Oversight of Pharmacy Technicians
45 States and Washington DC regulate pharmacy technicians
Alabama, Alaska, Arizona, Arkansas, California, Connecticut, Delaware, District of Columbia, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wyoming
24 States and Washington DC include national certification in their regulations
Arizona, California, Connecticut, District of Columbia, Idaho, Illinois, Iowa, Kansas, Louisiana, Maryland, Massachusetts, Michigan, Mississippi, Montana, Nebraska (4/16), New Mexico, North Dakota, Oregon, South Carolina, South Dakota, Texas, Utah, Washington, West Virginia, Wyoming. Note: Ohio for Qualified Pharmacy Technician
4 States require and/or accept only the PTCB Exam in their states
Louisiana, North Dakota, Wyoming. recognizes only PTCB’s Pharmacy Technician Certification Exam.
19 States require a background check
Alabama, Arkansas, California, District of Columbia, Georgia, Idaho, Indiana, Louisiana, Maine, Maryland, Mississippi, Missouri, New Jersey, Ohio, Oregon, Tennessee, Texas, Utah, West Virginia, Wyoming
22 States require continuing education
Alabama, Alaska, Arizona, District of Columbia, Florida, Idaho, Illinois, Kansas, Louisiana, Maryland, Michigan, Minnesota, Montana, Nevada, New Mexico, North Dakota, Oregon, South Carolina, Texas, Utah, Virginia, Washington, Wyoming
10 States have a pharmacy technician serving on their Board of Pharmacy
Arizona, Massachusetts, Michigan, Montana, North Dakota, Oregon, Texas, Utah, Washington, Wyoming
However…
5 States do not regulate pharmacy technicians
Colorado, Hawaii, New York, Pennsylvania, Wisconsin
15 States have pending legislation, regulation or board discussions
Pharmacy Technician Certification Board
Updated: May 26, 2016
*This data, based on research performed by PTCB, is for PTCB’s internal use only.

12. Various Points of Entry for Pharmacy Technicians
PTCE
ExCPT
State exam
Programmatically accredited
Non accredited
Community based
Hospital based
Registration
Licensure
Certification
Board Regulation
Employer Training
Board Approved Exam
Formal Education

13. GOING IN THE SAME DIRECTION
Well-educated and highly skilled pharmacy technicians have important roles and responsibilities in the pharmacy enterprise.
Safe and effective medication-use process depends significantly on the skills, knowledge, and competency of those pharmacy technicians.
To properly fill these roles, pharmacy technicians require standardized education, training, and competency assessment.
Pharmacists’ ability to redistribute their focus to more clinical and patient-centered activities is dependent upon pharmacy technicians utilization in key roles within the medication-use system.
Moving toward Provider Status:
The education, training, and certification of pharmacy technicians as well as the accreditation of pharmacy technician education/training programs have progressed greatly, yet there continues to be a lack of consistency and standardization of these elements due to many issues and influencing factors. There is a need to establish national standards for the education, training and certification of pharmacy technicians to provide the optimal deployment of the pharmacy workforce tomeet the health care demands and delivery of quality health care services to the public. The pharmacy profession has an obligation to ensure that pharmacy technicians are subject to rigorous standards—standards that are required of pharmacists and other health care professionals in order to provide the highest quality health care to improve patient outcomes and protect the public’s health.
ASHP Statement on the Role of the Pharmacy Technicians
American Society of Health-System Pharmacists. ASHP statement on the roles of pharmacy technicians. Am J Health-Syst Pharm. 2016; 73:928–30.

14. PHARMACY TECHNICIAN ADVANCED ROLES/RESPONSIBILITIES
Usually requires additional:
Experience
Education
Training
Competencies (including analytical and problem-solving skills)
Certification
Competence Assessment
Supervision of pharmacists
State Board of Pharmacy approval
Career ladders
Liability issues
Pharmacist resistance

15. ADVANCED ROLES IN COMMUNITY PHARMACY PRACTICE
CLINICAL SUPPORT TECHNICIAN
Patient screening for counseling and services
Appointment scheduling
Refill reminders
Medication history
Device training and vital sign measurement
Point of care testing
Patient outcomes data
Vaccine administration
PATIENT ASSISTANCE PROGRAM
TECHNICIAN
Patient identification for services
Appointment scheduling
Patient application completion, tracking and follow-up
Interprofessional team
Billing and payment monitoring
ICD-10 coding
May also assist in chronic care activities, medication adherence assessment, smoking cessation, taking vital signs, and data management. Point of care testing is best described as a quick and simple lab test which can be performed in the pharmacy (e.g. A1C, Cholesterol, Liver/Kidney function, Hep C, group A strep, influenza and others.
Technicians are immunizing in Idaho and Washington
Other roles/responsibilities include:
Community outreach programs
Refill counseling screening
Board of Pharmacy seat
Indigent care prescription programs

16. ADVANCED ROLES IN COMMUNITY PHARMACY PRACTICE
MANAGEMENT OR SUPERVISION
Supervision of other pharmacy technicians
Development of position descriptions
Development of policies and procedures
Scheduling
Personnel evaluations
Education and training
Projects management
TECH-CHECK-TECH (TCT)
Perform final verification on a product for which prospective drug utilization review had been previously performed by a pharmacist
Perform final verification for medications under the control of an ordering prescriber such as those in an automated dispensing system.
TCT:
In community pharmacy for at least 14 yrs discussions on community pharmacy TCT are under way in at least Arizona, Idaho, Iowa, South Dakota, and Wisconsin.
A key question will be what education and training tech-checkers should have. The studies as stated here required technicians to be nationally certified, have a minimum
level of practice experience (2000hrs +), complete advanced didactic training (training modules), and successfully complete a validation period prior to participating in a TCT model.
Pharmacy technicians statistically outperformed pharmacists in 6 of the 11 studies reviewed. Moreover, these studies demonstrate that pharmacists were able to devote more time to
direct patient care services, with a range of 10 hours per month to 1 hour per day. Additional institutional TCT studies have been published since the aforementioned systematic
review, all with similar results. These newer TCT publications have reported even greater pharmacist time savings, ranging from 50 hours per month to 5.75 hours per day.

17. ADVANCED ROLES IN INSTITUTIONAL/HEALTH-SYSTEM PHARMACY PRACTICE
INVESTIGATIONAL DRUGS TECHNICIAN
Manage drug and supply inventories and tracking expiration dates
Monitor for study protocol, regulatory and policies compliance
Database management
Coordinate sponsor visits
Personnel orientation and training
SPECIALTY MEDICATION TECHNICIAN
Obtain patient home medication regimens
Refill management
Medication adherence monitoring
Prior-authorization management
Patient assistance program management
Inventory management
Insurance reconciliation
Mailing/shipment management
Other Advanced Institutional Role/Responsibilities include:
DUE/ADR Monitoring
Medication safety initiatives
Medication therapy management, including assistance with pharmacokinetic dosing
Tech check Tech

18. ADVANCED ROLES IN INSTITUTIONAL/HEALTH-SYSTEM PHARMACY PRACTICE
CONTROLLED SUBSTANCE SURVEILLANCE TECHNICIAN
Maintain controlled substances records
Conduct audits
Prepare and distribute utilization and related reports
Serve on interdisciplinary monitoring teams
MEDICATION RECONCILIATION TECHNICIAN
Obtains patient prior-to-admission medication list from variety of sources
Compiles discharge medication lists and corresponding SNF admission lists
Communicates with patients, caregivers and other health care professionals
Communicates and documents activities
Assists the pharmacist in collecting, collating, maintaining, and auditing records of controlled substance utilization within the organization. May involve procurement, dispensing, distribution, and administration of controlled substances.
Patient medication lists from patient, family, caregiver, outpatient pharmacies, physician offices, dialysis centers, skilled nursing facilities (SNFs) for pharmacist review and reconciliation
Accurate medication list at admission-accurate list at discharge
Med rec: Sen et al. Am J Health-Syst Pharm. 2014;71(1):51-6.
Smith et al. Hosp Pharm. 2013;48(2):112-9.

19. ADVANCED ROLES IN TECHNOLOGY
AUTOMATION/IT TECHNICIAN
Configuration, testing, device rollout, troubleshooting
Bar coding and scanning
Maintenance of medication automation formulary databases
Development of rules/alerts
Quality assurance audits
Staff development and training
Special projects
TELEPHARMACY TECHNICIAN
Pharmacy technician at remote site
Processes and/or dispenses prescriptions (may be home-based)
Facilitates videoconferencing between pharmacist & patient
Completes medication transactions
May use automated drug dispensing systems
Generates reports
Automation technician:
Collaborates with pharmacy and other health care informatacists on data management methods
Needs to understand:
IT systems/technology
Pharmacy/medical terminology
Inventory/procurement
Clinical environment
Communications—oral and written
Telepharmacy technician
Saves pharmacies that might otherwise close down
Increases access to medications
Increases access to patient counseling
Relieves pharmacists in rural hospitals due to lack of health care professionals
Friesner et al. J AM Pharm Assoc. 2011;51:
Yam et al. J Am Pharm Assoc. 2009;49:
Image:

20. ADVANCED ROLES IN QUALITY ASSURANCE AND MEDICATION SAFETY
DOCUMENTATION
Medication errors
Medication adverse events
Drug utilization evaluation
Drug recall coordination
RESEARCH
Patient satisfaction
REGULATORY COMPLIANCE
Medication recall coordination
Maintaining staff competency database
Performing audits
Pharmacy staff education
PHARMACY ACCREDITATION PREPARATION
Works closely with pharmacists and other health care team members to ensure compliance to regulatory and legal standards.

21. How Will Technology Drive Roles?
As technology continues to expand, how will the roles that I described continue to evolve? The profession should drive this…
Incremental Change
Paradigm Shift

22. The Way Forward
Elevate standards within the profession to meet the demands of the growing healthcare system
Improve patient care, outcomes & access
Support evolving roles & scope of practice
Advocacy efforts with legislators, pharmacy associations and other stakeholders
Provide platform to advance pharmacy technicians
Technicians must have education, training and credentials to advance with the pharmacy workforce

23. Summary
Pharmacy technician roles are evolving as pharmacist scope of practice is expanding.
Regulatory variations for pharmacy technicians may support or suppress advanced roles creation.
Future role changes and expectations for pharmacy technicians can be anticipated.
Pharmacy technicians should be educated, enabled, and empowered to assume advanced roles to improve patient care and foster medication safety.

24. Practicing at Top Of Our License!!!
Summary about how they are the leaders of pharmacy, the voice of their states, and can help drive Pharmacists to the top of their License
Developing advanced roles for pharmacy technicians frees pharmacists to focus on clinical pursuits and improves patient care. Moreover, encouraging technician career advancement improves job satisfaction for technicians. Uniformly, technicians in specialty roles demonstrate pride in their work, enjoy the challenges of their unique positions, and appreciate the ability to assist patients, other health care providers, and the public.

25. Discussion on Key Issues
Pharmacy Technician
Education
Entry-level knowledge, skills, abilities
Certification/recertification
State laws and regulations
Advanced practice
Other

26. Self-Assessment Question #1
Which of the following statements are true?
The lack of uniform national standards for pharmacy technician education, training, and certification enhances roles and responsibilities advancement.
Pharmacy technician roles and responsibilities have advanced as a result of expanded direct patient care role for pharmacists.
The elevation of education, training and certification requirements for pharmacy technicians has been eagerly adopted across all pharmacy practice sectors.
Pharmacy technician education and training requirements for entry-level practice roles are equivalent to those for advanced practice roles.
B-There are numerous examples of how pharmacy technician roles and responsibilities have advanced across the country as a result of expanded roles for pharmacists and more specific identification/delegation of clinical vs. technical roles/responsibilities across pharmacy settings.

27. Self-Assessment Question #2
Which of the following are not emerging roles and responsibilities for pharmacy technicians?
Patient counseling for OTC medication and prescription drug transfers
Anticoagulation dosage adjustment and medication reconciliation
Prescription clarification and tech-check-tech in community pharmacies
Chronic care clinic medication history and influenza vaccine administration
B: technicians are assuming all the other roles in states such as Illinois (prescription clarification), Iowa and others (tech-check-tech), Idaho (vaccine administration), Utah (OTC counseling) several states (chronic care clinic medication), Maine/Idaho/South Carolina (prescription transfers). Technicians do not assume clinical roles such as medication dosage adjustment.

28. Self-Assessment Question #3
Which of the following statements are true?
Medication reconciliation technicians may compile discharge medication lists for skilled nursing home patient admissions.
Patient assistance technicians must be familiar with ICD-10 coding.
Tech-check-tech programs are conducted in both community and health-system pharmacy settings.
All of the above.
D-All of the above are true.

29. Self-Assessment Question #4
A “registered certified” pharmacy technician may be authorized to serve in which of the advanced roles as compared to a “registered” pharmacy technician?
Accept new oral medication prescriptions
Perform the final tech-check-tech program verification in both health-system and community settings
Work remotely, including remote order entry, in a telepharmacy practice setting or home-based setting.
All of the above.
D-All of the above are true.

30. References
Glowczewski J. Advanced Pharmacy Technician Practice Model Case Study South Pointe Hospital Warrensville Heights, Ohio A Cleveland Clinic Hospital Technician-Initiated Medication Histories in the Emergency Department.
9 New Ways Pharmacy Technician Roles Are Changinghttp://
Mihalopoulos C, Powers MF. Roles for Pharmacy Technicians in Community Pharmacy Practice Accreditation. J Pharm Technol 2013;29:
Desselle S, Holmes ER National Pharmacy Technician Workforce Study Sponsored by: Pharmacy Technician Accreditation Commission (PTAC), Pharmacy Technician Certification Board (PTCB), and Pharmacy Workforce Center (PWC) . Report Pharmacy Technician Workforce Survey.pdf
ASHP Statement on the Pharmacy Technician’s Role in Pharmacy Informatics Am J Health-Syst Pharm. 2014; 71:
Knoer et al. A review of American pharmacy: education, training, technology, and practice. Journal of Pharmaceutical Health Care and Sciences (2016) 2:32 DOI /s  

31. References
Laubenstein D. Specialized Roles for Pharmacy Technicians. Pharmacy Purchasing and Products. April Vol. 13 No. 4:18
Friesner et al. Expanding the role of pharmacy technicians. J AM Pharm Assoc. 2011;51:
Yam, et.al. Expanding the role of pharmacy technicians. J Am Pharm Assoc. 2009;49:
Sen, et.al. Exploring the role of hospital pharmacy technicians and assistants to enhance the delivery of patient centered care. Am J Health-Syst Pharm. 2014;71(1):51-6.
Smith et al. Pharmacy impact on medication reconcilliation in the medical intensive care unit. Hosp Pharm. 2013;48(2):112-9.

32. Thank you. Miriam A. Mobley Smith, PharmD, FASHP
Director of Strategic Alliances
Pharmacy Technician Certification Board (PTCB)