Pharmacy technicians practice in a variety of settings across all facets of the pharmacy profession. However, these roles can vary significantly from one setting to another, as there is a lack of consistency in what constitutes the minimum requirements necessary to become a pharmacy technician in the US. The Pharmacy Practice Model Initiative (PPMI) Summit held in 2010 developed a vision for the future of pharmacy practice to determine how pharmacists, pharmacy technicians, and technology can work together to provide the safest and highest quality patient care.1 Specific to technicians, attendees of the PPMI summit recommended the following:
Since then, PPMI has been rebranded as the Practice Advancement Initiative (PAI). In January 2020, a revision to the original PPMI recommendations was released—PAI 2030—which continues to focus on pharmacy technicians.2
Likewise, in 2016 the American Society of Health System Pharmacists (ASHP) released a position statement on the role of pharmacy technicians in pharmacy practice.3 Among other recommendations, ASHP believes that well-educated pharmacy technicians are integral to an effective medication-use process. In this statement, ASHP also advocates for states to develop uniform laws regarding the licensure and training of pharmacy technicians.
In order to understand the current pharmacy technician laws and regulations, a review of entry-level practice requirements for pharmacy technicians across the US was conducted in 2018.4 The results of this review indicated that:
This review concluded that there was a lack of standardization in minimum requirements for entry-level technicians with regards to registration, licensure, certification, education, and training across the US.
With appropriate training, pharmacy technicians can fulfill a variety of advanced roles within health system pharmacy practice.5 Examples of advanced roles and tasks include “tech-check-tech” (technician verification), pharmaceuticals purchasing, medication reconciliation, completing prior authorizations and patient assistance paperwork, supervising certain tasks, monitoring adverse drug reactions, and developing and populating pharmacy informatics.
Survey of Pharmacy Directors
In May 2018, to better understand the deployment of advanced roles fulfilled by technicians, pharmacy directors at academic medical centers across the country were surveyed by the author group regarding roles they have implemented at their institutions. The survey was designed to not only better understand current roles, but also to assess the experiences of pharmacy leaders throughout the country regarding the implementation of these roles and working with their respective state boards of pharmacy, when necessary. The survey was further refined and then sent to an email list representative of major US academic medical centers. Completion of the survey was voluntary and parts of it could be delegated by the director of pharmacy (DoP) to other members of the pharmacy leadership team per their areas of expertise. The survey questions are listed in TABLE 1.
The survey yielded 43 responses from DoPs or their delegates. Of these respondents, 86% indicated their state board of pharmacy regulates the practice of pharmacy technicians. Respondents were asked to further describe the type of regulation in their respective state. These results are included in FIGURE 1. Six respondents indicated an answer of “Other.” The descriptions of these six responses included that the board requires both certification and registration (n=1), has three levels of registration (ie, trainee, registered, or certified) (n=1), recognizes certified technicians, but must be licensed at a minimum (n=1), has no current requirement (n=2), and differs based on scope of practice (n=1).
In addition, 63% of respondents reported that the regulation of pharmacy technicians has impacted practice at their organization. Survey respondents indicated that when provided more direction from state boards of pharmacy, pharmacy technicians can practice at a higher level, such as completing technician verification or medication histories. This support enables pharmacists to spend more time engaging in complex clinical activities. Further, when licensure/registration is required, respondents indicated an improved quality of candidates and a higher level of professionalism. Respondents have also leveraged regulations to promote technicians to positions with greater responsibility, positions with more complex job functions, or to leadership roles within their organization.
According to the survey respondents, downsides to technician regulation include the following:
Respondents also indicated that minimal direction from the state board may lead to a lack of accountability in the event of controlled substance diversion, difficulty in advancing practice, and heterogeneity in technician functions.
When asked whether the state board allows pharmacy technicians to practice in advanced roles, 56% (n=24) indicated their board does allow for advanced roles. Respondents were asked to indicate all advanced roles that were allowed by their state board and those results are included in FIGURE 2. Eight respondents indicated “Other” roles are permitted within their state, which included: technicians in intensive care unit and emergency room specialty areas (n=1), investigational drug service (n=1), quality assurance (n=1), purchasing or inventory technician (n=1), lead roles (n=1), certain levels of responsibility in retail prescription processing and institutional dispensing technology (n=1), and many activities as long as under supervision of pharmacist (n=1).
When asked about advanced pharmacy technician roles at their institutions, 74% (n=31) indicated they have implemented advanced roles for pharmacy technicians. Examples of these advanced roles include prior authorization technicians, medication assistance program processing technicians, medication history technicians, technician coordinators and supervisor positions, intensive care unit/emergency department (ICU/ED) advanced specialty area technicians, tech-check-tech technicians, coordinators of technician training programs, temperature monitoring coordinators, and investigational drug service technicians.
Respondents were asked how they were able to justify these roles within their organizations. Answers included the ability to promote top of license work and adjust skill-mix of tasks, by evaluating cost and waste savings, by improved nursing satisfaction and turnaround times, by creating a full-time equivalent neutral change, through a regulatory need, and by a request from another discipline.
Of those academic medical centers that employ pharmacy technicians in advanced roles, 85% (n=35) indicated these roles require additional training. These respondents indicated the additional training may comprise a competency test (n=14), involvement in a career ladder (n=12), required training (n=8), one-on-one training with a pharmacist (n=1), leadership training (n=1), and application and interview (n=1).
A Current Lack of Standardization
Clearly, pharmacy technicians now fulfill a wide variety of roles to support the practice of pharmacy. When available, advanced pharmacy technician roles can expand practice not only for the technicians, but for pharmacists as well. Maximizing this valuable practice can be a tremendous asset for the profession, yet a more uniform approach is needed to support technicians professionally.
The survey responses from pharmacy leaders provided a clear message that there is no standardization in the regulation of pharmacy technician practice. After almost a decade since the PPMI Summit was held, gaps remain in the implementation of PPMI/PAI recommendations. Pharmacy technician scope of practice has yet to be defined, and there remains a lack of standardization in training programs and minimum job entry requirements. Furthermore, there are variations in certification and licensure requirements from state to state. While several organizations have developed specialized tasks for pharmacy technicians, which are considered “advanced roles,” these roles tend to vary from one organization to another, further complicating the use of this non-uniform/undefined term.
The survey results from pharmacy leaders revealed wide differences in technician training. While pharmacy technicians may participate in a variety of training programs to practice in advanced roles, the research team believes that all technicians should complete a minimum training program, in addition to on-the-job training provided by the employer. This process could enable the creation of a career ladder for pharmacy technician professional development. In recognition of the myriad advanced roles that could be assigned, additional training programs should be developed for continual professional development throughout a technician’s career.
One area of positive movement in support of technician practice evolution is the availability of advanced certificate training through the PTCB.6 Advanced certification offers technicians who are currently performing, or are interested in advanced tasks, the opportunity to obtain formal education. As recommended by the PPMI and ASHP, the profession needs to invest in the development of more formalized training programs in order to continue advancing the roles of pharmacy technicians in practice. These advanced certificate programs, as well as the implementation of accredited training programs, are great examples of formal education opportunities that highlight an investment in the training of pharmacy technicians.
Responses from pharmacy leaders indicate that while regulation from the state board of pharmacy could promote advanced technician practice, it also has the potential to limit it. Pharmacy leaders should advocate for regulations that are universal for the workforce, rather than restricted to individual technician roles or organizations. A uniform national standard is needed to define a technician’s scope of practice, determine minimum training requirements, delineate roles and responsibilities, and ultimately ensure patient safety and advance practice.
Implementing Advanced Roles
Apart from the findings of this research, the authors believe that it is important to pursue expanding the roles of pharmacy technicians to advance the practice of pharmacy. Pharmacy leaders should continue to advocate for and implement advanced technician roles. In states where no legislation exists, pharmacy leaders should develop processes to expand the role of the technician and work with state boards of pharmacy to incorporate these roles into legislation. Pharmacy leaders should advocate for the alignment of pharmacy technicians with applicable health care professional technicians, such as those in radiology and respiratory therapy. Pharmacy leaders should focus on the correlation between standardizing practice and increasing regulation. Supporting the strategies listed here will aid in expanding the role of the pharmacy technician, ensuring optimal patient outcomes and practice advancement for the entire profession of pharmacy.
Pharmacy technicians currently serve patients and the profession in several unique roles and are vital members of the pharmacy workforce. However, there is a lack of consistency in state board regulation of pharmacy technician practice as well as education requirements across the nation, which can hinder the widespread implementation of the PPMI recommendations for advancing technician roles. Pharmacy leaders must collaborate with their respective state boards of pharmacy on efforts to standardize regulatory requirements for pharmacy technicians and work within their organizations and communities to develop training programs that will set pharmacy technicians up for success in the profession.
Tyler A. Vest, PharmD, MS, BCPS, BCSCP, is a pharmacy manager of automated dispensing cabinetry and controlled substances and an interim pharmacy coordinator of medication delivery services at Duke University Hospital in Durham, North Carolina. He is also an assistant professor of clinical education at the UNC Eshelman School of Pharmacy. Tyler completed his pre-pharmacy studies at the University of Kentucky, and his Doctor of Pharmacy at the University of Cincinnati James L. Winkle College of Pharmacy. He is also a recent graduate with an MS in Pharmaceutical Sciences with a specialization in Health-System Pharmacy Administration from the UNC Eshelman School of Pharmacy.
Amy Beatty, PharmD, MBA, BCPS, is the senior director of pharmacy services, population health, for OhioHealth Health System in Columbus, Ohio. She obtained her Doctor of Pharmacy degree from Ohio Northern University, completed her pharmacy residency at OhioHealth, and obtained her Master’s in Business Administration from Ball State University.
Daniel Dickson, PharmD, BCCCP, is a critical care clinical pharmacist at Northwestern Memorial Hospital in Chicago. He obtained his Doctor of Pharmacy degree from Rosalind Franklin University of Medicine and Science in North Chicago, Illinois.
Tim Miller, PharmD, BCOP, is a pharmacy coordinator of oncology at University of Wisconsin Hospital and Clinics in Madison. He received his Doctor of Pharmacy from the University of Wisconsin-Madison in 2011. In his current role, Tim oversees hazardous medication production and distribution across the UW Health enterprise, as well as specialty retail oncology operations at UW Hospital.
Karen V. Youmbi, PharmD, BCPS, is the associate director of ambulatory pharmacy services and regulatory compliance at Cedars Sinai Medical Center in Los Angeles. She obtained her Doctor of Pharmacy from Northeastern University in Boston in 2011.