I am writing to you in my capacity as Executive Director of Regulatory Affairs for CVS Health and its family of pharmacies.  CVS Health, the largest pharmacy health care provider in the United States, is uniquely positioned to provide diverse access points to care to patients in the Commonwealth of Virginia through our integrated offerings across the spectrum of pharmacy care.   CVS Health appreciates the opportunity to submit comments on Guidance Document 110-33 Pharmacy Interns as Pharmacy Technicians; Pharmacy Technician Ratio. We would also like to thank the Board for their vigilance to continuously improve the laws and regulations that guide pharmacists, pharmacy interns and pharmacy technicians serving Alabama patients. 

CVS Health is opposed to the proposed language amendment of the guidance document prohibiting a pharmacy technician trainee enrolled in a training program for pharmacy technicians to administer drugs and devices.  This prohibition is in direct conflict with statutory language that was passed in House Bill 1323 during the 2022 legislative session that added the allowance of administration by a pharmacy technician in Virginia Code § 54.1-3321(A).   Virginia Code § 54.1-3321(F) states “a pharmacy technician trainee enrolled in a training program for pharmacy technicians described in subdivision B 2 may engage in the acts set forth in subsection A for the purpose of obtaining practical experience required for completion of the training program, so long as such activities are directly monitored by a supervising pharmacist.”   The use of the word may, which expresses permission, is used within both sections (A) and (F) of Virginia Code § 54.1-3321 for the purpose of identifying what tasks a pharmacy technician or pharmacy technician trainee can perform, not what tasks they shall perform as not all individuals will complete all tasks.    Additionally, the Legislature did not specifically carve out or exclude pharmacy technician trainees in this allowance. We do not believe that the Legislative intent was to prohibit pharmacy technician trainees, but rather to the allow for trainees to perform this vital function. Therefore, this guidance document is, not only in conflict of with the statute, but imposes a new regulatory prohibition via guidance document, which does not align with the definition of a guidance document under the Virginia Administrative Process Act.

The pharmacy profession continues to be called upon to provide COVID-19 countermeasures and response to the public health emergency.   On October 20, 2020, the Department of Health and Human Services issued guidance clarifying that “to be a qualified pharmacy technician, pharmacy technicians working in states with licensure and /or registration requirements must be licensed and/or registered in accordance with state requirements” for purposes of childhood and Covid-19 vaccine administration.¹  With registration of pharmacy technician trainees in Virginia required in 2021, a pharmacy technician trainee is a qualified individual under the PREP act. 

As the demand of the citizens of the Commonwealth of Virginia continues to grow for pharmacy services and Legislators continue to pass statutes allowing pharmacists to practice at the top of the education and experience, services/tasks such as administration, which can be provided by a pharmacy technician or pharmacy technician trainee, should be delegated.  40% of the CVS Health pharmacy technician workforce is comprised of pharmacy technician trainees.  Allowing a properly trained pharmacy technician trainee under the supervision of a pharmacist would assist in alleviating concerns by the Board pertaining to working conditions while still being able to meet the demands of the public.  In conclusion, CVS Health asserts that this guidance document is in direct conflict of statutory allowance, we do not feel this should move forward for publication with an effective date per VA Code Ann. § 2.2-4002.1(C).    

References

Guidance for PREP Act Coverage for Qualified Pharmacy Technicians and State-Authorized Pharmacy Interns for Childhood Vaccines, COVID-19 Vaccines and COVID-19 Testing.  Accessed October 7, 2022