What a Pharmacy Technician Does

What Does a Pharmacy Technician Do?

I have been writing articles on why and how to become a pharmacy technician, but some recent feedback has made me realize I left out the obvious. What is it that pharmacy technicians do in a pharmacy? Most people figure they help the pharmacist enter prescriptions and count pills. This is true for an outpatient pharmacy, also called a retail pharmacy, but there are many roles for pharmacy technicians in healthcare. The rest of this article will list different types of pharmacy settings and the roles that pharmacy technicians have in these settings.

Community/Retail Pharmacy:

I have worked retail, and I prefer other settings; however, it is where a large percentage of pharmacy technician jobs are found. What a pharmacy technician can do is determined by the state they work via state laws and rules. In general, technicians cannot provide clinical information to patients or be the final check for prescriptions. In some states, technicians are allowed to provide information on over-the-counter (OTC) medication (ie, medications that do not require a prescription, such as, acetaminophen and ibuprofen). Pharmacy technician tasks include, but are not limited to:

• Collecting patient information (insurance and personal information as needed)
• Entering and processing prescriptions in the computer system
• Filling and selling prescriptions
• Requesting refills from doctor offices for patients
• Compounding medications that are not commercially available
• Ordering medications
• Restocking shelves
• Answering the phone
• Working with insurance companies on approving payment for certain medications
• Maintaining the cash register and conducting accounting functions

Hospital Pharmacy:

There are many different roles for pharmacy technicians in a hospital pharmacy. I know this type of pharmacy best since this is where most of my work has been. The most common are technicians who work in the central pharmacy. In addition we have decentralized techs, sterile compounding techs, billing techs, OR techs, narcotic techs, database techs, automation techs, team lead techs, and buyer techs. These technicians as a whole perform the following tasks, but not limited to:

• Filling new orders, this includes a variety of medications from oral medications to specially prepared sterile compound medications (including chemotherapy meds)
• Answering the phone
• Tubing medications (if the pharmacy has a pneumatic tube station)
• Preparing medications for delivery
• Delivering medications
• Assisting floor pharmacists with medication histories
• Assisting floor pharmacists with IV drip checks
• Handling missing dose calls
• Billing medications where nurse charting does not bill
• Maintaining the pharmacy database
• Restocking operating rooms and anesthesia trays with appropriate medication
• Dispensing and tracking all controlled substances throughout the hospital
• Maintaining automation equipment [automated dispensing cabinets that store medication on nursing units, automatic fill systems (typically called Robot-Rx)]
• Purchasing of all medication and supplies needed in the pharmacy
• Leading and managing the technician workforce, including upkeep of schedules

Long-Term Care Pharmacy:

I have worked at a couple of long-term care pharmacies, and I think it is a great place to be a technician. They typically employee a lot of techs because the work load lends itself to a lot of technician tasks. These pharmacies provide the medication needs for nursing homes, assisted living facilities, and psychiatric facilities. The typical pharmacy is located in a warehouse. It does not have an open pharmacy for people to come to; they receive orders by fax and deliver all medications via couriers or drivers to facilities. The oral medication is filled in blister packs (cards of 30 tabs that are used to provide a 1 month supply of medication), or some other mechanism that provide the facility with an extended amount of medication doses that can be safely and cleanly kept until doses are due. Pharmacy technician tasks include, but are not limited to:

• Filling new and refill orders (different from hospital because of the number of doses provided)
• Processing new order and refills coming through the fax machine
• Order entry of prescriptions and printing of labels for fill techs
• Sterile compounding of medications (although there aren’t as many sterile compounded medications as a hospital, there are still enough that most long-term care pharmacies have a few techs specialize in sterile compounding
• Billing medications to homes
• Controlled substance dispensing and documentation
• Ordering medications and supplies
• Restocking medications that are returned that are still suitable for reuse.

Home Infusion Pharmacy:

These pharmacies primarily care for patients that require some form of IV or other non oral medication, and want to receive the therapy at home (hence the name home-infusion). I have also worked in a home-infusion pharmacy. As a tech I had a lot of experience in sterile compounding, and found my self in any position that needed a IV room tech. Pharmacy technician tasks include, but are not limited to:

• Compounding sterile preparations in the clean room
• Preparing supplies associated with sterile medication administration for delivery
• Billing medications delivered to patients home
• Coordinating deliveries of medications with patients
• Entering orders in the pharmacy order entry system

Nuclear Pharmacy:

No, I have not worked in a nuclear pharmacy (I am sure you were staring to think I got around quite a bit, but I have been in pharmacy for about 17 years). I have some friends who work in a nuclear pharmacy. The hours are interesting; they usually come in at about 3 AM and work until about noon. These types of pharmacies make radioactive compounds and they need to be made in a way that when they are delivered to the hospital or clinic administering them, that the dose has degraded to a specific amount. Without going into too much detail, these medications have short half-lives. So they have to time the compounding of the product with the time it takes to deliver the medication and the time the patient is to receive the dose. The job pays well, but as you can imagine, there are not a ton of these positions available. Pharmacy technician tasks include, but are not limited to:

• Preparing radioactive products
• Cleaning and preparing sterile compounding areas
• Entering orders into the pharmacy system
• Coordinating dose due times with deliveries and preparation
• Billing products to hospital or clinic

Health Plans/HMO Pharmacy Group:

I saved this one for last because it is a lot different. Most healthcare plans have a pharmacy department. They manage the pharmacy benefit of the health plan. I have worked with my companies health plan and have spent some time with the pharmacy department. Pharmacy technician tasks include, but are not limited to:

• Answering phone calls and providing support for patients on the pharmacy benefit
• Reviewing prior authorization requests
• Providing support to physicians and drug companies for information requests
• Supporting the pharmacists in the department with database and projects as needed

As you can see, pharmacy technician roles can be very diverse. The best advice I can give you is to figure out what setting you would most like to work in and obtain some experiential hours in that setting. I have found that the type of pharmacy you train in is typically the type of pharmacy you end up working in.

Online Pharmacies and Telemedicine

Not a day goes by when our email inboxes do not fill with advertisements for prescription drugs. Many of these emails promise to deliver drugs of all classes by overnight courier without a prescription. While there are legitimate online pharmacies, and the practice of telemedicine or cyber-medicine is gaining acceptance, this change in the way medicine is being practiced is rocking the foundations of the medical establishment. Being able to consult a doctor online, and obtain prescription drugs delivered to your doorstep by UPS has broad social and legal implications. The Internet facilitates making drugs available to those who may not be able to afford to pay US prices, are embarrassed to see a doctor face-to-face, or are suffering from pain, the treatment of which puts most doctors in direct conflict with the ‘war on drugs’ but on the other hand there is the question whether these pharmacies make drugs available to recreational drug users without the oversight of a licensed medical practitioner.

The Need for Alternatives

Medical care in the US has reached a point where it is expensive and impersonal which has caused the consumer to become generally unsatisfied with the medical establishment as a whole. Examples include the huge differences between the cost of drugs in the US and Canada, long wait times in US pharmacies, and poor service in general. Perhaps realizing this, US customs appears to tolerate the millions of Americans that visit Canada every year to buy their medications, as for the most part, these ‘drug buyers’ are elderly American’s that can’t afford the high cost of filling their prescriptions in the US.

Rather than to travel to Canada or Mexico millions of Americans are now turning to the Internet for both their medical needs. Telemedicine (or cyber medicine) provides consumers with the ability to both consult with a doctor online and order drugs over the Internet at discounted prices. This has resulted in consumers turning to online pharmacies for their medical needs, and in particular pharmacies with a relationships with a physician, which allow the consumer to completely bypass the traditional brick and mortar pharmacies, with the added benefit of having their physician act as an intermediary between the consumer and the pharmacy. According to Johnson (2005) this is as a result of consumers becoming very dissatisfied when it comes to dealing with both brick and mortar pharmacies and medical practitioners. As Johnson, notes, “Consumers are more likely to know the name of their hairdresser than their pharmacist.” When Johnson (2005) rated the various professions within the health care system, he found that pharmacists had the lowest interaction with their patients than did any other group. Today, as a result of this “consumers are buying 25.5 percent of their prescriptions online, opposed to 13.5 percent of which are picked up at a brick and mortar pharmacy” (Johnson 2005).

Drugs and Society

What has brought so much attention to online pharmacies is that it is possible to obtain just about any drug without a prescription online. Many of these prescriptions are for legitimate purposes purchased through an online pharmacy because the buyer is too embarrassed to visit the doctor or for other reasons including the unavailability of FDA approved drugs to the consumer. These drugs may include steroids that due to their misuse and being classed as a classed a category three drugs, are seldom prescribed by physicians. These drugs have a useful purpose to those suffering from any wasting disease such as AIDS, they also play a role in ant-aging (FDA, 2004).

The Doctor Patient Relationship

Today a visit to a doctor is generally brief, much of the triage it is done by a nurse or a nurse practitioner with the doctor only dropping in for a few minutes, if at all. In many cases the patient is seen by a nurse practitioner. One of the arguments against telemedicine or perhaps a better term is cyber-medicine, is that the doctor does not have a physical relationship with the patients and thus is in no position to make a diagnosis, and thus can not legally prescribe drugs.

Ironically when one compares the work up that one has to go through to consult with an online physicians and compares this to a face-to-face visit with a brick and mortar doctor, one finds that the online physician, in many cases, has a better understanding of the patient’s medical condition than does the doctor who meets face-to-face with the patient. In most cases before an on-line a doctor prescribes any type of medication they insist on a full blood workup they may also require that one has additional tests performed, for example.

The AMA, the federal government, and various states claim, however, that it is illegal for a doctor to prescribe drugs without a valid doctor-patient relationship. While there are no laws at present that outlaw online pharmacies, various states have enacted legislation, or are in the process of enacting legislation to prohibit a doctor from prescribing drugs to a patient that they have not seen face to face. Some states also require that the doctor that prescribes the drugs be licensed in their state. This alone could hamper the development of cyber-medicine. According to William Hubbard (2004), FDA associate commissioner “The Food and Drug Administration says it is giving states first crack at legal action, though it will step in when states do not act” (FDA, 2004).

Internet Pharmacies

The reason that email boxes around the country fill up with offers to supply drugs of all kinds, at reduced prices, without prescriptions, and more is because people buy them as the billions of dollars the drug companies are making each year attest to. The Internet has become the drug store of choice for many.

Categories of Internet Pharmacies

Internet pharmacies are generally acknowledged to be comprised of the following five categories:

Internet pharmacies can be divided up into five different categories, as follows:

Licensed online pharmacies with a no medical affiliation.

Licensed online pharmacies with a medical affiliation

No record online pharmacies (NRP)

International online pharmacies (IOP)

Licensed compounding pharmacies

The licensed online pharmacies with a no medical affiliation are of course Drugstore.com, CVV, and others. They all require a prescription from a licensed doctor that the patient has a doctor patient relationship with. The prescription can be called in by the doctor.

The licensed online pharmacies with a medical affiliation often depend on a broker. The broker collects your medical information, and then assigns your case to one of their networked physicians. Many of these networked physicians are willing to prescribe pain killers as they believe that it is only through the use of these drugs that some people can live a harmonious life.

A Government Accountability Office (GAO) Committee on aging held in June 2004 found that “Unlicensed international pharmacies do not require a prescription, and are generally located off shore.” No prescription pharmacies can be found all over the world. Many of these sites have come under controversy as in some cases all it takes to have that prescription delivered to you by next day air, is to fill out a questionnaire online.

A study conducted by Henkle in 2002 to ascertain how easy it would be to obtain drugs over the Internet found that “37 of the 46″ pharmacy required a prescription from a licensed doctor. The emphasis was on the prescription and not on the doctor. Henkle (2002) in fact notes that some sites offered to recommend a doctor.” Henkle (2002) was able to obtain prescription drugs from nine sites outside the US during the study, without a prescription.

Online pharmacies with a doctor affiliation

There are a number of online pharmacies, with a medical affiliation is that take great pain to differentiate themselves form unlicensed overseas pharmacies. These pharmacies, stress that they are “American based companies that provides consumer’s easy access to FDA approved online prescriptions over the Internet and are quick to point out that “An online consultation can be just as relevant as an in-person consultation.” It is interesting to note that many of these online pharmacies also point out that “While they are committed to making access to online prescriptions easier, they believe that the Internet can not replace the importance of regular doctor visits to fully evaluate your health and any medical conditions.” Many of these online pharmacy sites also makes a wealth of drug information available on its web site that enables the consumer to educate themselves on drugs that may have been prescribed. The Internet has for all intensive purposes is quickly replacing the brick and mortar base physician as a patient’s primary health care provider.

A sales pitch, of course, or is it? Most of the legitimate online pharmacies ensure that they comply with state and federal regulation. The doctors are licensed in all 50 states and their pharmacies are too. These legitimate Internet pharmacies cater to those that are looking for a better price; for some it comes down to making the choice of eating cat food on crackers in order to afford their medications because of the high US drug prices. In other cases patients resort to cyber-medicine to avoid the embarrassment of having to deal with a physician or pharmacy that may be judgmental. Many of these online pharmacies will arrange a consult with a licensed, medical doctor over the phone and will then fill the prescription accordingly.

According to Henkel (2000) “More and more consumers are using the Internet for health reasons” and references a study carried out by a market research firm Cyber Dialogue Inc., “that found that “health concerns are the sixth most common reason people go online” (Henkel 2000).

For many people a trip to the pharmacy is an ordeal. In some cases the local pharmacy may also be located in the closest town which may mean a long drive if one lives in a rural community. Online pharmacies provide a means through which their prescriptions can be delivered conveniently and quickly. Being online also allows the consumer to shop for the best prices, an important factor if one is living on a pension.

The Internet has also created a more aware user. It is not unusual for a consumer to research drugs on the Internet. A consumer may have seen a TV or magazine advertisement advertising a new drug. Ultimately, the Internet also provides the consumer the opportunity to enter into a doctor patient relationship that may in fact be more legitimate than the doctor who makes a physical appearance. Further information on doctors that practice telemedicine can be found at: http://www.becomeone.com

It is interesting to note, as discussed previously, that consumers are becoming dissatisfied with the care and treatment they receive from both brick and mortar physicians and pharmacies. Zanf (2001), references a study by Lang and Fullerton that “Identified four factors related to outpatient pharmacy services: professional communication, physical and emotional comfort, demographics, and location and convenience.” All of which are contributing factors as to why more and more consumers are resorting to cyber-medicine.

The Dark Side

There is also a dark side to the Internet pharmacy, as previously discussed, spam email touting the availability of any prescription drug one could want, without a prescription, is something everyone is familiar with has reached epidemic proportions.

From Ambien, and of course Viagra to more powerful drugs such as Oxycontin, you can have it all. Over night shipping is available in most case, or so these emails proclaim.
In some instances this pharmacy spam originates from unscrupulous individuals who have no intention of delivering the drugs, realizing that very few people, if any, will complain about the non delivery of an illegal drug through the mail.

In other cases the drugs are sent without a prescription from countries where that particular drug may legally be sold without a prescription, or at least the laws are more relaxed. Valium, for example, is sold over-the-counter in Taiwan.

According to Crawford (2004) “Consumers who purchase drugs online thinking that they are they are getting the same drugs as they would from their local brick-and-mortar pharmacy are being misled, and as a result are putting their health, and eventually their lives at risk” Crawford cites examples of Internet pharmacies supplying drugs that were under strength, contaminated and mislabeled (Crawford 2004).

According to Won (2005) Drug-industry executives think the Internet and mail-order operations will be the biggest source of counterfeit drugs over the next five years, according to a report released today by Ernst & Young. According to James G Dickinson (2005):

The federal government in July shut down an alleged illegal Internet pharmacy for selling counterfeit drugs and issued a warning on other counterfeits found to have been sold in Mexican border pharmacies to individual patients from the U.S. The Internet pharmacy had sold more than $7 million in counterfeit Viagra and other prescription drugs over the past five years, according to the San Diego Union-Tribune. The San Diego-based operation required individuals to complete a $35 “doctor consultation” survey before receiving the prescriptions, but the survey was never shown to a health professional to evaluate whether a safety risk existed, the paper says (Dickson, 2005).

In a separate action, the FDA warned Americans about counterfeit versions of Merck’s cholesterol drug Zocor and generic Carisoprodol – used for treating musculoskeletal conditions – that had been imported from Mexico by individual Americans (FDA, 2005).

Over the last year patients suffering from pain, and other conditions that they are reluctant to see a doctor face-to-face, have had the option of consulting a doctor online. The ability to consult with a doctor online, and then to receive drugs as a result has come under much controversy. This has for the most part been as a result of not adequately screening patient’s records, or ordering from unregulated overseas pharmacies.

The Internet – a new way of marketing

Not all Internet pharmacies are illegitimate, however, and there are many pharmacies that provide the consumer with a legitimate prescription by overnight service. My last prescription came by mail. The whole transaction was completed over the Internet. It was a prescription that my doctor had given to me personally, however. As discussed, what constitutes a doctor patient relationship is at the crux of the online pharmacy debate. This of course has implications as to what constitutes a legitimate prescription. What constitutes a legitimate prescription is a hotly debated topic.

The Future

As noted, being able to consult a doctor over the phone, and then have one’s prescription filled by an Internet pharmacy is convenient for many people. As the American population ages, more and more people will have trouble getting to the doctors office, not to mention driving to the pharmacy. Clearly safeguards are needed if cyber-medicine is to raise the quality of medical care available to Americans. The online pharmaceutical industry has taken a number of steps to ensure that consumers are protected against unscrupulous online pharmacy operators including the certification of online pharmacies.

According to Henkel (2000) “One way consumers can ensure the quality of an online pharmacy is to look for the Verified Internet Pharmacy Practice Sites (VIPPS) seal.” According to Henkel (2000) any site bearing this seal has gone through a rigorous series of quality checks which are part of the Verified Internet Pharmacy Practice Sites program. Unfortunately as Henkel (2000) notes, “Because VIPPS certification is fairly new and voluntary, only a few sites have been certified so far.” Recognizing the problem of ‘rouge’ pharmacies, SquareTrade, has also implemented a program to protect consumers from ‘rouge’ pharmacies. According to SquareTrade, “The Licensed Pharmacy program verifies that your business is a pharmacy in good standing. Verified pharmacies can display the Licensed Pharmacy Seal on their websites – distinguishing themselves from unverified and rogue pharmacies.”

If these safe guards are not put in place, and legislation is enacted that makes it illegal to obtain a prescription from an online pharmacy based on an online consult, the black market for drugs will continue to thrive. Customs by its own admission only catches approximately 2% of all illicit prescription drugs that enter the US.

Negating the fact that through technology, one could enter into a doctor patient relationship that may be affordable. Security, as some have suggested could be accomplished through the use of video cameras and biometric scanners which would cut down on the number of fraudulent prescriptions written. Measures like these would put the convenience of using an online pharmacy out of the reach of those without the technology. One could also not prevent consumers from using off shore online pharmacies. While the FDA is presently trying very hard to get the Canadian government to enact legislation that would prohibit the export of drugs from Canada by mail it appears that the profit that results from the sale of drugs is causing the legislation to stall. As one Canadian pharmacy owner noted, however “We will just move to the UK.”

Ironically, the Canadian’s are offering to crack down, not because of any concerns relating to the sale of drugs online, but because Canada controls drug prices, making them far cheaper than the same drug in the US. The Canadian authorities are planning on cracking down “arguing that the system was created to help Canadians, not Americans.” The drug industry itself has gone so far as to black list Canadian pharmacies that sell to American customers over the Internet. With all the paranoia relating to terrorism there is a concern that any drug coming in from another country may be contaminated. There are no instances on record of a consumer having received a contaminated drug from Canada (Matthews, 2003).

Even more ironically with all the talk about the dangers of drugs purchased from overseas, some legitimate companies are now being forced to buy from other than US sources because they have been black listed by US drug manufactures (Matthews, 2003). Mathews (2003) goes on to illustrate this by pointing out that “Canadian suppliers, in particular, that have been blacklisted, are now turning to sources in Europe.” Mathews (2003) notes that while for the most part these European sources are legitimate and make a high quality drug. In some cases, however Mathews et al. (2003) note that the pharmacies are having to go ‘farther a field’ to find product.

Conclusion

While there need for controls to be put in place to regulate the practice of both medicine online and Internet pharmacies, we also need to acknowledge that science and technology has furthered the practice of medicine, and that the Internet will further it yet.

The Internet has the potential of expanding medical care to those that may not routinely seek it, or are too infirm to travel to the doctor’s office. While the present trend appears to be to make it illegal for a doctor to prescribe drugs without seeing the patient face-to-face there is also a move to establish rules and regulations that ensure that patients receive quality care over the Internet. Unfortunately medicine and politics have become so intertwined and doctors have inadvertently become unwilling agents in the war against drugs.

One can’t turn back the clock though, and according to Larkin (1999) “At a July 30 US Department of Commerce hearing on the benefits and risks of ‘drugstores on the net’, the question was examined.” The main issue was how to shutdown the online pharmacies run by unscrupulous individuals, while still fostering the legitimate online pharmacy business in order to both promote commerce and still protect the consumer (Larkin, 1999). According to Larkin (1999) “What’s new here is not the practice of pharmacy, but the way we communicate with and inform customers.”

At a January 26th 2004 FDCH Congressional Testimony Jeff Kimmell who is vice President and Chief Pharmacy Officer at drugstore.com, inc. commented, “There is little doubt that as consumers increasingly bear the burden of paying for prescription drugs, they will turn to the Internet for cost- effective alternatives.” As discussed, however, measures need to be taken to ensure that consumers don’t receive counterfeit, tainted or expired drugs. For more up-to-date information on doctors that practice telemedicine, pending legislation, and more visit: http://www.becomeone.com

Copyright (2005) http://www.becomeone.com

All rights reserved. No part of this article may be altered without the express permission of the author.

Careers in Pharmacy – What Should I Pursue?

Pharmacies generally employ two types of professionals: Pharmacists and Pharmacy Technicians. While both are integral to a pharmacy’s performance, they represent two very different approaches to careers in pharmacy. When deciding what career path is right for you, a lot of factors come into play. In this article, we will outline these two careers in pharmacy so you can make the right choice!

Pharmacist- What is It?

Pharmacists are healthcare professionals who are in charge of dispensing prescription medications to patients. Typically, a pharmacist will fill prescriptions, check interactions of a patient’s prescriptions, instruct patients on proper use of a medication, and oversee pharmacy technician, interns, and various other careers in pharmacy. Many pharmacists own or manage their own pharmacy and are more business minded. Some pharmacists work for pharmaceutical manufacturers, and are involved in the creation of new medications. The median annual wage of pharmacists is very good, punching in at $111,570 in May 2010, according to the US Bureau of Labor Statistics.

How do I become a Pharmacist?

The path to becoming a pharmacist is unique- while most graduate programs require a bachelor’s degree or four years of undergraduate experience, a Doctor of Pharmacy program requires as little as two, as long as the appropriate prerequisites are met, such as courses in chemistry, anatomy, and biology (although some programs do require a bachelor’s degree). An entrance exam, known as the Pharmacy College Admissions Test (PCAT), is also required. Most programs will take about four years to complete, and graduates who want a more advanced pharmacist position will complete a one-two year residency program. Many pharmacists who go on to own their own pharmacies will also acquire a master’s degree in business administration (MBA). Graduates must also pass two exams detailing pharmacy skills and pharmacy law in order to attain a state license. While this process may seem long, it pays off with one of the most rewarding careers in pharmacy.

Pharmacy Technician- What is It?

Pharmacy (or pharmaceutical) technicians help pharmacists dispense prescription medications to patients. They will usually be the ones measuring out prescriptions, compounding medications like ointments, packaging and labeling pharmaceuticals, and performing routine tasks like answering phones and filling forms. The pharmacy technician will work under the supervision of the pharmacist- if the customer has questions about medications or health, the pharmacy technician will arrange for the customer to speak with the pharmacist, as he/she is the more trained of the two careers in pharmacy. Technicians must have great customer service skills, organizational skills, and be detail oriented. The median annual wage of a pharmacy technician was $28,400 in May 2010, according to the US Bureau of Labor Statistics.

How do I become a Pharmacy Technician?

Becoming a pharmacy technician provides the simpler process of the two careers in pharmacy. Each technician must have a high school diploma or equivalent and pass an exam or complete a formal training program, depending on the state. Many pharmacy technicians will learn their skills on-site, but some will attend vocational schools or community colleges to complete programs in pharmacy technology. These programs detail arithmetic, pharmacy law and ethics, and record keeping. This path will allow for the quickest work straight out of high school for graduates pondering one of the careers in pharmacy.

Both pharmacists and pharmacy technicians are absolutely vital to a pharmacy. These two positions are dynamic and rewarding, constantly helping patients get their medications. I hope this article has helped you decide which of the careers in pharmacy is right for you!

pharmacy