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CPE Information and Disclosures Advancing the Roles for Pharmacy Technicians in an Evolving Health Care Environment: Failure is Not an Option!

1 CPE Information and Disclosures Advancing the Roles for Pharmacy Technicians in an Evolving Health Care Environment: Failure is Not an Option! Michigan Pharmacists Association February 25, 2017 Miriam A. Mobley Smith declare(s) no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. Miriam A. Mobley Smith, PharmD, FASHP Director of Strategic Alliances, PTCB Learning Objectives A competent pharmacy technician workforce will be fundamental to advancing the patient care role of pharmacists in the FUTURE. Describe the national landscape and expanded roles for pharmacy technicians. Identify the differences in pharmacy technician education and licensing requirements across state regulatory boards. Describe the potential for enhanced patient care, patient safety, and pharmacy technician accountability through pharmacy technician accredited education, licensure and certification. Contrast and compare pharmacist and pharmacy technician viewpoints on pharmacy technician education, training and certification. Which of the following statements are true? a. There currently is one uniform national standard for pharmacy technician education, training, and certification. b. Pharmacy technician roles and responsibilities have advanced as a result of expanded direct patient care role for pharmacists. c. The elevation of education and training requirements for pharmacy technicians has been eagerly adopted across all pharmacy practice sectors. d. Boards of Pharmacy are responsible for enacting legislation that governs pharmacy technician practice. Which of the following are emerging roles and responsibilities for pharmacy technicians? a. Patient counseling for OTC medication and DUE/ADR monitoring b. Anticoagulation dosage adjustment and medication reconciliation c. Prescription clarification and tech check tech in community pharmacies d. Chronic care clinic medication history and influenza vaccine administration. 1

2 Pharmacists and pharmacy technicians can advocate for the adoption of uniform education, training, and certification standards through which of the following methods? a. Talk with state board of pharmacy members b. Correspond with members of the state legislature c. Volunteer for leadership positions within state and national pharmacy associations d. All of the above Reflecting on state regulation of pharmacy technicians across all 50 states and the District of Columbia, which of the following statements is true? a. Less than 50% require continuing education b. More than 50% require a background check c. More than 50% include national certification d. Less than 50% accept PTCB certification Status of Pharmacy Technicians By The Numbers The Odd Couple Blurred Lines House of Lies/Cards If You Don t Know Me by Now There s No You Without Me Bridge Over Troubled Waters Drop It Like Its Hot! The Ugly Truth Risky Business Sweet Smell of Success Our Day Will Come The Final Frontier A Bridge Too Far The Good, the Bad, the Ugly I Got a Feeling To Be or Not to Be Trouble in Paradise The Wages of Fear NIMBY (not in my backyard) Mission Impossible Radioactive A Star is Born Are We There Yet Madness! 2015, Median Pay $15.23 hr / $31,680 yr 2015, Number of Jobs 379,430 Job Outlook, % growth Employment Change, ,700 Employment increase is 9% faster than average for all occupations Increased demand for prescription medications and interprofessional team based care will lead to more demand for pharmacy services and advanced roles for pharmacists and technicians Advanced roles require moving technicians from unskilled labor to certification for protection of patient safety U.S. Bureau of Labor Statistics, Dec Pharmacy Times, Transitions of the Profession The pharmacy profession is under pressure to change. Access Affordable Care Act Mergers Collaborations Reimbursements Star Ratings Collaborative Practice Medicaid Expansion Provider Status Medical Home Model Access to Care PHARMACY Accountable Care Organization Reimbursement Rates Medically Underserved Affordable Care Act Emerging Pharmacy Technician Roles and Responsibilities Medication reconciliation Medication therapy management Immunization Indigent care prescription programs Sterile & non sterile compounding Clinical technicians (e.g., chronic care, appt. scheduling, medication adherence, smoking cessation, vital signs measurements, data management, etc.) Tech check tech Point of Care Testing Education Prescription clarification Quality assurance and quality improvement initiatives CMS CMMI Grant Projects (Innovations Center) Community outreach programs DUE/ADR monitoring Informatics Medication safety initiatives Telepharmacy Refill counseling screening Board of Pharmacy. 2

Going in the Same Direction Pharmacists Entry into the Profession Well educated and highly skilled pharmacy technicians have important roles and responsibilities in the pharmacy enterprise.

To properly fill these roles, pharmacy technicians require standardized education, training, and competency assessment.

ACPE Accredited Pharmacy School North American Pharmacist Licensure Exam (NAPLEX) Multistate Pharmacy Jurisprudence Exam (MPJE) State Board Requirements ASHP Statement on the Role of the Pharmacy

3 Going in the Same Direction Pharmacists Entry into the Profession Well educated and highly skilled pharmacy technicians have important roles and responsibilities in the pharmacy enterprise. Safe and effective medication use process depends significantly on the skills, knowledge, and competency of those pharmacy technicians. To properly fill these roles, pharmacy technicians require standardized education, training, and competency assessment. Pharmacists ability to redistribute their focus to more clinical and patient centered activities is dependent upon pharmacy technicians utilization in key roles within the medication use system. ACPE Accredited Pharmacy School North American Pharmacist Licensure Exam (NAPLEX) Multistate Pharmacy Jurisprudence Exam (MPJE) State Board Requirements ASHP Statement on the Role of the Pharmacy Technicians American Society of Health System Pharmacists. ASHP statement on the roles of pharmacy technicians. Am J Health Syst Pharm. 2016; 73: In Comparison... Pharmacy technicians do not experience the same linear path into the profession There is no national educational requirement Pharmacy board regulations vary among 50 states + D.C. 45 states regulate pharmacy technicians 24 states include national certification in their regulations Pharmacy Technician Training, Competency, Practice (CCP preferred state) Start Process of Becoming a Pharmacy Technician Accredited Training Certification Registration or Licensure by Board of Pharmacy Work as a Pharmacy Technician Exit Council on Credentialing in Pharmacy Pharmacy Technician Credentialing Framework Aug pdf Various Points of Entry for Pharmacy Technicians What do this ketchup bottle and the current U.S. pharmacy state board regulations on pharmacy technician education and certification have in common? Registration Licensure Certification Programmatically accredited Non accredited Board Regulation Formal Education Employer Training Board Approved Exam Community based Hospital based PTCE ExCPT State exam. 3

Technician Requirements No national uniform standards for employment, education, regulations Requirements may include: Formal pharmacy technician education Prior experience National certification

College of Pharmacy associated programs Employer sponsored High school programs Military training programs Certification review courses Approximately 1200 programs in US 270+ accredited by ASHP/ACPE

4 Technician Requirements No national uniform standards for employment, education, regulations Requirements may include: Formal pharmacy technician education Prior experience National certification (Certified Technician CPhT) State certification State registration Continuing education; competency assessments Types of Technician Programs Requirements may include: Certificate and degree programs College of Pharmacy associated programs Employer sponsored High school programs Military training programs Certification review courses Approximately 1200 programs in US 270+ accredited by ASHP/ACPE State Regulations Vary Widely What Does the Public Think? 45 states and DC regulate pharmacy technicians 24 states include national certification in regulations 4 states accept only the PTCE for national certification 19 states require a background check 22 states require CE JS7 10 states have a pharmacy technician serving on the state Board of Pharmacy 5 states do not regulate pharmacy technicians Many states have pending legislation or regulations In a recent survey, the public was asked about the importance of certification and training for pharmacy technicians: Everyone who compounds (or mixes) custom medications is specially trained and certified The people preparing prescriptions are certified State regulations require training and certification of all pharmacy technicians All pharmacy technicians are held to the same standard no matter what state they work in Pharmacies only hire pharmacy technicians who are certified Very important Somewhat important % 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% % 94% 94% 91% 91% What Does the Public Want? Three quarters of consumers say that they would seek out a pharmacy where the pharmacy technicians were certified. Frequent visitors are more likely to seek out a different pharmacy, and adults with children at home are even more likely to say they d look elsewhere.. 4

5 Slide 21 JS7 10 sounds like a LOT. Again, I don't know the numbers that well, but I haven't heard this one before. Jill Spivey, 6/21/2016

Teamwork Coming together is a beginning Keeping together is progress Working together is success Henry Ford Mission and Vision Mission: PTCB advances medication safety by certifying technicians who

JS1 PTCB s Goals The PTCB Certification Program Improve patient care, outcomes, and access Provide resources to further enable the evolution of pharmacy technician roles Elevate standards within the

certification requirements: A high school diploma or equivalent Disclosure of all criminal and state board of pharmacy actions A passing score on the PTCE Recertification Every two years 20 hours of

6 Teamwork Coming together is a beginning Keeping together is progress Working together is success Henry Ford Mission and Vision Mission: PTCB advances medication safety by certifying technicians who are qualified to support pharmacists and patient care teams in all practice settings. Vision: PTCB sets the standard for certification of technicians that improves medication safety and patient care. JS1 PTCB s Goals The PTCB Certification Program Improve patient care, outcomes, and access Provide resources to further enable the evolution of pharmacy technician roles Elevate standards within the profession to meet the demands of the growing healthcare system Pharmacy Technician Certification Exam (PTCE): Widely recognized and trusted throughout the profession Psychometrically sound Current certification requirements: A high school diploma or equivalent Disclosure of all criminal and state board of pharmacy actions A passing score on the PTCE Recertification Every two years 20 hours of pharmacy technician specific CE 1 credit in pharmacy law 1 credit in patient safety By the Numbers 608,903 pharmacy technician certifications since 1995* 283,267 active certified pharmacy technicians* 53,353 exams in 2016* 300+ secure Pearson Vue testing centers Administered & accepted in all 50 States, DC, Guam, PR PTCB is accepted in the regulations of 45 states New PTCB Recertification Requirements 2015 PTCB only accepting pharmacy technician specific CE 2015 Number of CEs earned via in service decreased from 10 to Number of CEs earned via college credit decreased from 15 to 10 *as of 12/31/ CEs earned via in service no longer accepted. 5

7 Slide 27 JS1 I'm not sure I was aware of these goals. Are these outlined somewhere? Jill Spivey, 6/17/2016

Future 2016 PTCB Job Analysis PTCB evaluates technician duties approximately every 5 years Principal tools are survey of tasks and knowledge/skills/abilities (KSAs) Over 40,000 surveys completed

ACPE/ASHPaccredited education program Pharmacy Technician Accreditation Commission (PTAC) Suspended January 2017 Why 2020 Expanding roles of pharmacy technicians Advance patient care and improve

8 Future 2016 PTCB Job Analysis PTCB evaluates technician duties approximately every 5 years Principal tools are survey of tasks and knowledge/skills/abilities (KSAs) Over 40,000 surveys completed Results inform test content (including domain weights) and other eligibility requirements Preliminary results incorporated into the 2017 consensus conference PTCB 2020 Initiative 2020 Complete an ACPE/ASHPaccredited education program Pharmacy Technician Accreditation Commission (PTAC) Suspended January 2017 Why 2020 Expanding roles of pharmacy technicians Advance patient care and improve patient safety Quality and necessity of education Profession directed Path Forward Additional deliberation and research needed Stakeholder meetings & consensus building Accreditation training standards changes Addressing demand; distance learning Why ASHP/ACPE Accredited Education? A better qualified and trained workforce Improved patient safety Greater consistency in technician workforce Accreditation standards updated as needed to stay consistent with expanding roles and responsibilities of technicians Greater ability to delegate technical tasks from pharmacists JS11 Less turnover in pharmacy technician positions Proactive approach to drug diversion prevention Distance Education Bringing the availability and affordability of accredited pharmacy technician education and training anywhere. Simulation and distance education TRC Pharmacy Technicians University accredited in June 2016 How Will Technology Drive Roles? Incremental Change Paradigm Shift. 6

9 Slide 34 JS11 Is this true? I didn't know that there was evidence of less turnover? Jill Spivey, 6/21/2016

Preparing for the Future Service model enhancement Prepare pharmacists and pharmacy technicians for roles/responsibilities expectations in advance of practice activities enhancement Minimizes

pharmacy to provide and conduct research on impact of advanced practice models and certified technician utilization How Do We Get There Future: What should practice look like?

10 Preparing for the Future Service model enhancement Prepare pharmacists and pharmacy technicians for roles/responsibilities expectations in advance of practice activities enhancement Minimizes pharmacist workforce reduction Seek collaborations with physician practice groups, accountable care organizations, others for alternative payment models compensation Partner with colleges/schools of pharmacy to provide and conduct research on impact of advanced practice models and certified technician utilization How Do We Get There Future: What should practice look like? Courage: Embrace/incorporate standards to get there Action: Time is now Teamwork: Work together to achieve goals The Future: A Need for Consensus PTCB State Certification Pharmacy Associations National Pharmacy State Boards of Technician Pharmacy Associations Employers, National Educators, Pharmacy PTAC Associations National Consensus Conference ASHP, ACPE and PTCB convened an invitational conference February 2017 Dallas, Texas; approximately 100 participants Preconference surveys, reports to inform Develop consensus among a broad group of pharmacy stakeholders with respect to: Technician scope of practice Entry level knowledge, skills, and abilities that all pharmacy technicians must have regardless of practice site Recognition of competencies beyond entry level practice and related issues Education, training and certification requirements State board of pharmacy registration or licensure Pre Conference Survey Results (High Agreement Among Respondents) Pharmacy supportive personnel encompass different types of workers, ranging from individuals with clerical duties to individuals (pharmacy technicians) who assist pharmacists with their professional responsibilities. The profession of pharmacy has an obligation to make certain that pharmacy technicians are educated and trained in a manner that ensures public safety. The profession of pharmacy has an obligation to make certain that pharmacy technicians are regulated in a manner that ensures public safety. Pre Conference Survey Results (High Agreement Among Respondents) In the interest of public safety, state boards of pharmacy have an obligation to regulate the scope of practice of pharmacy technicians. In the interest of public safety, state boards of pharmacy have an obligation to establish the minimum qualifications of pharmacy technicians. There are generalist (entry level) knowledge, skills, and abilities that all pharmacy technicians should have regardless of practice site.. 7

11 Pre Conference Survey Results (High Agreement Among Respondents) Beyond the generalist (entry level) knowledge, skills, and abilities of all pharmacy technicians, individual technicians may require education and training to achieve additional knowledge, skills, and abilities related to a specific sector of practice or for advanced duties. The profession of pharmacy should encourage pharmacy technicians to pursue their occupation as a lifelong career. Pre Conference Survey Results (Moderate Agreement Among Respondents) In the interest of public safety, state boards of pharmacy have an obligation to define the nature of licensed pharmacist oversight of pharmacy technicians. A valid national task analysis, inclusive of pharmacy technicians across all pharmacy work settings, should be used as the foundation for pharmacy technician education, training, and certification. Pre Conference Survey Results (Moderate Agreement Among Respondents) Pre Conference Survey Results (Moderate Agreement Among Respondents) Pharmacy technicians who have completed education and training that conforms to a uniform national standard should have their competence tested through a valid certification examination before becoming fully registered or licensed by a state board of pharmacy. State boards of pharmacy should require pharmacy technicians to maintain their national certification for continued registration or licensure. Additional certification programs should be developed to allow pharmacy technicians to demonstrate competence beyond entry level. Expanding the role of pharmacy technicians will allow pharmacists to devote more time to working closely with patients, physicians, and others in fostering responsible use of medicines. Pre Conference Survey Results (Strong Variance Among Respondents) Variability among states in the definition and regulation of pharmacy technicians should be minimized. A national accreditation system should evaluate pharmacy technician education and training programs against nationally established standards (using a process analogous to that for evaluating pharmacist education programs). State boards of pharmacy should require pharmacy technicians to complete a nationally accredited education and training program. State boards of pharmacy should develop a "pharmacy technician in training" registration category. Audience Discussion Questions Select, review and discuss the questions Will focus on areas with greatest divergence of opinion Consider both profession wide and state related perspectives Indicate the extent to which you agree/disagree with the statements. Strongly Agree Agree Disagree Strongly Disagree Share examples/viewpoints from discussions with audience Audience feedback. 8

In the interest of public safety, state boards of pharmacy have an obligation to define the nature of licensed pharmacist oversight of pharmacy technicians.

12 Please indicate the extent to which you agree/disagree with the following statements. Strongly Agree Agree Disagree Strongly Disagree 1. Expanding the legal role of pharmacy technicians will allow more pharmacists to devote more time to working closely with patients, physicians, and others in fostering responsible use of medicines. 2. In the interest of public safety, state boards of pharmacy have an obligation to define the nature of licensed pharmacist oversight of pharmacy technicians. Please indicate the extent to which you agree/disagree with the following statements. Strongly Agree Agree Disagree Strongly Disagree 3. A valid national task analysis, inclusive of pharmacy technicians across all pharmacy work settings, should be used as the foundation for pharmacy technician education, training, and certification. 4. Educational outcomes and competencies for pharmacy technicians, based on the national task analysis, should be defined and used in the education, training, and certification of technicians. Please indicate the extent to which you agree/disagree with the following statements. Strongly Agree Agree Disagree Strongly Disagree 5. A national accreditation system should evaluate pharmacy technician education and training programs against nationally established standards (using a process analogous to that for evaluating pharmacist education programs). 6. State boards of pharmacy should require pharmacy technicians to complete a nationally accredited education and training program. 7. Variability among states in the definition and regulation of pharmacy technicians should be minimized. Please indicate the extent to which you agree/disagree with the following statements. Strongly Agree Agree Disagree Strongly Disagree 8. Pharmacy technicians who have completed education and training that conforms to a uniform national standard should have their competence tested through a valid certification examination before becoming fully registered or licensed by a state board of pharmacy. 9. State boards of pharmacy should require pharmacy technicians to maintain their national certification for continued registration or licensure. 10. State boards of pharmacy should require pharmacy technicians to maintain their competency through the completion of continuing professional education. The Way Forward Elevate standards within the profession to meet the demands of the growing healthcare system Improve patient care, outcomes & access Support evolving roles & scope of practice Provide platform to advance pharmacy technicians Technicians must have education, training and credentials to advance with the pharmacy workforce Summary Roles are evolving & scope of practice is expanding Regulations vary governing entry No national standardized education requirement for pharmacy technicians exists Greater expectations from technicians Enable, empower, educate. 9

Practicing at Top Of Our License. Failure is Not an Option!!! Which of the following statements are true? a. There currently is one uniform national standard for pharmacy technician education, training, and certification.

re role for pharmacists. c. The elevation of education and training requirements for pharmacy technicians has been eagerly adopted across all pharmacy practice sectors. d.

13 Practicing at Top Of Our License. Failure is Not an Option!!! Which of the following statements are true? a. There currently is one uniform national standard for pharmacy technician education, training, and certification. b. Pharmacy technician roles and responsibilities have advanced as a result of expanded direct patient care role for pharmacists. c. The elevation of education and training requirements for pharmacy technicians has been eagerly adopted across all pharmacy practice sectors. d. Boards of Pharmacy are responsible for enacting legislation that governs pharmacy technician practice. Which of the following are emerging roles and responsibilities for pharmacy technicians? a. Patient counseling for OTC medication and DUE/ADR monitoring b. Anticoagulation dosage adjustment and medication reconciliation c. Prescription clarification and tech check tech in community pharmacies d. Chronic care clinic medication history and influenza vaccine administration Pharmacists and pharmacy technicians can advocate for the adoption of uniform education, training, and certification standards through which of the following methods? a. Talk with state board of pharmacy members b. Correspond with members of the state legislature c. Volunteer for leadership positions within state and national pharmacy associations d. All of the above Reflecting on state regulation of pharmacy technicians across all 50 states and the District of Columbia, which of the following statements is true? a. Less than 50% require continuing education b. More than 50% require a background check c. More than 50% include national certification d. Less than 50% accept PTCB certification Questions? Miriam A. Mobley Smith, PharmD, FASHP Director of Strategic Alliances mmobleysmith@ptcb.org Constitution Avenue, NW Suite 101 Washington, DC

What s New? Objectives. Disclosures. PTCB Certified Pharmacy Technicians: Playing a Critical Role in Practice Model Change

What s New? Objectives. Disclosures. PTCB Certified Pharmacy Technicians: Playing a Critical Role in Practice Model Change PTCB Certified Pharmacy Technicians: Playing a Critical Role in Practice Model Change Disclosures The program chair and presenters for this continuing pharmacy education activity report no relevant financial