Comments on NOIRA/Emergency Regulations for 18VAC110-20-110 and 18VAC110-20-113
Dear Executive Director Juran and members of the Virginia Board of Pharmacy,
I am writing to you in my capacity as Sr Vice President, Pharmacy Regulatory Affairs for CVS Health and its family of pharmacies located across Virginia. CVS Health appreciates the opportunity to submit comments on the Virginia Board of Pharmacy emergency regulations and NOIRA related to pharmacy permits and pharmacy working conditions.
CVS Health is committed to providing access to consistent, safe, high-quality health care to the patients and communities we serve and are engaging in a continuous two-way dialogue with our pharmacists to directly address any concerns they have. In response to recent feedback from our pharmacy teams, we’re making targeted investments to address their key concerns, including enabling teams to schedule additional support as needed, enhancing pharmacist and technician recruitment, and hiring, and strengthening pharmacy technician training. Our goal is to develop a sustainable and scalable action plan to support both our pharmacists and our customers so we can continue delivering the high-quality care our patients depend on.
Meal and Rest Breaks
CVS Health supports and is committed to providing a work environment that protects the health, safety, and welfare of patients and employees. Our commitment to our pharmacists, interns and technicians was shown most recently with the adoption of closure of all pharmacies across the country for 30 minutes to allow for an uninterrupted lunch break. We support the Board for recognizing the importance of uninterrupted rest and meal breaks.
Pharmacist Services and Vaccines
As we continue to see a shortage of primary care providers, more patients seek out care at alternative locations, such as a pharmacy, especially in rural locations. The Virginia legislature and the Board of Pharmacy recognize this movement with the allowance in law and regulation for pharmacists’ initiation of treatment for drugs, devices, controlled paraphernalia, and other supplies and equipment. This is also recognized in the allowance for an intern or technician to administer immunizations, under the supervision of a pharmacist. If immunizations or other services are not available, this may cause a patient not to return or seek care elsewhere, leaving them without resolution of the issue they sought care for which can continue to increase medical costs. Therefore, we request the Board continue to weigh the restriction of patient access with these emergency regulations and work with industry stakeholders to promulgate regulations that promote innovation, reduce regulatory barriers, and allow for the use of technology. An important reason to be focused on partnership in solutions is the forecasted decrease in pharmacists. American Association of Colleges of Pharmacy (AACP) data has shown significant decreases in the number of students interested in pursuing pharmacy careers. In fall 2011, AACP found that there were 106,815 applicants to pharmacy school, a figure that dropped to 76,525 by fall 2015 and 40,552 by fall 2021. In less than a decade, pharmacy school applications had decreased by more than 60%.1
Scheduling and Staffing Forms
Today’s pharmacy operation is a complex, dynamic healthcare work environment employing highly skilled professionals. For this reason, CVS Health has developed a sophisticated and robust scheduling program that uses the resources of experienced industrial engineers, statisticians, analysts, and pharmacists to ensure that sufficient pharmacy personnel are scheduled to work in our community pharmacies to support the needs of our patients. As part of this proprietary program, measurements including drug utilization review, patient counseling, immunization administration, patient testing, and prescription volume are used to forecast the needs for the pharmacy workday schedule. These measurements and programs are used by CVS Health PICs to schedule the appropriate amount of personnel during the week which is vital to ensure the healthcare needs of the communities that we serve are met. The data points used to inform PICs as to how to properly staff and schedule are based on science. Additionally, we have recently announced enhancements to pharmacist and technician recruitment and hiring to help make it faster and easier to support our local pharmacy teams.
With the implementation of a staffing form, we seek clarification from the Board and board staff on how they plan to review staffing forms which are submitted for immediate review and what actions they may take from that review. Furthermore, CVS Health has been actively engaged in fielding and responding to “Staffing Requests or Concerns forms” submitted by pharmacists. Based on the utilization of a “paper form,” an administrative challenge has presented itself whereby execution and visibility to the forms varies by those pharmacists who submit them and the district managers who receive them. To mitigate these challenges and to optimize the process, CVS Health would like to convert the Staffing Request or Concerns form, in its complete form and wording as approved by the Board, into an electronic format in lieu of using the paper form.
We feel that there are multiple benefits for electronic submission and response such as:
• Immediate visibility for the supervisor of the PIC or pharmacist to the staffing request or concern once submitted
• Faster acknowledgement of receipt to the PIC or pharmacist submitting
• Timely review of the concern for partnership on an action plan or inaction determination
• Documentation of the action plan or reason for inaction stored electronically, in compliance with the recordkeeping provisions of the regulation.
Therefore, we request the Board allow electronic capture of the information in the form to streamline the process of review and expediting confirmation and response.
CVS Health appreciates the opportunity to comment on these emergency regulations/NOIRA. Patient safety is our highest priority. Our more than 30,000 CVS pharmacists approach this responsibility with seriousness and dedication, and we work hard to earn the trust of our pharmacy patients. Safeguards to support patient safety are integrated throughout our prescription workflow, and our pharmacists and pharmacy technicians receive extensive training on all pharmacy systems. Decisions about staffing, labor hours, workflow process, technology enhancements and other operational factors are made to ensure we have appropriate levels of staffing and resources in place at our pharmacies. We want our pharmacy teams to succeed and are committed to ensuring our they’re well-positioned to serve their patients.
Jeffrey Sinko, RPh, JD
Sr Vice President, Pharmacy Regulatory Affairs
1 Antrim, Aislinn. “Despite Rapid Growth of Institutions, Pharmacy School Applications Decline,” Pharmacy Times, April 5,2023