Brief Pharmacists and Pharmacy Technicians

Pharmacists and pharmacy technicians work in community clinics, hospitals, grocery stores and convenient stores, making them a first point of access to health care services for many Americans. According to the AACP's Pharmacy Demand Report, there were 60,882 job postings for pharmacists and 111,803 jobs postings for pharmacy technicians in the first three quarters of 2023, significantly higher than the 13,400 openings for pharmacists and 44,900 openings for pharmacy technicians projected each year, on average. Research suggests shortages may be due to several reasons, such as the increasing demand as pharmacists and technicians are filling provider gaps and taking on additional responsibilities, as set by state legislatures, especially in remote areas. Other reasons for shortages may include burnout and medication shortages that are putting stress on pharmacies and leading to closures.

Pharmacy is a multidisciplinary specialty, and pharmacists have several responsibilities. Pharmacists protect patient safety by ensuring that the medications and doses are accurate. They review the patient's drug history and check for any contraindications, or conflicting drug or vaccine interactions. They prepare custom medications to meet a patient's specific needs and provide patient education. Pharmacists may work collaboratively with physicians and provide information on new medications and guidelines in the pharmaceutical industry.

Pharmacy technicians work closely with pharmacists and perform similar duties. The job outlook for pharmacy technicians is projected to grow 6 % from 2022 to 2032, which is faster than average for all occupations. Pharmacy technicians are supervised by pharmacists and can interact with patients to obtain medication histories and update records. They maintain the medication inventory, keep pharmacies up to safety and cleaning standards, communicate with insurance companies to negotiate billing claims, and obtain preauthorization. They can also support vaccination efforts by administering vaccines (varies by state law), screening patients for vaccines and promoting vaccine campaigns. At least 13 states, such as Maryland and Georgia, allowed pharmacy technicians to administer vaccines to individuals under certain conditions in 2023.States may ensure access to health care by increasing access to pharmacists and pharmacy technicians and strengthen their role as trusted providers in the community. States play an important role in establishing the scope of practice, education, licensure and certification requirements, financing and reimbursement of services, and recruitment and retention of pharmacy professionals.

Scope of Practice

Pharmacist and pharmacy technician scope of practice has changed over time as a result of legislative changes to practice and prescriptive authority. While pharmacists' duties have historically focused on compounding and dispensing medicine, states may allow pharmacists to perform other tasks, such as administering vaccinations and prescribing or modifying certain prescriptions.

The COVID-19-pandemic underscored the importance of pharmacists in the community as they played a frontline role in providing COVID-19 counseling and prevention services. The federal Public Readiness and Emergency Preparedness (PREP) Act (continued through December 2024) allows pharmacists to administer the COVID-19 vaccine in all 50 states and D.C. The PREP Act also grants pharmacists, pharmacy technicians, pharmacy students and other providers liability protection for administering COVID-19 countermeasures. Connecticut and West Virginia passed legislation in 2023 to allow pharmacists to administer any vaccine, not limited to those listed on the CDC website.

States may leverage pharmacists as providers treating a range of conditions, such as preventing and treating COVID-19 and influenza and managing medications for opioid use disorder and pre- and post-exposure prophylaxis (PrEP and PEP) for HIV. Arkansas and Illinois allow pharmacists to provide patients with HIV PrEP and PEP after completing relevant training, as authorized by the state.

States may also allow pharmacists to prescribe certain medications, including hormonal contraceptives, tobacco cessation aids and opioid antagonists, and modify certain prescriptions without the authorization of the patient's physician. Nevada authorizes pharmacists to prescribe and dispense drugs for medication-assisted treatment of opioid use disorder and perform certain assessments under certain conditions. Oklahoma increased pharmacist authority from prescribing and dispensing naloxone to prescribing and dispensing any FDA-approved opioid antagonist.

Not all states grant pharmacists provider status, so to establish eligibility for Medicare Part B reimbursement, some states enacted legislation allowing for collaborative practice agreements between pharmacists and physicians. Pharmacists may enter these legal agreements to define their relationship and the joint services they may provide with other health care practitioners. For example, pharmacists in Alaska may enter into collaborative practice agreements with authorized health care providers, such as physicians, to perform specific patient care functions like adjusting medication dosages, administering medications and ordering laboratory tests. Delaware allows pharmacists to provide care and manage drug therapy services through collaborative agreements with one or more practitioners, permitting activities that would otherwise be beyond their scope.

Education and Training Requirements

Pharmacists earn a Doctor of Pharmacy degree. Students may complete two different tracks: a six-year track with two years of prerequisite courses followed by four years of pharmacy school or an eight-year track with a four-year bachelor's degree program before four years of pharmacy school. Most pharmacy programs require an admissions test. Students take several advanced science courses and complete a formal internship during the program.

There are no educational standards for pharmacy technicians, but they may have a high school diploma or equivalent, followed by formal training or certification program. Pharmacy technicians can also earn advanced certifications to specialize in areas across the medical field and use their experience as a steppingstone to move into other positions in their career. With additional training and education, they may advance to working in many roles such as pharmacists, laboratory technicians, health care administrators and supervisors.

Licensure and Certification Requirements

States set education and licensure standards for pharmacists and pharmacy technicians, including required examinations and background checks for initial licensure, as well as continuing education requirements for licensure renewal.

Upon completing education and training requirements, pharmacists must then take the North American Pharmacist Licensure Exam and either the Multistate Pharmacy Jurisprudence Exam, in states that recognize the exam, or a jurisprudence exam set by the state board of pharmacy as a condition for licensure.

Similarly for pharmacy technicians, licensure and certification requirements vary by state. For example, some states, like Pennsylvania, do not mandate certification or licensure for pharmacy technicians, while other states, like Tennessee, require pharmacy technicians to be licensed. In states that require certification, pharmacy technicians may either take the nationally-recognized Pharmacy Technician Certification Exam or the Ex Certified Pharmacy Technician exam. Renewal and continuing education requirements vary by certification type.

Financing and Medicaid Reimbursement

Pharmacists' services can be covered through various mechanisms, including private insurance, Medicare and Medicaid. Reimbursement for pharmacists' services is subject to state-specific regulation. Many private insurance plans and Medicare Parts B and D cover certain pharmacist services, and reimbursement rates may vary depending on the plan. Medicaid coverage also varies by state.

North Dakota requires any health insurance plan to reimburse licensed pharmacists to provide comprehensive medication management to eligible patients. Nevada requires insurance plans to cover FDA-approved drugs for medicated-assisted treatment and to reimburse pharmacist services at a rate equal to that provided by other providers for similar services. Maryland allows pharmacists to bill for any service that is within their scope of practice that insurance plans cover for other providers.

In Louisiana, Medicaid Managed Care Organizations must reimburse local pharmacies at least the fee-for-service rate. Missouri and Wyoming both allow Medicaid reimbursement for services provided by pharmacists within their scope of practice.