Pharmacy Technician Career
Environments
 Retail Pharmacy
 Retail pharmacy, also know as community based pharmacy or
community pharmacy, is a very common environment in
which pharmacy technicians are employed. These
pharmacies provide prescription services and an outlet for the
sales of commonly purchased good and services.
 Retail pharmacies consists of independent pharmacies and
chain pharmacies.
 In general, the major benefit of retail pharmacies is
accessibility. Often the patient will go to see the pharmacist
at a retail store first before seeking medical attention for
which they may have limited access to or no insurance to help
cover the costs.
Independent Pharmacy
 Owned as a sole proprietorship by one or a few owners.
 Provide prescription filling along with other ancillary
services (surgical supplies, vitamins, hallmark®)
 Often provide personal services
 Major benefit: familiarity of the pharmacists with the
customers
 Disadvantage: may not have the pricing power of
larger chain stores.
Chain Drug Stores
 National franchises like Walgreen’s, CVS, Rite Aid, and
Duane Reade (east coast) have many stores around the
US and/or in a regional area
 Offer convenience with many stores operating 24/7
 Major advantages: pricing power, convenience, and
accessibility.
 Disadvantages: lack of personalized service between
pharmacist and patient.
Retail Staff
 Supervising pharmacist: a full time pharmacist who is in charge
of the legal and administrative aspect of the pharmacy
 Store Manager: a person, who may or may not be a pharmacist,
that is in charge of the operation of the store in general
 Typically the store is divided into front end and back end.
 Front end deals with OTC issues and other non medication issues a
customer may have
 Back end contains the pharmacy
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Stores the legend medications
Stores other restricted meds and higher priced devices
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Blood glucose strips, blood pressure monitors, Plan B, and products that
contain pseudoephedrine.
Combat Methamphetamine epidemic act of 2005 requires removal of
pseudoephedrine products from the public area and mandates record
keeping with the per transaction limit of 3.6 grams per patient.
Regulatory Agencies
 State Boards of Pharmacy regulates the practice of
pharmacy which in NYS are contained in the education law
of the board of regents article 137, the public health law
article 33 for controlled substances, and the NYSRR title 10
among others. SBOP conducts inspections of pharmacy
facilities.
 Centers for Medicare and Medicaid Services: CMS
regulates the federal programs of Medicare and Medicaid
along others. CMS conducts inspections to ensure
compliance with federal regulations.
 Third Party Payers: Third party insurance companies also
may conduct inspects of pharmacy establishments to
determine if contractual agreements are kept between
insurance payer and the pharmacy.
The Prescription
 The pharmacy technician is often the first person to
examine the patient’s prescription for completeness
and other issues.
 Due to this it is very important that a pharmacy
technicians understands the basic elements of the
prescription to save time and to ensure customer
satisfaction. This is probably the technician’s primary
function in the retail setting.
The Elements of the Prescription
 Patient’s name, address, and age.
 Prescriber’s name, address and phone.
 Date it was written
 Name, strength, and quantity of drug
 Directions for use
 Signature of the prescriber (very important)
 Route of administration
 Product selection permitted (if brand or generic
permitted)
 Probably the most important element on the prescription is the
signature of the prescriber. Whether electronic or hard copy the
signature must be there for the prescription to be valid.
 In NYS, according to article 137 of the education law 6802
electronic prescriptions are allowed in NYS. An electronic
prescription is a prescription that is created and generated by the
prescriber and sent electronically (E prescribing). Prescriptions
for controlled substances are not permitted to be electronically
generated in NYS; however under federal law CIII-CV can be sent
electronically. In all cases CII can’t e-prescribed
 Section 6810 states that in addition to the signature, the stamped
or imprint name of the prescriber must be on the prescription
 In NYS, the pharmacist is permitted to clarify and enter data on the
prescription to include all information with the exception of the
signature. If a prescription is filled without the signature the
pharmacist will be guilty of professional misconduct under Part 29.7 of
the board of regents. In addition, the date can’t be added on an Rx for a
controlled substance
 If the patient’s information and/or the prescriber’s information is
readily retrievable in the pharmacy computerized records, the physical
presence of this information on the prescription is not necessary
 The face of the prescription must be signed or initialed by the
pharmacist with the date filled; refills must be documented on the
back with the date filled along with the Pharmacist’s initials. Records
of refills may be stored electronically (NYS)
 Remember, CII can’t be refilled.
 CIII can be refilled 5 times or 6 months
 CIV and CV for 11 refills or one year.
Prescription Elements Continued
 Other elements on the prescription may include
 Prescriber’s license number and registration number
 Prescriber’s DEA number (required to write a controlled
substance prescription)
 Prescriber’s NPI or national provider’s identification
number. This is required by medicare in the filling of
surgical products.
DEA Numbers
 Any entity handling controlled substances in the US
from prescribing , dispensing and manufacturing
requires registration with the DEA of the US
Department of Justice.
 Consists of two letters A or B followed by the first
letter of the prescriber’s last name following by a seven
digit number. One way to determine if a DEA is
fraudulent is the calculate the sum of digits 1,3, and 5
and add it to twice the sum of 2,4,and 6. The result
will have a digit which should match the check digit of
the DEA number, the last digit
NPI numbers
 The NPI is a ten digit number that was created by HIPAA
act of 1996. The NPI is a unique identifier that is used by
CMS to identify healthcare providers for the purposes of
administrative issues and reimbursements.
 Often other third party payers utilize this number to file
claims and payments to pharmacies.
 Often an adjudication is denied because of lack of
prescriber’s NPI. The NPI for various providers can be
found at:
https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forwa
rd=static.npistart
Who can write prescriptions?
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MD
NP
DO
DVM
DPM
Ophthalmologists
DDS
PA
Physician’s assistants can in general write for prescriptions so long as their
primary supervising physician name, address, and registration number is on
the prescription. Often the PA will use his/her physician’s prescription blank
so long as the PA signs the Rx and stamps his/her name on it with his
registration number.
 Physician Assistants, as of 2007, can write for prescriptions for CII and other
scheduled drugs. In this case he/she would use his own Rx blanks with their
own DEA numbers.
NYS Official Prescription Program
 Public Health Law 21 requires all prescriptions for
controlled drugs and other legend drugs to be issued
on an official NYS prescription which contains all
required information on it with the NYS seal, and a
serialized number on the lower right hand corner.
 Issued in an attempt to discourage doctor shopping
and to monitor prescription drug usage patterns in the
state.
 When using electronic prescribing official Rx not
required.
Filing Prescriptions
 Most states require hard copy Rx to be stored for a 5
year period.
 Further federal regulations require that controlled
substance Rx’s be filed in such a way as to be easily
retrievable by law enforcement.
 Option 1: three separate cabinets for CII, CIII-CV, and
other legend Rxs.
 Option 2: two drawer system: CII-CV with CIII-CV
marked with a “C” in the lower right corner in one
drawer and all other prescription in second drawer.
Prescription Transfers
 A refill may be transferred from one pharmacy to
another either in the same state or different states.
 A pharmacist is to handle Rx transfers.
 Some states allow transfer of all of patient’s Rx refills.
In NY only one transfer at a time is allowed.
Summary of the Retail Prescription
 Patient and Prescriber’s name and address
 Prescriber’s license #, Registration # and/or NPI
 Drugs name, strength, quantity and directions from
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use
Route
Specific issues (DAW or not, easy caps, etc)
Signature of prescriber
In some states, the imprinted name of prescriber must
be on Rx
Federal Law on Retail Prescription
 Federal law provides many means to issues prescriptions
 Electronically (even for controlled substance C3-C5, C2 can
be filled but must have written script to release to patients)
 Fax copies of C3-C5 are acceptable as original (remember
state law may be stricter)
 Controlled Substance Rx: Federal law
 C2
 No fax as original (exceptions: LTCF, Hospice, Infusion care)
 30 days only
 No refill
 Partial fill ok with remainder to be fill in 72 hours. If can’t fill
balance in 72 hours, the balance is voided. (exception is LTCF or
terminal ill patient)
 C3-C4
 30 days only
 5 refills in 6 months
 C5 (Federal Law)
 Depending on state law can be dispensed without a prescription
 Codeine containing cough syrup must be combined with other med
and be no more than 2 mg/ml codeine
 Patient must be 21 or older
 Sale by pharmacist
 Log book maintained
 Max of 120 ml in 4 days
 Oral Controlled Substances (Federal Law)
 Permitted on C3-CV (in NYS 5 days for C2, C3 and C5)
 C2 emergency oral Rx
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For the emergency period only ( 5 days in NY)
Must reduce to writing by pharmacist
No alternative available
72 hours MD must deliver hard copy
 To destroy controlled substances
 Must notify DEA office and state narcotic office (NYS DOH Bureau
of Narcotic Enforcement) of Day and time of destruction
 DEA 41 is used to surrender drugs to the DEA directly
 To report theft of controlled substances
 Notify local police
 Notify DEA office
 State narcotic office
 Fill out DEA 106 form
 To order c2 drugs complete
 DEA 222 form
 To apply for a DEA registration
 DEA 224
Other Technician duties
 Handling Deliveries
 Inventory management
 Record keeping
 Stock rotation and others
 Remember, counseling is the pharmacist’s duties.
 One area where technician can offer advise is in the
use of medical devices like blood pressure monitors,
glucose testing equipment, etc.
PCTE key ideas on Retail Pharmacy
 Only Pharmacist can counsel patients, check for drug
interactions, speak with prescribers and disclose HIPAA PHI to
others and accept oral telephone Rx’s for new prescriptions from
prescribers
 Pharmacy technician can :
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Physically prepare medications (remember exceptions)
Prepack medications
Gather medical information from patient
Key in data in pharmacy computer system
 Physical Inventory of controlled substances every 2 years
(Federal law)
 FDA is charged with protecting the public by enforcing FDCA
 Adulterated drugs’ strength and purity subpotent
 Misbranding drugs have labels that can not true in fact to what is in
the container. Also, if the name and place of manufacturer not on
label. If a drug is a habit forming drug and is not stated on the label
its misbranded
 All dispensed prescriptions must comply with the poison prevention
packaging act of 1970
 Child resistant caps on all dispensed vials
 Except when patient or prescriber requests non resistant caps (i.e easy caps)
 Excepted drug (i.e Sublingual Nitroglycerin)
 Patient Package Inserts (PPI)
 Must be given to patients when dispensing in retail setting
 FDA governs this
 Drugs that require this:
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OC
Estrogen and progesterone products
Isotretinoin
Inhalers
 OSHA Pharmacy requirements
 MSDS for hazardous substances
 Flammable agents (alcohol) in a non flammable environment
 Exceptions to the 30 day rule to controlled substance
prescriptions
 With certain medical conditions state law permitted greater
than 30 day filling of Rx
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Code A= panic disorders
Code B= ADHD
Code C= neurologically (seizures)
Code D= Pain relief in incurable conditions
 If a patient is a resident in a LTCF or a terminally ill patient
then a C2 prescription may be filled for upto 60 days. Fax
copies are permitted in these cases but pharmacist must write
“LTCF patient” or “terminal” patient on the face of the
prescription
Health System Pharmacy
 Pharmacy setting where patients reside at the facility where
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the pharmacy is located
Includes acute care hospitals
Long term care facilities-provides skilled nursing services
to patients in need of long term rehabilitative services
Hospices-facilities that provide end of life palliative care to
terminally ill patients.
Nursing Homes-facilities that provide skilled nursing care
to elderly people who can no longer care for themselves due
to chronic illness
Correctional Facilities-prisons
Hospital Staff
 Includes pharmacists, nurses, physical therapists, respiratory therapists,
nutritionists, etc
 DO- doctor of osteopathy is a medical doctor that can practice conventional
medicine and tends to use musculoskeletal manipulation to assist the patient.
 MD- doctor of medicine who practices conventional medicine.
 Physician Assistant- a licensed individual who is trained to work with and
under the supervision of a physician in the care of patients.
 Nurse Practitioner- a licensed individual who has rights similar to a physician
assistant
 RN- a licensed individual who is trained to provide and administer medical
therapy (including medications) to patients under the order of a DO or MD
 LPN- similar to an RN, however, works under the supervision of an RN.
 Certified Nursing Assistant- CNA works under the supervision of an RN;
however medication administration is not allowed
Regulatory Agencies in the Hospital
 Joint Commission on the Accreditation of Healthcare
Organizations
 Called Joint Commission or JCAHO for short
 Provides accreditation to hospitals, Long term care
facilities and other organizations
 Site inspections conducted every three years
 Passing of site inspections required for accreditation
 Accreditation required for CMS funding by the
government
State Board of Pharmacy
 State board of pharmacy typically monitors
community pharmacies; but in the hospital setting
monitors the staff in the hospital and not the
department as a whole.
State Health Departments
 State health departments directly governs hospitals,
including the pharmacy department.
 Directly charters a hospital and grants its privilege to
operate in the state.
Medication Dispensing System
 Floor Stock Distribution. A system where a complete
compliment of medication inventory is keep at the
nursing station. System is prone to diversion and is
not used anymore in most hospitals, except in cases of
ADC.
 Unit Dose System: A system where a unit of
medication is dispensed for a 24 hour period to a
patient at any given time. System is more common
and discourages diversion. Prepacking works hand in
hand with such a system.
Medication Orders in the Hospital
 An order usually contains patient name, DOB, and
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MRN.
Date and hour the order is written.
Name of Drug, dose, frequency and if routine, STAT or
PRN.
Route
Name of the prescriber and the pager
Can be a paper order sent to the pharmacy or an order
entered into a CPOE.
Pharmacy Technician’s Duties in
the Hospital
 Data collection (information on drug turnover and
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usage)
Survey and inspections (nursing station inspection)
Education (training new technicians)
Maintenance (restock of omnicell and pyxis,
monitoring and replacement of crash cart items)
Dispensing/inventory management (assist with
preparation of drug products, and in some states
parenteral medications)
Prepackaging of medications
 An operation in which a medication in bulk is processed into a smaller
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unit by the institution.
Works well with a unit dose system
Normally in most states once a medication is dispensed a pharmacy is
prohibited from placing the medication back into stock if the
dispensed drug is returned.
If a drug is dispensed in a tamper resistant prepacked blister pack (in
case of tablets) then the medication is permitted to be put back into
stock.
Thus prepacking is a very cost efficient process
Normally done by pharmacy technicians and checked by pharmacists.
Most states provide a guideline of a one year maximum expiration date
or 50% of the lapsed time to manufacturer’s expiration. This dating
has been shown to prevent unintentional loss of potency.
A word about NDC numbers
 When manufacturers package their medications
federal law mandates a unique identifier known as a
national drug code (NDC)
 Has three parts: a five digit first part which indicates
its manufacturer, a second three digit part which
indicates the drug, its strength, and dosage form.
Finally the third number indicates its package size.
 Part of the barcode on the container of the drug
product.
Technology in the Pharmacy
 Counting Machines
 Uses an electronic eye to detect or count tablets or
capsules
 i.e. McKesson’s Baker Universal ® 2010 and Kirby Lester
KL15df ®
 Drug Dispensing Robotics
 McKesson Baker Cells® and Scriptpro® 200
 Larger institutions tend to have such robots
 Consists of a mechanical arm that can pivot along a
track to retrieve drugs from preselected drug cassettes
 Very expensive and not commonplace
 Automated Dispensing Machines
 Examples include Acudose ®, Omnicell®, Pyxis ®
 Consists of medication storage area and a central
keyboard terminal
 Pharmacist profiles a medication for a patient which is
electronically transmitted to the ADM or ADC.
 Nurse retrieves the medication at the required time and
helps to decrease TAT.
 ADC are very cost effective and helps to maintain
inventory and assists with billing by charging issues and
crediting returns
Bar Code Systems
 Provides for medication checks to increase medication
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safety.
Bedside Bar-coding act as a final check in the
medication verification process. RN scan the barcode
on his/her ID badge, then scans the patient’s
wristband ID barcode and finally scans the barcode of
the medication’s packaging.
The transaction is recorded in the patient’s MAR.
Ensures the five “rights” of medication administration
commonly used systems are Intellidot ® and Patient
Safe Solutions ®