PHARMACY

Pharmacy techs tackle expanded role

BY Jim Frederick

Are the nation’s more than 330,000 pharmacy technicians ready to step up to a higher level of patient services and a more demanding but rewarding career?

For most pharmacy techs, that step up in duties is either fast approaching or has already begun. Given the massive changes sweeping the severely stressed U.S. healthcare system and the retail, clinical and hospital pharmacies that serve it, thousands of technicians in those settings are already taking on meatier roles as they fill the void left by pharmacists called on to perform additional clinical services.

The additional support needed by technicians is a direct result of the fundamental shifts in patient care responsibilities that are transforming the pharmacy workplace. As overburdened primary care physicians turn to pharmacists, nurse practitioners and other health professionals to take on more of the routine care and monitoring of patients, pharmacists are focusing increasingly less on prescription drug dispensing, pharmacy administration and insurance adjudication. With physicians looking to ease their patient caseloads for routine conditions, hospitals releasing patients “quicker and sicker,” and health plan payers desperately scrambling for more cost-effective ways to improve their patients’ health and well-being, pharmacists are taking on increasing responsibility for such clinical services as patient education and oversight, disease management, immunizations and medication therapy management.

Given the growing complexity of the position, training and certification are fast becoming a basic requirement for any post as a pharmacy technician. “More and more employers are requiring pharmacy technician certification,” the American Society of Health System Pharmacists noted. “Most pharmacy technician job postings say that they want candidates who are either already certified or are currently enrolled in pharmacy technician school.”

At this point, only a relative handful of states — Colorado, the District of Columbia, Georgia, Hawaii, Michigan, New York, Pennsylvania and Wisconsin — “currently do not require registration, licensure or certification of pharmacy technicians,” according to the Pharmacy Technician Certification Board. And a growing number of states — a total of 16, according to the “2011 Survey of Pharmacy Law” from the National Association of Boards of Pharmacy — now require that all pharmacy techs be certified by PTCB or other accrediting body before working behind the counter.

PTCB urges techs to “consult their state board of pharmacy for complete and current pharmacy regulations and practice acts.”

The growth of tech responsibilities and the rise in training requirements go hand in hand. “With increasing levels of training and certification, the role of the tech continues to evolve,” the Bureau of Labor Statistics noted in a recent report. “In many cases, he or she handles virtually every step of the prescription dispensing workload, up until final verification of the script by the pharmacist before it goes to the patient. Techs also may establish and maintain patient profiles, prepare insurance claim forms, and stock and take inventory of prescription and over-the-counter medications.”

“As cost-conscious insurers begin to use pharmacies as patient care centers and pharmacists become more involved in patient care, pharmacy technicians will continue to see an expansion of their role,” the bureau report predicted.

At its most basic level, the forces that are reshaping the roles of pharmacists and pharmacy technicians are driven by “the power of community pharmacy services to improve health and reduce costs,” said Steve Anderson, president and CEO of the National Association of Chain Drug Stores, at the organization’s annual meeting April 22.

“The value added by community pharmacy — in the areas of medication counseling, health education, screenings, vaccinations and disease state management — can add tremendous value to a healthcare system that needs solutions that are cost-effective, high-quality and patient-centric,” Anderson said.

NACDS, for its part, is on record supporting “mandatory requirements for training and evaluating technicians.” The organization also favors the adoption by all state boards of pharmacy of a set of standards that would “require employer-based pharmacy technician training programs and evaluation exams” to provide techs with “hands-on training and interaction with pharmacists.”

Pressure for a training and certification standard for pharmacy techs also is coming from state boards of pharmacy. Although, at present, “only a few states require you to be certified,” ASHP noted, “that list is growing as pharmacists depend more on technicians for support.”

What’s more, noted a report from the National Pharmacy Technician Association, “with the invention of e-prescribing, pharmacy technicians may find they may need to attend training on electronic prescribing and protocol in the pharmacy … as more pharmacies adapt to more efficient and electronically savvy ways of doing business.”

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PHARMACY

Blood Sugar Basics Game Plan seeks to help Type 2 diabetics better manage condition

BY Allison Cerra

PHILADELPHIA — An interactive user-friendly program that breaks down diabetes management into four goals to help people with Type 2 diabetes better manage their disease has made its debut.

Developed by the American College of Endocrinology with support from drug maker Merck, the Blood Sugar Basics Game Plan, available on BloodSugarBasics.com, outlines four personalized goals — Huddle, Enter the Nutrition Zone, Get in the Game, and Check the Scoreboard — that people with Type 2 diabetes can put into practice with the help of a healthcare professional. The website also includes such resources as questions to ask your doctor, tips about managing high and low blood sugar, a blood sugar knowledge quiz and checklists on how to help get through episodes of low and high blood sugar.

The Blood Sugar Basics Game Plan is supported by "coaches," including Mike Golic, co-host of ESPN’s "Mike & Mike in the Morning" and a former National Football League star, who has Type 2 diabetes; clinical endocrinologist Farhad Zangeneh and Samantha Heller, a registered dietitian and exercise physiologist with expertise in diabetes.


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PHARMACY

Electronic prescribing spreads like wildfire among retail pharmacies

BY Alaric DeArment

Big trends can sometimes take centuries or even millennia to develop. Think about how long it took between the dawn of anatomically modern humans and the adoption of agriculture. Health care is no different, having come a long way since the days of bloodletting and the assorted quackeries that were once considered acceptable medical practices.

But there’s one trend in health care that has happened with astonishing speed, particularly in the United States: the adoption of electronic prescribing. According to the latest numbers from e-prescribing network Surescripts, there were 16,000 office-based prescribers who had adopted e-prescribing in 2006. Within two years, that number climbed to 74,000, but that still represented only 12% of the total. By 2011, however, that number had reached 390,000 — 54% of all prescribers in the country. The numbers from the pharmacy side have increased even faster. In 2008, 46,000 pharmacy retailers, or 76%, were set up for e-prescribing; in 2011, it was 56,900, or 91%. Of those, chains have adopted the technology to the greatest degree, with 98% of chain pharmacies using it, compared with 79% of independents. According to Surescripts, of the 62,461 community pharmacies in the United States, 64% are part of a chain, while 36% are independents.

One case in particular is Walgreens, which in March announced a program with Surescripts whereby it would send immunization records directly from Walgreens and Duane Reade stores, and Take Care Clinics, to primary care providers using Surescripts’ Clinical Interoperability services, with plans to share immunization data with public health authorities starting later this year.

Currently, the percentage of prescriptions transmitted electronically remains relatively small: In 2011, 570 million prescriptions, or 36%, were sent electronically — but compare that with 2008, when that figure was 68 million, or 5%. The reason for the discrepancy, according to Surescripts, is that actual use of e-prescribing tends to lag adoption, with the most recent adopters among prescribers using it less than those who adopted it in earlier years.

At the same time, adoption has been somewhat uneven when examined on a state-by-state level. So far, according to Surescripts, Massachusetts has seen the most comprehensive use of e-prescribing, while such states as Minnesota and Oregon have seen widespread use as well. On the other hand, adoption has been relatively light across Nevada and California, and appears almost nonexistent in all but a few portions of Alaska. Also, while e-prescribing is common in Dallas and Houston, it’s extremely rare, if not absent, in many other Texan counties, with Kansas, Nebraska and South Dakota showing similar patterns.

One major reason why e-prescribing has seen such dramatic growth is government incentives under the Medicare Improvements for Patients and Providers Act of 2008. According to a report released in February by the Centers for Medicare and Medicaid Services, nearly $271 million was paid to physicians as part of the eRx Incentive Program in 2010, an 83% increase over 2009, the first year of the program, when the program paid out $148 million. The payments went to 65,857 individual professionals and 18,713 practices. The CMS report also found that almost 700,000 professionals were qualified to participate in the eRx Incentive Program in 2010, compared with close to 669,700 in 2009.

At press time, CMS didn’t have complete data for 2011, but it found that by 2011, 160,959 eligible professionals, or 26.3% of those eligible, had submitted data for the eRx measure through claims.

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