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Pharmacies Are Hampered by States’ Technician Limits

State-level ratio requirements limiting the number of pharmacy personnel able to work under a licensed pharmacist are restricting the operational capabilities of pharmacies, a new report concludes.

Many states limit the number of pharmacy technicians permitted to work under the supervision of a licensed pharmacist at any given time, state the authors of the report, James Broughel, a senior research fellow at the Mercatus Center at George Mason University and adjunct professor of law at the Antonin Scalia Law School, and Yuliya Yatsyshina, program manager at Academic and Student Programs at Mercatus Center at George Mason University.

In some states, though, these regulations have been relaxed as part of the emergency response to the COVID-19 pandemic. In their research paper, Broughel and Yatsyshina argue that this apparent trend toward less restrictive regulation could be an important way to advance public health.

Rationale for Ratios Unclear

The reason behind these regulations seems to be that pharmacists supervising too many junior staff might become overwhelmed and quality could suffer, Broughel tells Health Care News.

“This rationale is strange, however, because we don’t typically see the same ratio restrictions placed on other health care workers (e.g., doctors),” Broughel said. “To the extent these restrictions are intended to impede competition, they might exist to protect pharmacists, who earn significantly more than technicians, but who perform some of the same tasks. That said, pharmacists often support giving more responsibility to technicians.”

Costs Passed On

Another reason for concern is whether the restrictions can drive up costs and limit consumer choice. There isn’t much research on the effects of these regulations, but basic economic theory suggests that restricting the supply of something makes it more expensive, Broughel says.

“In this case, a pharmacy’s costs will rise if it is prevented from hiring more relatively lower-paid technicians unless it hires a relatively much higher-paid licensed pharmacist,” Broughel said. “Most likely, some of these costs are passed on to consumers.”

Ratios to the Test

There is not a lot of research on the consequences of these laws or the consequences of repealing them, Broughelsays. That said, there are 22 states without a pharmacist-technician ratio requirement as of 2020.

“It is not obvious that the quality or safety of pharmacy services is any lower in states without ratio requirements than in states that have them. Moreover, the trend over time seems to be towards relaxing these laws,” Broughel said. “We’ve seen that trend accelerated during the pandemic. If these restrictions don’t make sense during a public health emergency, they may not make sense during ordinary times either.”

Increasing Consumer Satisfaction

Relaxing pharmacy technician ratio laws can go far to increase consumer choice and satisfaction Broughel says.

“America’s aging population will put increased stress on the healthcare system in the years ahead,” Broughel said. “Pharmacists and technicians have the training needed to provide far more care for patients than they are currently providing. Three obvious areas where they can be doing more are testing, prescribing, and vaccinating.”

Unaware to most consumers, pharmacies can assist in medical diagnosis, Broughel says.

“Some pharmacists have the ability to conduct low-risk tests for illnesses such as COVID-19, the flu, strep throat, and other common ailments,” Broughel said.  “However, states routinely set up roadblocks to pharmacists having the ability to perform these tests. Similarly, once tests are conducted by pharmacists, it often makes sense to allow them to prescribe based on the results of the test. Idaho is a model for its reforms expanding pharmacists’ prescribing authority.”

Pharmacists and technicians have played a prominent role in rolling out the COVID-19 vaccine, with many Americans visiting their local pharmacies for the shots and pharmacy chains widely promoting the vaccine. However, there are often regulations that prohibit pharmacists and technicians from vaccinating.

“One of the reasons they can do so now is because a public health emergency has been declared, but this will not always be the case,” Broughel explained.

A final reform worth noting is tele-pharmacy reform, whereby licensed pharmacists can oversee multiple pharmacies remotely via video conferencing technology, Broughel says.

“These reforms can be especially important for rural areas, where the population is too small to support a pharmacy with a full-time licensed pharmacist on staff,” Broughel said.

Kenneth Artz (kennethcharlesartz@gmx.com) writes from Dallas, Texas.

Internet info:

James Broughel, Yuliya Yatsychina, “Pharmacy Technician Ratio Requirements,” Mercatus Center, George Mason University, March 16, 2021:



Kenneth Artz
Kenneth Artzhttps://www.heartland.org/about-us/who-we-are/kenneth-artz
Artz has more than 20 years’ experience in nonprofit organizations, publishing, newspaper reporting, and public policy advocacy.


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