Pharmacy Technicians Affected by State Regulator Actions to Address COVID-19 Crisis

As of April 1, 2020, regulatory authorities in 31 US states, territories, and the District of Columbia, have published emergency rules and guidance that has the potential to change the roles and duties of pharmacy technicians as the coronavirus disease 2019 (COVID-19) pandemic continues to pose new challenges to pharmacies.

As the urgency to minimize transmission and maintain social distance has grown, many states have issued orders for non-essential businesses to close or limit hours, and for citizens to self-isolate. However, pharmacies remain an essential business even as pharmacy technicians and other pharmacy employees are still a hazard for and at risk of transmission of COVID-19.

In response to concerns, many pharmacies across the nation are seeking to reduce exposure by limiting hours and staffing, leaving fewer pharmacists and technicians on site. State boards of pharmacies—as well as governors issuing executive orders—have responded to the need for guidance on these regulatory changes in a multitude of ways.

To date, most published policy changes responding to COVID-19 involve suspending or expanding pharmacist-to-technician ratios, permitting technicians to work remotely, and validating out-of-state technician licenses to permit work during the crisis. Many states are also extending license renewal dates.

Nine states have loosened regulation of technician-to-pharmacist ratios, allowing fewer pharmacists to be present in the pharmacy. State responses range from the most liberal of suspending enforcement of the ratios in Massachusetts, Iowa, and Tennessee. Minnesota¹ and West Virginia² are permitting temporary excess of ratio provided the state board is notified within a certain time frame.

On the other hand, the most conservative change in the pharmacist-to-technician ratio is in Louisiana, which is allowing more flexibility in the makeup of the technician ratio but not changing the total number of technicians or technician trainees from the original 4:1.³ The remaining states—California, Indiana, and Nevada—permit a specific increased number of technicians to pharmacist.

Twenty-one states have made changes to permit remote processing by technicians. Of these states, 8 have placed restrictions on which type of work pharmacy technicians may perform remotely, such as performing non-dispensing tasks like data entry, order entry, or insurance processing from home or out of state.

Regarding the use of out-of-state technicians, 11 states have published regulation changes online, with some states, such as Minnesota,¹ permitting technicians to work out of state without prior notification. In other states, such as Kentucky,⁴ technicians must first notify the state board and are subject to a 90-day limit pending extension.

Meanwhile, the National Association of Boards of Pharmacy (NABP) has initiated the NABP Passport, a temporary licensure to allow technicians and pharmacists to more easily practice in other states.⁵ According to their webpage, the Passport can be used both as a “designation for temporary practice” so that license-holders may practice in other states, as well as a prerequisite for temporary or emergency licensure in those states where out-of-state licensees are permitted to work.

Currently, 13 states recognize the NABP Passport, according to NABP’s website. The verification of the Passport comes at no expense to either licensee or state board.

References

• Minnesota Board of Pharmacy. Frequently Asked Questions: COVID-19. https://mn.gov/boards/assets/FAQ-COVID-19-03312020_tcm21-425830.pdf. Updated March 31, 2020. Accessed April 1, 2020.
• West Virginia Board of Pharmacy. West Virginia Board of Pharmacy Current COVID-19 Update 3-20-2020. https://www.wvbop.com/article.asp?id=40. Updated March 20, 2020. Accessed April 1, 2020.
• Louisiana Board of Pharmacy. COVID-19 Public Health Emergency. http://www.pharmacy.la.gov/index.cfm?md=pagebuilder&tmp=home&pid=530. Updated March 28, 2020. Accessed March 31, 2020.
• Kentucky Board of Pharmacy. COVID-19 Frequently Asked Questions and Board Guidelines. https://pharmacy.ky.gov/Documents/Kentucky%20Board%20of%20Pharmacy%20COVID-19%20FAQs.pdf. Updated March 26, 2020. Accessed April 1, 2020.
• National Association of Boards of Pharmacy. Temporary or Emergency Licensure Facilitated by NABP Passport. https://nabp.pharmacy/coronavirus-updates/passport/. Accessed April 1, 2020.

About the Authors

Evaline Han, BS, is a fourth-year Doctor of Pharmacy student in the School of Pharmacy, Bouvé College of Health Sciences at Northeastern University.

David Zgarrick, RPh, PhD, FAPhA, is a Professor in the Department of Pharmacy and Health-systems Sciences in the School of Pharmacy, Bouvé College of Health Sciences at Northeastern University.