PREP Act Provides Opportunities for Advanced Roles

The scope of practice for pharmacy technicians has expanded rapidly over the past decade, accelerating recently because of the COVID-19 pandemic. But depending on the jurisdiction in which a technician practices, this most recent expansion may not last. Although much of the direct regulation of pharmacy practice has been traditionally left to the states, the federal government’s legal authority under the Public Readiness and Emergency Preparedness (PREP) Act marked a drastic departure from that policy, putting pharmacy team members in a position to decide what each of them could do and how, to ensure compliance when accepting broader roles.

It is unclear how long the US will remain under a public health emergency, and it is likewise unknown whether the profession can revert to its pre-pandemic state. Although momentum has been building toward greater responsibilities for technicians, including laboratory specimen collection, product verification, and vaccine administration, these duties were not widespread before the pandemic. For instance, before October 2020, most states did not allow technicians to administer vaccines or provide other types of patient care.¹

The results of studies that report pharmacists’ perceptions of advanced technician roles, though generally positive, have been mixed. This is particularly true with respect to technician-administered vaccinations, although these perceptions are likely to continue shifting.^2,3 It is unlikely that the public health emergency will continue to be extended. So the question is not whether the profession prefers expanded roles for technicians but rather whether it can afford not to retain these roles in a post-pandemic era.

In preparation for the eventual end of the public health emergency and expiration of its associated federal legal authorities, some legislatures may contemplate changes to their statutes, and boards of pharmacy may reassess existing rules. Legislative and rulemaking processes are cumbersome and time-consuming but may be necessary if a state seeks to retain a previously unauthorized but temporarily revised pharmacy practice status when not previously authorized. In some states, changes to both rules and statutes may be necessary.

There are a number of statute sections a legislature may amend to expand technician roles, such as the definition of what constitutes a technician or other sections of its pharmacy practice act. However, since the onset of the pandemic, few states have modified how they define a technician and the scope of their practice.^4-9

Tennessee, for example, changed its long-standing definition of a technician to read: “an individual who is specifically trained and designated to assist a pharmacist and may perform tasks delegated by the pharmacist, including participation in drug, dietary supplement and device selection, storage, and distribution and administration, consistent with the pharmacy technician’s education, training, and experience, as defined by rules promulgated by the Board.”⁴

This amendment, while seeming to broaden the statute, ultimately defers to the Tennessee Board of Pharmacy to promulgate rules to operationalize the definition. Some states may change other sections of their statutes to expand or modify existing technician roles, as was done in Indiana.¹⁰ In addition, not every state defines a technician or the scope of a technician’s role, which may leave both in the purview of the board of pharmacy. If a board already has the authority to determine the scope of practice for technicians but has not authorized such expanded roles as final verification or vaccine administration, it may begin the process to amend its rules to allow for expansion. Some states promulgated emergency rules early in the pandemic to maintain the continuity of patient care, with the intent that they would exist only temporarily, usually for 90 days.¹¹ Others created or modified their rules permanently, and some initiated the temporary change and later followed up with a permanent change. For example, the Alabama Board of Pharmacy created a rule in 2021 that defined the criteria technicians had to meet to provide immunizations.¹²

The status of technician roles in a post-pandemic era is unknown. Although vaccine administration is the primary expansion of their role, it will probably be the springboard for a broader discussion about what are appropriate technician tasks—such as obtaining medication histories, medication therapy management, product verification, and possibly even delivering other patient care services—and what their minimum education requirements should be.^13-16 Considering the current patchwork of state-issued entry-level training requirements to work as a technician in the US, the expansion, if any, will likewise lack uniformity.¹⁷

It will thus be important for every member of the pharmacy team to stay abreast of the ever-changing pharmacy statutes and rules that directly and indirectly affect pharmacy practice at the federal and state levels. Key tips for staying up to date include using reliable, reputable sources of information, reviewing them regularly, and knowing whether and how changes, if they occur, affect pharmacy practice.¹⁸ Information and updates provided by government agencies, national and state pharmacy organizations, and state regulatory board are reliable ources of practice guidance. But because some areas of practice evolve more rapidly than others, the frequency and timeliness of a review may vary depending on area. Considering the highly regulated nature of pharmacy practice, which more often adds than removes rules and statutes, every member of the pharmacy team must remain informed to ensure compliance.

References

1. Adams AJ, Bright D, Adams J. Pharmacy technician-administered immunizations: a five-year review. J Am Pharm Assoc (2003). 2022;62(2):419-423. doi:10.1016/j.japh.2021.11.011

2. Kulczycki A, Grubbs J, Hogue MD, Shewchuk R. Community chain pharmacists’ perceptions of increased technicians’ involvement in the immunization process. J Am Pharm Assoc. (2003). 2021;61(5):596-604. doi:10.1016/j.japh.2021.04.017

3. DiMario A, McCall KL, Couture S, Boynton W. Pharmacist and pharmacy technician attitudes and experiences with technician-administered immunizations. Vaccines (Basel). 2022;10(8):1354. doi:10.3390/vaccines10081354

4. Tennessee Code § 63-10-204(38)(2022)

5. Colorado Revised Statutes Sections § 12-280-103

6. Arkansas Code § 17-91-101

7. Oregon Revised Statute § 689.005

8. Wisconsin Statute § 450.01 (2022)

9. Wyoming Statute § 33-24-301(2022)

10. Indiana Code § 25-26-13-31.7 (2022)

11. Alabama Codes §§ 41-22-5(b) and 41-22-6(c) (2)a. and b.

12. Alabama administrative code 680-X-2-.46-immunization training

13. Lengel M, Kuhn CH, Worley M, Wehr AM, McAuley JW. Pharmacy technician involvement in community pharmacy medication therapy management. J Am Pharm Assoc (2003). 2018;58(2):179- 185.e2. doi:10.1016/j.japh.2017.12.011

14. Hohmeier KC, McDonough SLK, Rein LJ, Brookhart AL, Gibson ML, Powers MF. Exploring the expanded role of the pharmacy technician in medication therapy management service implementation in the community pharmacy. J Am Pharm Assoc (2003). 2019.;59(2):187-194. doi:10.1016/j.japh.2018.11.006

15. Jobin J, Irwin AN, Pimentel J, Tanner MC. Accuracy of medication histories collected by pharmacy technicians during hospital admission. Res Social Adm Pharm. 2018;14(7):695-699. doi:10.1016/j.

sapharm.2017.08.005

16. Corelli RL, Merchant KR, Hilts KE, Kroon LA, Vatanka P, Hille BT, et al. Community pharmacy technicians’ engagement in the delivery of brief tobacco cessation interventions: results of a randomized trial. Res Social Adm Pharm. 2022;18(7):3158-3163. doi:10.1016/j.sapharm.2021.09.001

17. State regulations and map. Pharmacy Technician Certification Board. Updated December 31, 2021. Accessed November 29, 2022. https://www.ptcb.org/resources/state-regulations-and-map

18. Barenie RE, Schwab CA, Dinkelaker T. Common legal aspects of pharmacy practice. In: Wooster J, Yu FS, eds. Community Pharmacy Practice Guidebook. McGraw Hill; 2022.

About the Authors

Rachel Barenie, PharmD, JD, MPh, is an assistant professor and the assistant director of continuing professional development at the College of Pharmacy of the University of Tennessee Health Science Center, in Memphis.

Durand Martin is a PharmD candidate at the College of Pharmacy of the University of Tennessee Health Science Center.

Kenneth Hohmeier, PharmD, is an associate professor of clinical pharmacy and translational science and the director of community affairs at the College of Pharmacy of the University of Tennessee Health Science Center, in Nashville.