Pharmacy Essential Updates August 2021

Pharmacy Essential Updates August 2021

Rachel Maynard, PharmDEditorVickie Danaher, PharmDAssociate Editor Pharmacist’s Letter | Pharmacy Technician’s Letter

Copyright © Therapeutic Research Center. All rights reserved.

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CE Information


▪ Identify emerging trends in drug therapy and their place

in patient care practices.

▪ Discuss the use of injectable semaglutide for weight loss.

▪ Recommend appropriate treatment for rheumatoid

arthritis.

▪ State two considerations regarding rimegepant ODT for

migraine prevention.

▪ Describe four strategies to treat hypo- or hyperkalemia

in patients with heart failure.

Pharmacist Objectives


▪ Identify emerging trends in drug therapy and their place

in pharmacy practice and operations.

▪ Describe three key points about injectable semaglutide

for weight loss.

▪ Discuss treatment options for rheumatoid arthritis.

▪ Name two considerations regarding rimegepant ODT for

migraine prevention.

▪ Explain four strategies that may be used to treat low or

high potassium levels in patients with heart failure.

Pharmacy Technician Objectives


Injectable Product for Weight Loss


OBESITY & WEIGHT LOSS

Pharmacist's Letter. August 2021, No. 370802

Emphasize Lifestyle Changes for Obesity Before Wegovy


New Rx Wegovy for weight loss will hit your pharmacy shelves. It's injectable semaglutide...the same GLP-1 agonist as injectable Ozempic or oral Rybelsus for type 2 diabetes. Explain that Wegovy starts at the same 0.25 mg weekly dose as Ozempic...but titrates to 2.4 mg. Ozempic maxes out at 1 mg weekly. Using Wegovy 2.4 mg weekly for about a year leads to roughly 10% to 12% more weight loss than with placebo, or 20 lb for a 200 lb patient. This is about double the weight loss with daily Saxenda (liraglutide), the other GLP-1 agonist for obesity...and similar to Qsymia (phentermine/topiramate ER). Other Rx meds lead to less weight loss. Educate that GI side effects are common with Wegovy. But most patients can tolerate it if titrated appropriately...over 16 weeks. Balance this against downsides of other weight loss meds. For example, Qsymia has a REMS program due to the risk of birth defects. Point out that weight loss meds often aren't covered by payers. Wegovy or Saxenda costs about $1,400/month...versus $200/month for Qsymia. Continue to emphasize lifestyle changes BEFORE weight loss meds. Don't jump to discussing meds unless patients have a BMI of 30 or more...or 27 or more plus a weight-related condition (diabetes, etc). Lean toward Wegovy if a GLP-1 agonist is preferred for weight loss. But advise stopping the med if 2.4 mg/week isn't tolerated...or patients don't lose 5% of their body weight after 12 weeks at this dose. Expect long-term use for patients who are successful. Don't recommend combining Wegovy with other weight loss meds...due to lack of evidence. And avoid combining it with other GLP-1 agonists...or DPP-4 inhibitors (Januvia, etc), which work similarly. Compare options in our chart, Weight Loss Products. And get our toolbox, Weight Loss: Helping Your Overweight Patients, for advice on suggested diets, physical activity, and helping patients reach goals.

Wegovy Ozempic Rybelsus

Dosage Form Injectable Injectable Oral tablet

Indication Weight loss Type 2 diabetes Type 2 diabetes

Starting

Dose

0.25 mg

subcutaneously

once weekly

Increase dose every

4 weeks for 16

weeks

0.25 mg

subcutaneously

once weekly

Increase dose after 4

weeks

3 mg tablet daily

Increase dose after

30 days

Max Dose 2.4 mg weekly 1 mg weekly 14 mg daily

Comparison of Rx Semaglutide Products



About 70% of adults in the U.S. are overweight or obese

Category BMI (kg/m2)

Underweight Less than 18.5

Healthy weight 18.5 – 24.9

Overweight 25.0 – 29.9

Obese 30.0 and above

BMI Calculator:

https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/

bmicalc.htm

▪ Being overweight or obese

increases the risk of:

» Heart disease, stroke, diabetes,

some cancers, etc

▪ A 5% to 10% drop in weight

may improve blood pressure,

cholesterol, and glucose

Impact of Weight


Case: Gloria


Current Medications

Drug Strength Sig

Metformin 500 mg Take 1 tablet by mouth twice

daily

Lisinopril 20 mg Take 1 tablet by mouth daily

Norethindrone/ethinyl

estradiol

1 mg/20

mcg

Take 1 tablet by mouth daily

for 28 days

Medical Conditions

Type 2 Diabetes

Hypertension

Patient Details

Name: Gloria Hernandez

DOB: 02/17/1975

Age: 46

Tobacco Use: N

BMI: 28

Allergies

Penicillin

▪ Leads to roughly 10% to

12% more weight loss than

with placebo after ~1 year

» About double the weight loss

than liraglutide (Saxenda)

» Similar to phentermine/

topiramate ER (Qsymia)

▪ Other Rx meds lead to less

weight loss

Wegovy Efficacy


Selected Weight Loss Products


Drug

(Brand)Usual Dosing

~Cost/

MonthComments

Injectable

semaglutide

(Wegovy)

2.4 mg once weekly

(0.25 mg once weekly, increase every four

weeks to 0.5 mg, 1 mg, 1.7 mg, and 2.4 mg)

$1,400 GI side effects

are common

Injectable

liraglutide

(Saxenda)

3 mg once daily

(0.6 mg once daily, increase weekly by

0.6 mg to 3 mg once daily)

$1,400 GI side effects

are common

Phentermine/

topiramate ER

(Qsymia)

7.5 mg/46 mg once daily

3.75 mg/23 mg PO once daily for 14 days,

then double the dose

$200 REMS program

(risk of birth

defects)

Medication pricing by Elsevier, accessed July 2021


Continue to emphasize lifestyle changes BEFORE

weight loss meds.

Reduced-Calorie Diet

▪ 1,200 to 1,500

kcal/day for women

▪ 1,500 to 1,800

kcal/day for men

Physical Activity

▪ 30 to 45 minutes,

3 to 5 days a week

Behavior Therapy

▪ Counseling,

education, or

support for at least

6 months

Lifestyle Changes for Weight Loss


Don’t jump to discussing meds unless patients have a BMI of 30 or more...or

27 or more plus a weight-related condition (diabetes, etc).


▪ Don’t recommend

combining with other

weight loss meds

▪ Avoid combining with

» Other GLP-1 agonists

▪ Exenatide, etc

» DPP-4 inhibitors

▪ Sitagliptin, etc

Wegovy Considerations


▪ Advise stopping if

» 2.4 mg/week isn’t tolerated

» Patients don’t lose 5% of body

weight after 12 weeks at this dose

▪ Expect long-term use for

patients who are successful

Wegovy Considerations


▪ Choose products carefully

» 0.25 mg/0.5 mL, 0.5 mg/0.5 mL, 1 mg/0.5 mL, 1.7 mg/0.75 mL,

2.4 mg/0.75 mL

▪ Enter a 28 days’ supply

» Four pens/box x 1 pen/7 days

▪ Don’t substitute Wegovy for Ozempic, or vice versa

Practice Pearls: Wegovy


▪ Tell patients to store Wegovy in the fridge

» If needed, a pen can be kept at room temp for up to 28 days

▪ Counsel on administration

» Injected subcutaneously in the abdomen, thigh, or upper arm

Practice Pearls: Wegovy


Rheumatoid Arthritis Meds


New guidelines will lead to questions about treating rheumatoid arthritis...especially with the plethora of med options.Which med is first-line? Recommend sticking with oral methotrexate 7.5 mg once weekly for most patients. Generally advise titrating to at least 15 mg/week within 4 to 6 weeks...and up to 25 mg/week if needed.But be aware that hydroxychloroquine or sulfasalazine can be enough for patients with low disease activity...and tend to be better tolerated.What are tips to optimize methotrexate? Educate all patients on methotrexate to take folic acid...usually 1 mg/day...to limit GI upset, liver damage, mouth sores, etc.Explain that it's okay to take folic acid and methotrexate on the same day...there's no proof this reduces methotrexate efficacy.Consider additional strategies if GI upset is an issue...or there's an inadequate response to higher doses of oral methotrexate.For example, suggest splitting once-weekly oral methotrexate into 2 doses given 12 hours apart on the same day. Or advise changing to subcutaneous methotrexate before adding or switching to other meds.What are considerations with oral steroids? Suggest limiting them to the lowest dose and shortest duration possible.And don't automatically recommend adding steroids when starting treatment. Risks often outweigh benefits...and patients may not want to taper off due to fear of having a disease flare.What if methotrexate isn't enough? Weigh pros and cons of adding another med after at least 3 months of optimized methotrexate.For instance, point out that biologics (Humira, etc) are injectable...but many have a longer track record than oral Janus kinase inhibitors (Xeljanz, etc), whose risks are piling up (thrombosis, etc).Find med dosing and monitoring advice in our charts, DMARDs for Rheumatoid Arthritis and Biologics for Rheumatoid Arthritis.


RHEUMATOID ARTHRITIS

Help Patients Stick With Methotrexate for Rheumatoid Arthritis


https://pharmacist.therapeuticresearch.com/content/segments/prl/2014/oct/methotrexate-for-rheumatoid-arthritis-faqs-7583

https://pharmacist.therapeuticresearch.com/content/articles/pl/2018/apr/expect-to-see-subcutaneous-methotrexate-for-rheumatoid-arthritis

https://pharmacist.therapeuticresearch.com/content/segments/prl/2010/may/corticosteroids-selection-tapering-and-more-2614

https://pharmacist.therapeuticresearch.com/content/articles/pl/2021/apr/be-alert-for-rare-risks-with-janus-kinase-inhibitors-xeljanz-etc

https://pharmacist.therapeuticresearch.com/content/segments/prl/2018/dec/dmards-for-rheumatoid-arthritis-12938

https://pharmacist.therapeuticresearch.com/content/segments/prl/2017/may/biologics-for-rheumatoid-arthritis-11130

▪ Autoimmune disease that

causes the body to attack

the joints

» Joint pain, stiffness, damage

▪ Disease-modifying

antirheumatic drugs

(DMARDs) can help

» Gain control

» Slow further joint damage

Rheumatoid Arthritis


DMARDs for Rheumatoid Arthritis


Sulfasalazine

Hydroxychloroquine

Methotrexate

Biologics (Humira, etc)

JAK inhibitors (Xeljanz, etc)

Which med is first-line?


▪ Recommend oral

methotrexate 7.5 mg once

weekly for most patients

▪ Generally titrate to

» At least 15 mg/week within 4

to 6 weeks

» Up to 25 mg/week if needed

First-Line Meds


▪ Hydroxychloroquine or

sulfasalazine can be enough

» For patients with low disease

activity

» Tend to be better tolerated

First-Line Meds


What are tips to optimize methotrexate?


Educate all patients on methotrexate to take folic acid...usually 1 mg/day...to

limit GI upset, liver damage, mouth sores, etc.



Explain that it’s okay to take folic acid on the

same day as methotrexate.

Strategies to Improve Tolerability or Efficacy


▪ Suggest splitting once-weekly oral methotrexate into

2 doses given 12 hours apart on the same day

▪ Advise changing to subcutaneous methotrexate

» May have fewer GI side effects and better efficacy

» More expensive and less convenient than oral

15 mg once weekly

7.5 mg x 1 dose,

then 7.5 mg 12 hours

later, once weekly

What if methotrexate isn’t enough?


Common Biologics for Rheumatoid Arthritis


Drug (Brand)

Usual Dosing ~Cost/Month Comments

Adalimumab (Humira)40 mg subcutaneously every

2 weeks or weekly$6,300

Can be used as

monotherapy

or in combination

with methotrexate

Certolizumab (Cimzia)200 mg every 2 weeks

subcutaneously$4,800

Etanercept (Enbrel)50 mg subcutaneously

weekly$6,000

Golimumab (Simponi)50 mg subcutaneously

monthly$5,200

Indicated for use

with methotrexateInfliximab (Inflectra,

Remicade)

3 to 10 mg/kg IV infusion

every 4 to 8 weeks

$950-$1,200 for

100 mg vial


JAK Inhibitors for Rheumatoid Arthritis



Drug (Brand)

Usual Dosing ~Cost/Month Comments

Baricitinib tablet

(Olumiant)2 mg once daily $2,400

Increased risk of

blood clots,

serious infections,

etc

Rare heart events

(Xeljanz)

Require routine

lab monitoring for

anemia, high

cholesterol, etc

Tofacitinib tablet

(Xeljanz, Xeljanz XR)

Xeljanz: 5 mg BID

Xeljanz XR: 11 mg once daily$4,900

Upadacitinib ER tab

(Rinvoq)15 mg once daily $5,300

▪ Triple-check methotrexate sigs

» Usually dosed once WEEKLY for rheumatoid arthritis...but DAILY

for some cancers

▪ Watch out for look-alike/sound-alike mix-ups

» Hydroxychloroquine with hydroCHLOROthiazide or hydrOXYzine

» SulfaSALAzine with sulfADIAZINE or sulfamethoxazole

Practice Pearls: Rheumatoid Arthritis Meds


Rimegepant ODT for Migraine Prevention


MIGRAINE


Put Nurtec ODT for Migraine Prevention in PerspectiveNurtec ODT (rimegepant) will now be used for migraine PREVENTION in adults...in addition to acute treatment.

It blocks receptors of calcitonin gene-related peptide (CGRP), a vasodilator and pain sensitizer that spikes during migraine

attacks.

Until recently, only the INJECTABLE CGRP antagonists (Aimovig, etc) were approved for prevention.

Now evidence shows Nurtec ODT prevents about 1 migraine day/month more than placebo in patients with an average of 10

migraine days/month...after 2 months of use.

Explain that this seems similar to injectable CGRP antagonists and other oral preventive meds (beta-blockers, topiramate,

etc).

You'll hear Nurtec ODT promoted to "take control of migraine with one medication." But this is misleading.

For example, Nurtec ODT is used every OTHER day for prevention.

But for a "breakthrough" migraine, recommend using a DIFFERENT acute med (NSAID, triptan, etc). Tell patients not to

exceed a max of 1 Nurtec ODT tab/day or 18 tabs/month.

Point out that Nurtec ODT every other day costs about $1,800/month. Once-monthly Aimovig, Ajovy, or Emgality costs about

$630/month.

Continue to suggest a preventive med if patients have frequent attacks, such as 4 migraine days/month...or if migraines

significantly impact quality of life.

For most patients, stick with first-line, low-cost options, such as a beta-blocker or topiramate...or combos of these meds.

Think of an injectable CGRP antagonist...or Nurtec ODT...if an 8-week trial of at least 2 first-line meds or combos doesn't do

the trick. Base the choice on patient preference, payer coverage, etc.

Don't be surprised if some experts use an injectable CGRP antagonist for prophylaxis WITH Nurtec ODT for treatment...but

data are scant.

Educate that Nurtec ODT doesn't seem to cause medication overuse headache...or rare blood pressure spikes

like Aimovig...but keep in mind that real-world use is still limited.

Use our chart, Drugs to Prevent Migraine in Adults, to compare dosing, side effects, and more.


Case

Rimegepant (Nurtec ODT) 75 mg

Take one tablet every other day

#16

Refills: 1 2 3 4 5 NRO Matt Welker

Smithfield Medical Group

234 Main Street

Somecity, ST 10001

Patient: Angeline Considine

DOB: 8/28/93

▪ Calcitonin gene-related peptide (CGRP) is a vasodilator

and pain sensitizer that spikes during migraine attacks

CGRP Antagonists

CGRP Antagonists

CGRP

CGRP Receptor

CGRP Antagonists

CGRP

CGRP Receptor

▪ CGRP antagonists either:

» Block CGRP receptors

» Bind CGRP so it can’t bind to receptors

CGRP Antagonists

Bound CGRP

Blocked CGRP

Receptor

▪ Erenumab (Aimovig)

▪ Fremanezumab (Ajovy)

▪ Galcanezumab

(Emgality)

▪ Eptinezumab (Vyepti)

▪ Rimegepant

(Nurtec ODT)

▪ Ubrogepant (Ubrelvy)

Injectable Oral

CGRP Antagonists


Rimegepant ODT for Migraine Prevention


Prevents about 1 migraine day/month more

than placebo in patients with ~10 migraine

days/month after 2 months of use

Seems similar to injectable CGRP antagonists

and other oral preventive meds


This is misleading.

“Take control of migraine with one

medication.”

Rimegepant ODT for Migraine: Dosing


75 mg every other day 75 mg/day as needed

Prevention Acute Treatment

1 tablet/day

18 tablets/month

Maximum

For a “breakthrough” migraine, recommend using a different acute med

(NSAID, triptan, etc).


▪ Rimegepant ODT

» Every other day

» ~$1,800/month

▪ Most injectable CGRP

antagonists

» Can be dosed once monthly

» ~$630/month

Meds for Migraine Prevention

Copyright © Therapeutic Research Center. All rights reserved.Medication pricing by Elsevier, accessed July 2021

▪ Continue to suggest migraine prophylaxis if:

Preventing Migraine in Adults


Migraines significantly

impact quality of life

Frequent attacks, such as

4 migraine days/month

For most patients, stick with first-line, low-cost options...

or combos of these meds.


First-Line Meds to Prevent Migraine


Beta-blockers (propranolol, etc)

Topiramate

ValproateTricyclic

antidepressants (amitriptyline, etc)


Think of an injectable CGRP antagonist...

or consider rimegepant ODT

If an 8-week trial of at least 2 first-line meds or

combos doesn’t do the trick

▪ Some experts may use it for

treatment + injectable CGRP

antagonist for prophylaxis

» Data are scant

▪ It doesn’t seem to:

» Cause medication overuse

headache

» Cause rare blood pressure

spikes like erenumab (Aimovig)

Considerations: Rimegepant ODT


Products


Managing Potassium Levels in Heart Failure


POTASSIUM


Be Armed With Tips to Get Potassium Levels Right


Getting potassium levels right for patients with heart failure can be a balancing act...due to changes in meds, diet, kidney function, etc.Low or high potassium levels increase risk of arrhythmias.And patients with heart failure seem to have a higher risk of death as potassium levels fall below 4 mEq/L...or rise above 5.5 mEq/L.For mild HYPOkalemia, first optimize doses of heart failure meds that raise potassium...such as an ACEI, ARB, or spironolactone.If that's not enough, rely on Rx potassium chloride as the go-to salt form...to replace potassium AND chloride loss from diuretics.Fine-tune potassium supplementation based on diuretic dose...baseline potassium...kidney function...and other meds.Think of potassium chloride 20 mEq/day as a starting dose to prevent hypokalemia while on a loop diuretic. In general, suggest checking electrolytes about weekly until stable...then every 3 or 4 months.Also advise checking magnesium levels and supplementing if needed...since magnesium is required for potassium uptake.Be alert for changes that may affect the potassium dose.For example, if the diuretic dose is doubled for a few days, suggest also "boosting" the usual potassium dose by 40 to 80 mEq/day.Don't rely on potassium-rich foods alone...or non-Rx supplements. For instance, 1 banana provides about 12 mEq of potassium...and a 595 mg potassium gluconate supplement only has about 2.5 mEq potassium.For mild HYPERkalemia, recommend reducing potassium doses...limiting dietary potassium (salt substitutes, etc)...and avoiding NSAIDs, TMP/SMX, and most other meds that raise potassium.Then suggest adding or increasing the dose of a loop diuretic...if volume status and blood pressure allow.If necessary, consider stepping down the spironolactone dose...then reducing the ACEI, ARB, or Entresto (sacubitril/valsartan) dose.But try to avoid stopping these meds. If needed, evaluate whether to add a potassium binder...after weighing costs, side effects, etc.Think of Veltassa (patiromer) first...Lokelma (sodium zirconium cyclosilicate) or sodium polystyrene sulfonate can cause edema.Find more tips on managing potassium in our updated charts, Comparison of Potassium Salts and Potassium Content of Foods.

▪ Low or high potassium levels increase risk of arrhythmias

▪ These patients seem to have a higher risk of death:

Potassium Levels in Patients With Heart Failure

As potassium levels fall below 4 mEq/L

As potassium levels rise above 5.5 mEq/L5.5 mEq/L

4 mEq/L

Mild Hypokalemia

Mild Hyperkalemia



▪ Advise optimizing doses of

HF meds that raise potassium

» ACEI, ARB, spironolactone, etc

Managing Mild Hypokalemia


Standard “Triple Therapy” for HFrEF


ARB(losartan, etc)

ACEI (lisinopril, etc)

Beta-blocker (carvedilol, etc)

Aldosterone

antagonist (spironolactone,

etc)

Sacubitril/valsartan

(Entresto)

OR

OR

Fine-tune supplementation based on:

Diuretic doseBaseline

potassiumKidney

functionOther meds

If that’s not enough, rely on Rx potassium chloride as the go-to salt form

Replaces potassium and chloride loss from diuretics



Think of potassium chloride

20 mEq/day as a starting dose

In general, suggest checking electrolytes

weekly until stable, then every 3 or 4 months

Advise checking magnesium levels and

supplementing if needed



▪ Be alert for changes that may affect the potassium dose

» E.g., if the diuretic dose is doubled for a few days, suggest also

“boosting” the usual potassium dose by 40 to 80 mEq/day



▪ Don’t rely on these alone:



▪ 1 banana ≈

12 mEq potassium

▪ 595 mg potassium

gluconate supplement ≈

2.5 mEq potassium

Potassium-rich foods Non-Rx supplements



Mild Hypokalemia

Mild Hyperkalemia

Managing Mild Hyperkalemia


Reducing potassium doses

Limiting dietary potassium

(salt substitutes, etc)

Avoiding NSAIDs, TMP/SMX, and most other meds that raise

potassium

Suggest adding or increasing the loop diuretic dose

If needed, consider stepping down the spironolactone dose

Then suggest reducing the ACEI, ARB, or sacubitril/valsartan dose



But try to avoid stopping “triple therapy” meds.


▪ If needed, evaluate whether to add a potassium binder

» Weigh costs, side effects, interactions, etc

▪ If one is used, think of patiromer (Veltassa)

» Sodium zirconium cyclosilicate (Lokelma) or sodium polystyrene

sulfonate can cause edema



Expanding Pharmacy Technician Roles


PHARMACY TECHNICIANS

Pharmacist’s Letter. August 2021, No. 370806

Empower Your Techs to Take on Advanced Roles


You'll be able to rely even more on your pharmacy technicians...as they take on new activities and expanded roles.COVID-19 was a catalyst that allowed pharmacy teams to clearly demonstrate their value...and changes will last beyond the pandemic.Techs still can't do tasks requiring your professional judgment.But there's a lot they CAN do to free up your time for patient care...so each of you can practice at the top of your ability.Immunizations. Many trained techs are already giving COVID-19 or childhood vaccines under supervision, based on emergency federal guidance.Now PERMANENT laws or regulations allowing qualified techs to administer routine vaccines are proposed or in place in at least 7 states.This may feel like a big change. But it lets you focus on tasks that require clinical judgment...such as evaluating which vaccines are needed, assessing contraindications and precautions, etc.Point-of-care testing. More patients are turning to pharmacies to identify certain infections (COVID-19, flu, etc)...or to screen for or monitor conditions (cholesterol, diabetes, etc).Consider leveraging techs beyond paperwork, scheduling, etc...to obtain samples (fingerstick, etc) and vital signs (BP, etc).Other patient services. Techs continue to be critical in supporting MTM and disease state management services (diabetes, etc).For instance, train techs to become experts at gathering med histories, monitoring adherence, or coordinating specialty meds.Operations. We know techs keep pharmacies running smoothly.Encourage techs to further improve efficiency and quality with specialized roles, such as leading internal audits...preventing diversion...or exploring tech product verification ("tech-check-tech").Look with "fresh eyes" at tasks you currently do that could be delegated...such as scheduling, training, or supervising other techs.If needed, recommend advanced training...so you and your techs feel comfortable as they take on new responsibilities.Our Pharmacy Technicians University's PTU Elite can help train your techs on Immunizations, Point-of-Care Testing, and Soft Skills.

Techs can’t do tasks requiring pharmacist professional judgment

But there’s a lot techs CAN do to free up pharmacist time for patient care

Allows each role to practice at the top of their ability

Expanding Technician Roles


Immunizations


Many trained techs are already giving certain vaccines (COVID-19, etc)

▪ Under emergency federal guidance

Permanent laws/regulations allowing qualified techs to administer routine vaccines are proposed or in place in at least 7 states

▪ Identifying infections

» COVID-19, flu, strep, etc

▪ Screening or monitoring

conditions

» Cholesterol, diabetes, etc

▪ Techs can go beyond

paperwork, scheduling, etc

» Obtaining samples, vital

signs, etc

Point-of-Care Testing


▪ Techs continue to be critical in

supporting activities such as:

» MTM

» Disease state management

services (diabetes, etc)

▪ Example tech roles:

» Gathering med histories

» Monitoring adherence

» Coordinating specialty meds

Other Patient Services


▪ Techs are the backbone that

keep pharmacies running

smoothly

▪ Consider specialized roles:

» Internal audits

» Controlled substance diversion

» Inventory management

» Tech product verification

(“tech-check-tech”)

Pharmacy Operations


▪ Look with “fresh eyes” at tasks

techs can do

» Scheduling, training, or

supervising other techs

» Resolving billing issues

Pharmacy Operations


▪ If needed, recommend

advanced training

» To improve knowledge,

proficiency, and comfort as techs

take on new responsibilities

Expanding Technician Roles


Pharmacy Essential Updates August 2021

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