Drugstore chains rely on pharmacy technicians By Erik Brady and Kevin McCoy, USA TODAY When Americans bring

prescriptions to their neighborhood pharmacies, odds are the person in the white lab coat who greets them and enters the prescription in the computer is not a pharmacist. Neither, most likely, is the person who puts the pills in the medicine vial. They're probably pharmacy technicians, in some cases teenagers with no more than high school diplomas. The nation's largest drugstore chains say technicians don't replace pharmacists. But the companies have come to rely on technicians because of regional shortages of pharmacists and steady increases in prescriptions. *MORE ON OUR EXCLUSIVE SERIES: *Inside a pharmacy where a fatal error occurred <http://www.usatoday.com/money/industries/health/2008-02-12-pharmacy-errors_N.ht m> Walgreens, the nation's largest drugstore chain by sales and profits, employs about 39,000 technicians, compared with more than 24,000 pharmacists. CVS, (CVS) <http://stocks.usatoday.com/custom/usatoday-com/html-quote.asp?symb=cvs>the largest retail chain in terms of store count, employs about 41,000 pharmacy technicians, more than double the 20,000 pharmacists who work for the firm. Technicians do much of the administrative work pharmacists used to perform, such as prescription data entry, counting pills, filling vials and ringing registers. Depending on your point of view, that's good news, because it frees pharmacists to do more important clinical functions or bad, because technicians sometimes make mistakes that pharmacists don't catch, and because pharmacists often have little time to help teach the technicians. The hiring practice does make good business sense: Technicians earn an average of $11 an hour. That translates to about $23,000 a year for those who work full time. Many pharmacists make more than $100,000 a year. *Techs aren't required to be certified * Unlike pharmacists, who are regulated by pharmacy boards in each state, technicians are inconsistently monitored from state to state. The Pharmacy Technician Certification Board guarantees that those who pass its examination meet a national standard. But technicians don't need that certification to work in many states. Just 30 states even mention certification in their rules, and most of those don't mandate it. That comes as a surprise to many Americans, according to the certification board, which administers the two-hour, 100-question exam that tests technicians' knowledge of pharmacy practices. In December, the board released the results of a survey that found 73% of respondents believed technicians "are required by law to be trained and certified before they can help prepare prescriptions." Just 9% recognized that as false. The nation's state legislatures should raise standards by requiring technicians to pass a standardized certification exam, says Paul Doering, a University of Florida pharmacy professor. He notes that some

nations, such as Germany, mandate two years of formal training. Walgreens (WAG) <http://stocks.usatoday.com/custom/usatoday-com/html-quote.asp?symb=wag>says nearly 26,000 of its technicians are certified; the chain subsidizes test fees and gives raises to technicians who pass. CVS says about 12,000 of its technicians are certified; the chain pays for study guides and registration fees. Both chains also have companywide training systems. Walgreens says it is the only chain whose training has been approved by the American Society of Health-System Pharmacists. CVS requires technicians to pass internal training at three levels as they move up to more difficult duties, says Papatya Tankut, vice president of pharmacy professional services. Technicians "focus on the technical functions and (allow) the pharmacist time to do the professional functions that a technician cannot," such as counseling patients, Tankut says. "That allows a pharmacist time to really feel not overworked." *The technician-to-pharmacist ratio * Within the industry, there is no consensus on how many technicians a single pharmacist is capable of supervising while still ensuring prescription safety. At least 16 states have no limits, according to a survey by the National Association of Boards of Pharmacy. Six others allow a 4-to-1 ratio of technicians to pharmacists. The remaining states have ratios of 2-to-1, or 3-to-1. Pharmacy chains and many industry experts say such ratios are safe. Still, a USA TODAY review of pharmacy board records in 10 states found numerous cases in which pharmacists did not catch technician errors. In a typical example, Massachusetts pharmacy board records show an unidentified technician "entered the information incorrectly into the computer" in the prescription a CVS pharmacy dispensed to Shaun Taylor. The Kingston man suffered breathing difficulties that required hospital treatment in 2005 after he was given a Fentanyl painkiller skin patch three times stronger than prescribed, the records show. An investigation report by the Massachusetts Division of Health Professions Licensure found the prescribing doctor wrote other information in the space where information about drug strength normally goes, which CVS said was a contributing factor. But the pharmacist didn't verify the hard copy of the prescription, "and by skipping this step, she missed the opportunity of detecting the technician error," the report said. CVS and Taylor agreed to a confidential settlement. Philip Burgess, Walgreens' national director of pharmacy affairs, said in a 2006 deposition that the chain had to rely on technicians and new technology to cope with rising prescription volume. The number of prescriptions "is going to continue to rise as the baby boomers move into the pill-taking age," Burgess said. "And the numbers of pharmacists to fill them is not going to be able to keep pace."