Pharmacists practicing at the top of their licenses is something Ed Vess, R.Ph., has long advocated. QS/1’s senior manager of pharmacy professional affairs wants pharmacists to use their education to provide clinical patient care and claim their place as reimbursed members of the healthcare team. In turn, many medication-dispensing tasks currently handled by pharmacists could be absorbed by technicians practicing at the top of their own training.
A growing number of stakeholders are joining Ed in this discussion about the roles of pharmacists and technicians, as illustrated by a session at the August expo of the National Association of Chain Drug Stores (NACDS). QS/1’s SharpRx product manager Rich Muller, attended the session in Denver called “Collaborative Care: Optimizing Patient Care – Expanding Access to Pharmacy Care by Empowering Pharmacy Technicians in Supporting Roles.” The information Rich brought back, shared below, will help his team keep developing pharmacy management system innovations that match the industry’s best practices.
The NACDS session is the latest in a growing conversation. In February 2017, the Pharmacy Technician Certification Board (PTCB) sponsored a stakeholder conference that sought consensus on entry-level requirements, advanced technician practice, state regulations, and standardization models. Why the momentum to expand technicians’ roles? First, it alleviates time burdens for pharmacists that arise from technical dispensing functions. But why do pharmacists need their time freed? So they can perform clinical tasks – ultimately, the goal of these role expansions and shifts is better patient health, a win-win for both patients and pharmacists seeking reimbursement gains in an increasingly results-oriented landscape. The session’s speaker emphasized that the goal is not reduced pharmacist hours; rather it’s a reallocation of how their time is spent.
In Ed’s view, “Technicians should be employed to remove any barriers that prevent pharmacists from spending more time with their patients.” Instead of confining techs to traditional responsibilities like data entry, counting pills, inventory maintenance, and checkout, new practice models would expand their responsibilities in:
Medication dispensing support – accepting verbal prescriptions as well as transferring, clarifying, and doing prescription drug monitoring program (PDMP) database checks of prescriptions; performing final verification after the pharmacist’s drug utilization review (DUR).
Technical support for pharmacist clinical services – collecting patient data, scheduling appointments, working with insurance, running reports, and doing prep work for medication therapy management (MTM).
So what are some of the obstacles to expanding tech roles? While it’s relatively easy to gain consensus in a ballroom setting like the PTCB conference, real-world agreement between interested parties is more elusive. Questions swirl around even the most basic issues, like the lack of a single legal definition for pharmacy technician, let alone what constitutes entry-level versus advanced practice. Barriers exist in several areas:
- Training and certification: What education should be required? What competencies should drive the curriculum? Which certification exams should be recognized or required?
- System limitations: Pharmacy management software is integral to new practice models. For example, systems may not have the workflow separations needed to involve techs in new prescription fills, and the technical changes needed for even a pilot program involve time, expense, and disruption that large chains are reluctant to take on. Conversely, independent pharmacies that haven’t kept up-to-date with their software can lack tools to implement a different process. In QS/1 Pharmacy Management Systems NRx, PrimeCare, and SharpRx, Workflow tools make this easier.
- State regulations: There are widespread differences in rules for pharmacy techs, and crafting new statutory language is a lengthy, complex process.
- Retention and poaching: Nobody wants to go to the expense of training techs for bigger roles only to have them leave for greener pastures.
- Expense: Higher wages for techs must be offset by pharmacists building their business with clinical services.
- Opposition and engagement: According to the speaker, when told “We’re going to give you more tech help with some core functions,” the first thing pharmacists fear is having their hours and income reduced. Another question can be, “Then what do I do?” Pharmacists may need practical support of their role as clinical caregivers.
How Iowa Did It
In the second part of the NACDS session, a speaker described Iowa’s 10-year experience expanding roles for pharmacy techs. The ultimate result was a modification of tech-check-tech1 programs called “technician product verification.” He first explained the context surrounding pharmacists’ push for a new practice model: state requirements for Pharm.D. education and technician certification, rising pressures on insurance reimbursement, pharmacists’ own ad hoc experiments with saving time, and the Affordable Care Act leading them to wonder how to fit into new healthcare models.
This created a chicken-and-egg question – which should come first, new payment models or new operational models? Deciding to pilot a new operational model, the state board gathered community and chain pharmacies, the Collaborative Education Institute (CEI), third-party payers, colleges of pharmacy, the state pharmacy association, health systems with tech-check-tech experience, and funding partners.
The pilot found that pharmacist time spent in patient care increased by 133%, and the total number of services, such as MTM and disease-specific education, approximately doubled. Here are other lessons learned:
- Expect it to take a while: It took more than a year to gather the information, leadership support, pharmacy buy-in, etc. to create a proposal for the board of pharmacy.
- Recognize the worry about liability and mandates that could reduce hours: Pharmacists will naturally worry about liability while experimenting with new practices. They’ll also have concerns about retaining the freedom to practice as they choose. Involve insurers in the process and disseminate reassuring information on safety, pharmacist workload, and alternative ways to enhance pharmacists’ clinical services, such as collaborative practice agreements.
- Assess site readiness: Is the store proactive about adapting their workflow? Are their pharmacy management systems adequate? Create documents outlining what participants are agreeing to, from technical system requirements to physical space changes to what data they must collect.
- Keep talking to the board of pharmacy: Board participation is crucial so that the pilot can be designed with an insight into their evaluation demands.
- Coach pharmacists in clinical care: While techs loved their new career ladder, pharmacists’ feelings were more mixed. Don’t underestimate their basic questions, even down to “If you don’t need me at the end to check stuff, where do I stand?” Provide technical support on how to interact with patients to improve health outcomes.
Iowa’s process and results have been extensively documented; an internet search for “Iowa pharmacy new practice model” provides more details.
Pilot participants continue to be innovators, disseminating improved practices to other pharmacies and approaching the board with new ideas to enhance patient care. As the speaker concluded, “We had a saying – if it’s right for the patient, it’s right for the profession.” Increasingly, supporting pharmacists as clinical caregivers by letting them delegate tasks to technicians looks good for everybody.
1An institutional program in which certified pharmacy technicians check the technical prescription-filling work of other certified pharmacy technicians