Missouri Pharmacy Technician Informational Guide (2021) Missouri Board of Pharmacy P.O. Box 625 Jefferson City, MO 65109 (573) 751-0091 The Missouri Pharmacy Technician Informational Guide is provided for informational purposes only. The Informational Guide does not constitute a comprehensive review of all governing law or controlled substance requirements. To ensure compliance, registrants should thoroughly review Chapter 338, RSMo, 20 CSR 2220 and all applicable state and federal laws. The Informational Guide does not constitute a rule statement of general applicability or binding law. In the event of a conflict or inconsistency, duly promulgated or enacted state or federal law shall control. The Board expressly reserves the right to revise the contents as deemed appropriate or necessary. Questions regarding this document may be addressed to the Board office. 1 WHAT IS A “PHARMACY TECHNICIAN”? A pharmacy technician is any person who assists a pharmacist in the practice of pharmacy, including anyone who assists a pharmacist with routine functions related to receiving, preparing, compounding, distributing or dispensing medication. This would include: • Accepting written prescriptions; • Accepting or recording telephone prescriptions when a pharmacist is present; • Entering prescription information into the pharmacy’s prescription records; • Counting, pouring, preparing or compounding medication; • Accepting or clarifying prescription information with a prescriber; • Labeling prescription containers; and • Stocking or restocking the drug inventory. All pharmacy technicians must have a current and active Missouri pharmacy technician registration. A pharmacy technician registration is also required if you will have independent access to prescription drugs on a routine basis. This list includes some of the most common examples and is not complete. A pharmacy technician registration may still be required even if you perform activities that are not listed above. Except as otherwise allowed by law, pharmacy technicians MUST be under the direct supervision of a pharmacist at all times. HOW DO I GET REGISTERED? To obtain a Missouri pharmacy technician registration, you must: • Submit a pharmacy technician application to the Board (available on the Board’s website) • Pay the required application fee; and • Submit to a criminal background check by getting fingerprinted at a Board approved fingerprint vendor. (A fingerprint fee must be paid to the Board approved vendor. This fingerprint fee is paid directly to the vendor and is different from your pharmacy technician application fee). DO I NEED TO BE CERTIFIED? Pharmacy technician certification is not required to be registered as a Missouri pharmacy technician. However, your employer may require that you become certified. Technician certification is handled by private entities and not the Board. The Board cannot provide information or advice on obtaining or renewing your pharmacy technician certification. Although certification is not required to be issued a Missouri technician registration, pharmacy technician certification is required for pharmacy technicians who are: 1. Administering medication by prescription order, as delegated by a pharmacist 2. Administering vaccines, as delegated by a pharmacist, or 3. Assisting at a Class R Remote Dispensing Site pharmacy when the pharmacist is not present/supervising. (See rules 20 CSR 2220-2.600, 20 CSR 2220-6.040, and 20 CSR 2220-6.050 for additional requirements for these activities) Pharmacy Technicians performing the above activities must be certified by an entity that is accredited by the National Commission for Certifying Agencies (NCCA). As of June 2021, the Pharmacy Technician Certification Board (PTCB) and the National Healthcareer Association (NHA/ExCPT) are accredited by NCCA. 2 Once again, pharmacy technician certification is NOT required to be registered as a Missouri pharmacy technician. However, certification is required to perform the additional activities listed above (administering medication, immunizing, or assisting at a Class R Remote Dispensing Site Pharmacy without a pharmacist present). WHEN CAN I START WORKING? You can begin working if: • You’ve been fingerprinted by the Board’s approved vendor and paid the fingerprint fee, and • You’ve submitted a completed Missouri technician application that includes your photo, application fee and a receipt showing that you’ve paid to be fingerprinted. Your fingerprint registration page is insufficient if it does not show your payment. A copy of your application and fingerprint receipt must be kept at the pharmacy. A Board inspector will ask to see either your registration or the copy of your application when the pharmacy is inspected. WHEN DO I RENEW MY REGISTRATION? Your registration must be renewed before May 31st of each year. Renewal information will be electronically sent to your e-mail address on record with the Board (make sure your e-mail address is current). You cannot continue working after May 31st if your registration has not been renewed. WHAT IF MY REGISTRATION HAS ALREADY EXPIRED? If your registration has expired, you must stop working immediately. You cannot continue working until your license has been renewed or a new application has been submitted to the Board. WHAT ACTIVITIES CAN I PERFORM? Pharmacy technicians may assist a pharmacist in the practice of pharmacy as authorized by the supervising pharmacist and Missouri law. Technicians should review the following statutes/rules for additional information on authorized technician activities: • Section 338.013, RSMo • 20 CSR 2220-2.700 (General technician requirements) • 20 CSR 2220-2.600 (Class F: Renal Dialysis Pharmacies) • 20 CSR 2220-2.650 (Class L: Veterinary Pharmacies) • 20 CSR 2220-2.680 (Class R Remote Dispensing Site Pharmacies) • 20 CSR 2220-2.710 (Pharmacy Technician & Intern Pharmacist Supervision) • 20 CSR 2220-2.725 (Remote Data Entry) • 20 CSR 2220-6.040 (Administering medication by prescription order) • 20 CSR 2220-6.050 (Immunizing by protocol) • 20 CSR 2220-6.055 (Non-Dispensing activities) The below list includes examples of activities a technician may perform under the supervision of a pharmacist, if allowed by the pharmacist-in-charge/supervising pharmacist: (This list is provided for informational purposes only and does not include all activities that a technician may be allowed to perform.) 3 • Stocking/restocking drug inventory • Accepting written prescriptions • Accepting or recording telephone prescriptions • Entering prescription information into the pharmacy’s prescription records • Counting, pouring, preparing, compounding or reconstituting medication • Accepting or clarifying prescription information with a prescriber • Labeling prescription containers • Remote data entry*** • Dispensing/selling prescriptions that have been checked by a pharmacist, and • Immunizing or administering medication*** *** Pharmacy technician certification and/or additional training is required. However, technicians cannot perform any of the following activities (even if a pharmacist tells you to): • Verifying the final prescription product or label*** • Providing, accepting or receiving a controlled substance prescription transfer (this must be communicated between pharmacists) • Independent prospective drug utilization review • Counseling patients. This includes relaying counseling information that a pharmacist tells you to say or advising patients on over-the-counter medication; or • Any other act that requires a pharmacist’s professional judgment of a pharmacist. ***Exceptions apply for Class F: Renal Dialysis Pharmacies (20 CSR 2220-2.600), Class L Veterinary Pharmacies (20 CSR 2220-2.675, Class R: Remote Dispensing Site Pharmacies (20 CSR 2220-2.680), and Class Q: Charitable Pharmacies. WHAT CAN I DO WHEN A PHARMACIST IS NOT IN THE PHARMACY? Pharmacy technicians CANNOT compound, fill, prepare, label, count, dispense/sell prescriptions or immunize/administer medication unless a pharmacist is physically present at the pharmacy.*** For all other activities, technicians must be under the direct supervision of a pharmacist who is either physically present on-site, or who is supervising technician activities using qualifying technology. Technicians CANNOT assist in pharmacy practice if a pharmacist is not present or supervising via technology, as required by the Board’s rules. This includes: • Taking telephone prescription orders • Data entry • Stocking/restocking pharmacy inventory, or • Selling, dispensing or distributing a prescription, even if the prescription has already been checked by a pharmacist. (This list is not exhaustive)*** ***Exceptions apply for Class F: Renal Dialysis Pharmacies (20 CSR 2220-2.600), Class L Veterinary Pharmacies (20 CSR 2220-2.675, and Class R: Remote Dispensing Site Pharmacies (20 CSR 2220-2.680) Your supervising pharmacy or pharmacist-in-charge may place additional restrictions on what you are allowed to do. To assist patients who may be waiting, the Board has determined that a technician may accept a written prescription from the patient when a pharmacist is absent or not supervising via technology (i.e., the patient 4 physically hands a technician a written paper prescription). However, the written prescription cannot be filled, entered into the pharmacy’s prescription records or dispensed/sold to the patient unless a pharmacist is present. Compliance with Missouri law is mandatory. Once again, pharmacy technicians CANNOT compound, fill, prepare, label, count, dispense/sell prescriptions or immunize/administer medication unless a pharmacist is physically present on site. REMOTE DATA ENTRY In September of 2020, the Board amended its regulations to allow pharmacy technicians to perform data entry activities for a Missouri-licensed pharmacy at a remote data entry site (e.g., at home or non-pharmacy facility). Talk with your pharmacist-in-charge about allowed activities at a remote data entry site. Pharmacy technicians working at a remote data entry site must comply with the following items under rule 20 CSR 2220-2.725: • Patient data and prescription information at a remote data entry site must be securely maintained to prevent unauthorized access to confidential information. Security breaches should be immediately reported to the pharmacy. • Paper patient or prescription/medication records may not be generated, printed or maintained at a remote data entry site. This includes faxed prescriptions that will be printed at the remote site (fax to electronic prescriptions are allowed if the electronic prescription will not be printed at the remote data entry site). • Written prescriptions cannot be accepted at a remote data entry site (from the prescriber or a patient). • A pharmacist must be available to respond to technician questions whenever a remote data entry site is in operation. Additionally, a mechanism must be in place to allow technicians to communicate with the supervising pharmacist in real-time when needed. Technicians cannot perform remote data entry activities if a pharmacist is not available to assist/supervise, or if the required real-time communication mechanism is not working or available. Technicians performing remote data entry from home or outside of the pharmacy, must make sure patient and any other confidential information is securely protected at all times. This includes protecting computer screens and other equipment to prevent unauthorized individuals from inadvertently viewing confidential information. When possible, the Board recommends that you work in a secure area/room that can be locked or, at a minimum, working in a low-traffic area (pharmacy management may have other requirements). Remember, you are responsible for properly securing confidential information. Talk with pharmacy management if you have any questions, and immediately report any security breaches. PATIENT CONFIDENTIALITY As a technician, you will handle a lot of confidential patient information. Both state and federal law prohibit a technician from disclosing, accessing or using confidential patient information without a legitimate business purpose. This would include looking at a patient’s medical information for personal use or discussing patient information outside of the pharmacy. Talk with your pharmacist-in-charge for more information on what patient information is considered confidential. Improperly disclosing, accessing or using confidential information could result in discipline. 5 HOW YOU CAN HELP PREVENT MEDICATION ERRORS Pharmacy technicians are a key part of providing safe health care. Medication errors cause unnecessary medical consequences. Under the supervision of a pharmacist, you can help ensure that the right medication is given to the right patient. Talk with your pharmacist-in-charge about how you can help prevent medication errors. Here are A few suggestions from the Board: • When in doubt ask! Whether you’re a new technician or have been working for years, pharmacy terms and technology are constantly changing. If you have questions, can’t read a prescriber’s handwriting or are unsure about something, ask a pharmacist. Don’t assume….ask! • Look Again! Medication and patient names can easily sound or look alike. Don’t just look at the color of the container or assume an item was placed on the shelf correctly. Read labels and names out loud. This simple step could prevent a mix-up. • Slow Down and Stay Focused. The Board continues to see errors that were caused by technicians who were simply moving too quickly. Between phones, filling prescriptions and talking to patients, a pharmacy can be a busy place. However, patients are counting on you. A mistake could have serious consequences! Slow down, stay focused and be safe. • Drug Alerts. Some pharmacy computer systems will alert you if a medication may not be appropriate for a patient or if there are other medical concerns/questions (i.e., a drug interaction, duplicate therapy, drug allergy, excessive dose). These alerts must be brought to the attention of a pharmacist and can only be reviewed and cleared by a pharmacist. To hear a patient’s perspective on preventing medication errors, the Board encourages you to view the Christopher Jerry story online at http://www.youtube.com/watch?v=9jmULQ_m04o. HOW YOU CAN HELP PREVENT PRESCRIPTION FRAUD Prescription fraud can lead to drug abuse and other illegal activity. As a pharmacy technician, you may be the first staff member to recognize a suspicious prescription. There are several types of fraudulent prescriptions: • A forged prescription that is written on a stolen form or a prescription pad. • A prescription that was legitimately issued but has been changed or altered. For example, the patient may increase the quantity from 15 to 150. • A prescription that is fraudulently phoned into the pharmacy by someone pretending to be a physician or nurse or from a doctor’s office. • A fake prescription that a forger or drug seeker may have created and printed on their own. If you suspect a fraudulent prescription, talk with a pharmacist. A few things to look for or ask: • Does the prescription look unusual? Are the abbreviations, directions or other wording normal? • Does the prescription make sense? A prescription with directions to refill “ASAP” should probably be questioned. • Are the quantities or directions normal based on other prescriptions? • Is the quantity unusually large? Does the quantity match the directions? A prescription authorizing a 30-day supply of 240 tablets with directions to take 4 tablets a day may be questionable. • Does the prescription look like it’s been erased, photocopied or whited-out? Dust or black dots may be evidence of a photocopy. 6 • Does the prescription have obvious misspellings or other errors? Is the doctor’s name or the drug spelled correctly? (i.e., “dyeazapam”) • Have other patients presented similar prescriptions from the same prescriber or clinic within a short period of time? • Is the prescriber located a significant distance away from Missouri? While a controlled substance prescription from Arkansas or Kansas may be normal in some areas, multiple prescriptions from Florida or New York within a short period of time should raise concerns. WHAT SHOULD I DO IF I SUSPECT SOMEONE IS ACTING ILLEGALLY? Report your suspicions to the pharmacist-in-charge or pharmacy management. If you believe someone has violated pharmacy law, you may also file a complaint with the Board. Complaint forms are available online at http://pr.mo.gov/boards/pharmacy/375-0428_UCR.pdf. Please note, the Board can only address complaints involving violations of § 338.055, RSMo, and the Missouri Pharmacy Practice Act. The Board cannot resolve personnel issues that are unrelated to matters under the Board’s jurisdiction. CAN MY REGISTRATION BE DISCIPLINED? Yes. Section 338.013, RSMo, authorizes the Board to take two different types of technician disciplinary actions: (1) placing a technician on the “Employment Disqualification List” or (2) issuing a “conditional registration.” Pharmacy technicians on the Employment Disqualification List, or “EDL”, are prohibited from working as a technician in the state of Missouri. Technicians issued a conditional registration are authorized to work subject to conditions established by the Board. Section 338.055, RSMo, contains a detailed list of reasons for discipline. Technicians and new applicants should read the entire list. In the past, the Missouri Administrative Hearing Commission has found legal grounds for the Board to impose discipline under § 338.055, RSMo, for the following types of conduct: • Practicing without a license or registration • Dispensing medication that has not been verified by a pharmacist • Falsifying prescriptions • Altering a prescription without authorization • Diverting medication • Dispensing without a valid prescription • Stealing/theft of merchandise, gift cards, food or other items • Violation of state/federal controlled substance laws • Impairment/Illegal drug use • Submitting a false license application, and • Criminal history (This list is provided for informational purposes only and is not a complete list of all conduct that could result in disciplinary action) WHAT IS THE EMPLOYEE DISQUALIFICATION LIST (EDL)? The Board may place a technician or an applicant on the EDL if the technician has committed any act which constitutes grounds for discipline under § 338.055, RSMo. Technicians or new applicants on the EDL are prohibited from working as a technician in the state of Missouri. 7 WHAT IS A CONDITIONAL REGISTRATION? Technicians issued a conditional registration are authorized to work subject to conditions established by the Board. Failure to follow the Board’s conditions may result in additional discipline, including, but not limited to, being placed on the EDL and prohibited from working as a technician. WHAT IF I HAVE CRIMINAL CHARGES? The Board may deny or discipline a technician registration if: (2) The person has been finally adjudicated and found guilty, or entered a plea of guilty or nolo contendere, in a criminal prosecution under the laws of any state or of the United States, for any offense reasonably related to the qualifications, functions or duties of any profession licensed or regulated under this chapter, for any offense an essential element of which is fraud, dishonesty or an act of violence, or for any offense involving moral turpitude, whether or not sentence is imposed. [§ 338.055.2(2)] The crime/charge does not have to be drug or alcohol related. A criminal charge does not mean that you will automatically be denied or disciplined. The Board reviews each application and criminal history report on a case-by-case basis. The Board looks at a variety of factors, including, but not limited to: • The nature and seriousness of the crime • The length of time since the crime occurred • If probation or other criminal punishment was successfully completed • The relationship of the crime to pharmacy practice, and • Any evidence of rehabilitation or treatment since the conviction If you have a criminal charge, you should provide a full description of the circumstances surrounding the offense as well as any information that shows why you should be licensed. This could include information regarding your activities since the conviction such as any educational achievements, extracurricular activities, related job history or any rehabilitation, therapy or support group attendance (i.e., NA, AA, Al-Anon, etc.) You must provide full and accurate information about your criminal history on a new or renewal application. The Board has denied and disciplined technicians for not being truthful about their criminal history. IMPORTANT INFORMATION ABOUT SIS AND SES CHARGES Under § 338.055, the Board may deny an application or discipline a technician even if the technician received a Suspended Imposition of Sentence (“SIS”) or a Suspended Execution of Sentence (“SES”). The Board asks about criminal history on both new and renewal applications. An attorney may advise you that you do not have to report or disclose SIS or SES information. However, the Board has access to both SIS and SES records. You must answer “yes” to a criminal history question even if you received an SIS or SES. ADDITIONAL INFORMATION ABOUT DRUG CHARGES Under state and federal law, your employer may be required to obtain an employment waiver if you have been convicted of certain controlled substance related crimes. Specifically, a waiver is required from the federal Drug Enforcement Administration (DEA) if you have a felony controlled substance related conviction. A waiver from the Missouri Bureau of Narcotics and Dangerous Drugs 8 (BNDD) is required if you’ve been convicted of any felony or misdemeanor controlled substance charges. You may not work as a pharmacy technician without a required waiver. Current technicians and new technician applicants with controlled substance related convictions/charges should consult with your legal counsel. Even if your registration is issued by the Board or the Board votes not to impose discipline, you may not be able to work as a pharmacy technician without a state/federal waiver. Questions about obtaining a BNDD or DEA waiver should be addressed to: Missouri Bureau of Narcotics and Dangerous Drugs (BNDD) P.O. Box 570, Jefferson City, MO 65109 (573) 751-6321 [email protected] U.S. Drug Enforcement Administration (DEA) 7600 College Blvd., Suite 100, Overland Park, KS 66210 (913) 951-4100 or 317 South 16th Street, St. Louis, MO 63103 (314) 538-4600 or (888) 803-1179 TOP TECHNICIAN COMPLIANCE VIOLATIONS This list reflects the most commonly observed pharmacy technician compliance violations and does not include all possible violations (the list is not ranked in any specific order): 1. Working with an expired or suspended technician registration: This violation most commonly occurs with technicians who fail to renew or who have been suspended for failing to pay state taxes but continue working. Your pharmacy technician registration expires on May 31st each year. You may not work after May 31st unless your registration has been renewed by the Board. 2. For taxes, the Missouri Department of Revenue will notify you if you have an outstanding tax obligation. Tax deficiency notices should be taken seriously. Failure to pay outstanding taxes or make payment arrangements with the Department of Revenue will result in your registration being automatically suspended (see “Important Tax Information” section below). 3. Dispensing errors: The Board continues to see errors with technicians selling a prescription to the wrong patient after the prescription has been checked by a pharmacist. In most cases, the technician was either moving too quickly, or dispensed the prescription without verifying that the name on the label matched the patient. Dispensing errors can cause serious medical consequences and may result in confidential medication being released to the wrong patient, which violates HIPAA. Slow down and pay attention- patients are depending on you! 4. Providing patient counseling: Technicians cannot counsel patients under any circumstances. This includes recommending or advising patients on over-the-counter medication, answering questions about side-effects, or telling patients how medication should be administered or used. Even if the pharmacist tells you what to say, technicians are not allowed to counsel patients under any circumstances. 5. Stealing or diverting medication: Taking or using prescription medication without a valid prescription is a state and federal crime that could result in incarceration, as well as disciplinary action by the Board. 6. Fraud & Theft: Your technician registration can be disciplined for fraud or stealing from your employer- even if the activity is unrelated to the pharmacy. This includes taking food or merchandise without paying, or using gift cards, store rewards or coupons in violation of pharmacy policy (this list is not exhaustive). 9