Dear Executive Director Juran:
I am writing to you in my capacity as Sr 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 of care to patients in the state of Virginia through our integrated offerings across the spectrum of pharmacy care. CVS Health appreciates the opportunity to submit comments on the petition for rule-making of 18 VAC 110-20-276 to allow technicians to practice remote order entry from outside the licensed pharmacy space. 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 Virginia patients.
While CVS Health appreciates the petitioners sentiment to amend 18 VAC 110-20-276 allowing technicians to perform remote order entry from outside the licensed pharmacy space, we feel the petitioner places undue restrictions on the allowance by proposing additional requirements outlined in subsection (F)(1-4), which are mostly duplicative of requirements already in regulation through policy and procedure. We support the allowance for technicians to perform prescription processing functions without specific additional restrictions. The NABP Model Rules address individual practice of not only a pharmacist, but also a pharmacy intern and pharmacy technician in the Practice of Pharmacy, within Section 8, Shared Pharmacy Services. The model rules provide an avenue for these individuals to access the pharmacy’s electronic database from inside or outside the pharmacy to perform prescription drug order processing functions if there are established controls to protect confidentiality and integrity of protected health information and if no part of the database is duplicated, downloaded or removed. This is similar to language in Virginia regulations allowing pharmacists to perform certain prescription processing functions. Currently 11 states allow technicians to work remotely performing prescription processing functions, with 4 of those states using language from the model act to permit the practice. In light of the COVID-19 pandemic, an additional 34 states, including Virginia, either through guidance, waivers, emergency regulations or suspension of laws and/or regulations have allowed technicians to practice remotely. Therefore, we support the allowance of technicians to perform remote order entry and prescription processing functions remotely. Please see below our recommended language based on the petitioner’s proposal along with NABP Model Rules for your reference.
Suggested Language:
18VAC 110-20-276 Central or Remote Processing
F. Nothing in this section shall prohibit an individual employee licensed as a pharmacist, pharmacy intern or pharmacy technician in Virginia from accessing the employer pharmacy’s database from a remote location for the purpose of performing certain prescription processing functions as described in subsection A of this section, provided the pharmacy establishes controls to protect the privacy and security of confidential records. No part of the database is duplicated, downloaded, or removed from the Pharmacy’s electronic database. A pharmacy technician is permitted to access the pharmacy's database only under the following conditions:
1. The remote location must be a location that is on the same premises as the licensed pharmacy;
2. The technician is performing only prescription processing functions, patient care documentation, patient and
prescriber communications, activities falling within the scope of VA ST § 54.1-3321 that do not require the handling of
or access to prescription drug inventory; and activities that do not fall within the scope of the practice of pharmacy;
3. The prescription processing functions performed by the pharmacy technician shall be limited to the entry of
prescription information and drug history into the database: and
4. A policy and procedure manual that relates to remote processing functions performed by a pharmacy technician shall be maintained at each pharmacy involved in the processing of a prescription and available for inspection. The manual shall at a minimum include the following:
a. Procedures for protecting the confidentiality and integrity of patient information;
b. Procedures for ensuring that original prescriptions received by the pharmacy as an original hard copy or
verbally and reduced to writing do not leave the licensed space, and that technicians performing processing
functions have access to an exact, unalterable image of such prescriptions to perform prescription order entry;
c. Procedures for ensuring adequate pharmacist supervision of pharmacy technicians that perform prescription
processing functions;
d. Procedures for objectively and systematically monitoring and evaluating the quality of the program to resolve
problems and improve services; and
e. Procedures for annually reviewing the written policies and procedures for needed modifications and
documenting such review.
NABP Model Rules Section 8. Shared Pharmacy Services
(e) Individual Practice
(1) Nothing in this Section shall prohibit an individual Pharmacist licensed in the state, who is an employee of or under contract with a Pharmacy, or a licensed Certified Pharmacy Technician, Certified Pharmacy Technician Candidate, or Pharmacy Intern, working under the supervision of the Pharmacy, from accessing that Pharmacy’s electronic database from inside or outside the Pharmacy and performing the Prescription Drug Order processing functions permitted by the Pharmacy Act, if both of the following conditions are met:
(i) the Pharmacy establishes controls to protect the confidentiality and integrity of Protected Health Information; and
(ii) no part of the database is duplicated, downloaded, or removed from the Pharmacy’s electronic database.
CVS Health appreciates the opportunity to submit comments on this petition for rule-making.