Allow me to begin this article by stating emphatically that I am a committed supporter of the pharmacy technician profession. I applauded the progression toward technician certification and the expanded roles that this included. Well-trained pharmacy technicians make any pharmacy workflow far more effective, safe and efficient.

Recently, Drug Store News reported that the National Association of Chain Drug Stores (NACDS) in conjunction with the Pharmacy Society of Wisconsin (PSW) is exploring opportunities to expand the utilization of technicians into the community pharmacy setting. The expanded utilization is specifically related to technicians performing the final verification step of the filling process.

The concept is referred to "tech-check-tech" (TCT) and essentially removes the pharmacist from the filling and checking process altogether. This expansion is being described as simply a "pilot" at this point, with the intention of monitoring the results over a three-year period.

How should pharmacists respond?

Those of us who have been in the industry for many years know the concept of TCT is nothing new. TCT has been discussed and studied in a variety of settings, often related to the verification of accurately filled medication cassettes for distribution to long-term care settings, or the restocking of automated dispensing machines. As many as nine states currently have legislation allowing TCT programs in certain circumstances and settings.

Where this has been done, considerable accuracy and safety has been well documented. In one study, published in the American Journal of Health System Pharmacists, the authors concluded, "The published evidence demonstrates that pharmacy technicians can perform as accurately as pharmacists, perhaps more accurately, in the final verification of unit dose orders in institutional settings."

But the latest announcement from NACDS seems to be pushing the technician verification concept into a new arena, notably the community pharmacy setting. This idea raises several important and serious questions. Unfortunately, the announcement provided no details to help answer these questions.

But as a concerned pharmacist with over 20 years' experience in this setting, I think the following questions need to be raised.

1. Will the technician be checking new prescription orders?

A new prescription order involves more than simply the interpretation of the information provided. Those who have never worked in community pharmacy may (understandably) assume prescriptions come to the pharmacy in perfect form — flowing infallibly and clearly from the prescriber's pen. They don't.

Prescriptions often come over as a mess: poorly written, inaccurate, unclear and unspecific. In some settings — particularly those surrounded by teaching hospitals and new residents — the quality of the prescriptions being written is simply horrible.

In my opinion, a new prescription should always be handled by a pharmacist.

2. Will the process allow pharmacists to review for drug interactions?

Again, those who do not work in a community settings might assume a drug interaction is simply a "black and white" event that a computer can screen for and simply alert the pharmacy about. The reality is that retail pharmacists today are bombarded by potential drug interactions on the majority of prescriptions we check, and we are constantly assessing the clinical relevance and potential harm of these situations.

3. What impact will the TCT programs really have on increased patient access to pharmacist counseling?

Christopher Decker, the EVP of the Pharmacy Society of Wisconsin, optimistically stated, "The people of Wisconsin will benefit from greater access to patient care services and enhanced patient safety as a result of this pilot."

But those of us who have actually worked on the front lines for various chain pharmacies recognize that the implementation of programs like this could be nothing more than helping to reduce pharmacist staffing and improve the bottom line. Who is the real winner, and who is the loser should this sort of model be approved?

As a pharmacist who truly appreciates the role pharmacy technicians play, I am happy to endorse expanding their roles, but never at the expense of patient safety. The profession needs to work at finding financially responsible ways to expand the amount of time a pharmacist has when verifying orders, particularly new orders.

I see a place for the TCT model in the community setting, but it must be approached with emphasis on the safety and health of our patients.