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TECHNICIAN TRAINING PROGRAMWALGREENS AREA #63 - SALT LAKE CITY, UT

PROGRAM DEVELOPED BY KRISTA WALL

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Dear Tech-in-Training, Welcome to Walgreens! We are so excited you have chosen to complete your externship with our team. We have developed this training curriculum to help you have the best experience possible. Our pharmacy manager and senior technician staff have collaborated to design a program that will help you apply what you have learned in class and further develop the skills that we think will help you most in your future career. Our promise to you is that we will help you obtain the skills necessary to be a competitive applicant for pharmacy technician jobs once you graduate. In return, we expect your full commitment to this experience. There is a high demand for externship positions, so in order to accommodate as many students as possible, we expect you to decide on and stick to a schedule. Reliability is a key character trait prospective employers will look for when choosing a candidate to hire. Timely attendance is required for all employees here at Walgreens, and as training for a future career, we expect the same from you as you complete your externship. Feel free to come to any of us with thoughts and concerns. We look forward to working with you! Walgreens Pharmacy Staff

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TABLE OF CONTENTS I. HIPAA/HOUSEKEEPING……………………………………………………………………4 PHARMACY VISITOR’S AGREEMENT……………………………………………...4 HIPAA ONLINE TRAINING MODULES………………………………………………4 DRESS CODE ACKNOWLEDGEMENT………………...…………………………...5

II. INTERCOM PLUS…………………………………………………………………………...6 INTERCOM PLUS ONLINE TRAINING MODULES………………………………...6

III. PRESCRIPTION PROCESS AND WORKFLOW………………………………………..7 IN-STORE ACTIVITIES…………………………………………………………………8

IV. FILLING PRESCRIPTIONS………………………………………………………………..9 IN-STORE ACTIVITIES…………………………………………………………………9

V. ENTERING PRESCRIPTIONS……………………………………………………………11 IN-STORE ACTIVITIES……………………………………………………………….11

VI. CUSTOMER INTERACTION……………………………………………………………..13 IN-STORE ACTIVITIES……………………………………………………………….13

VII. THIRD PARTY BILLING AND REJECTIONS…………………………………………15 INTERCOM PLUS THIRD PARTY PROCESSING……...………………………...15 COORDINATION OF BENEFITS…...……………………………………………….16

THIRD PARTY REJECTIONS………………………………………………………..17 IN-STORE ACTIVITIES……………………………………………………………….20

VIII. GOVERNMENT-FUNDED INSURANCE……………………………………………...21 MEDICARE……………………………………………………………………………..21

PART D…………………………………………………………………………21 PART B…...…………………………………………………………………….22 MEDICAID……………………………………………………………………………...23

IX. VACCINES………………………………………………………………………………....25 IN-STORE ACTIVITIES……………………………………………………………….26

X. MANAGING INVENTORY…………………………………………………………………27 INSUFFICIENT STOCK……...……………………………………………………….27 EXCESS INVENTORY………………………………………………………………..28

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HIPAA AND HOUSEKEEPING

HIPAA The Health Insurance Portability and Accountability Act (HIPAA) is a law that ensures the protection of patient health information. As a pharmacy technician, you will need to access and use patient information on a daily basis. In keeping with HIPAA—and just good ethics—it is important to remember to use only the amount of information necessary to complete the task at hand, and not to disclose patient information to anyone outside of the pharmacy. This includes team members who work in the front end of the store. HIPAA does allow for the sharing of information between two providers who share a common patient, and in limited cases with a subpoena to law enforcement. If you are unsure of whether or not to disclose patient information, consult a pharmacist or senior pharmacy technician. Protected Health Information must be disposed of in the designated DPI bins located in several places around the pharmacy. Anything containing patient information (IE name, phone number, medication name, etc.) must be thrown in these bins. This includes old amber vials, unused leaflets, notes taken in the pharmacy, etc. Ask a pharmacy staff member to point out the DPI bins in our pharmacy. IN-STORE ACTIVITIES Sign Walgreens Pharmacy Visitor Agreement. RPH/SPHTC SIGNATURE DATE Complete the online HIPAA training module on StoreNet. RPH/SPHTC SIGNATURE DATE

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WHAT TO WEAR Professional attire is an important part of your experience with us. You may choose to wear scrubs or business casual attire (e.g., khakis, collared shirt, etc.) The following items are not permitted in the pharmacy:

• Sweatpants and sweatshirts • Jeans or denim clothing or fabric, leggings, shorts • Headwear that covers the top of the head, unless due to a religious belief • Miniskirts • Sleeveless shirts, T-shirts • Open toe or open heel shoes • Personal beepers, cell phones, smart phones, MP3 players, or headphones • Sunglasses • Excessive jewelry • Halter tops • Hooded garments • Overly revealing clothing • Tattoos that are offensive in nature

Additionally, each person working in the pharmacy is required to wear a name badge

at all times. Clarify any questions you may have about the dress code with your store’s leadership, and sign below acknowledging that you understand the policy. RPH/SPHTC SIGNATURE DATE Have the store manager print you a name badge. RPH/SPHTC SIGNATURE DATE Bring a copy of your training license to display at the pharmacy. RPH/SPHTC SIGNATURE DATE

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INTERCOM PLUS

An essential part of the workflow in any pharmacy is its information system. Software is used to manage and store patient profiles, medication histories, drug databases, insurance profiles, prescriber contact information, and much more. In order to effectively maneuver in the pharmacy, you will need a working knowledge of the computer system. Walgreens uses a software program called Intercom Plus (IC+). The best way for you to learn this system is through the completion of an online training course designed to demonstrate the features of this unique software. The training is lengthy but will give you a foundation for the rest of your externship. While every pharmacy uses a different software system, a working knowledge of ours will allow you to build skills that you can take to any pharmacy you may work in.

IN-STORE ACTIVITY Complete the online IC+ training module on StoreNet. RPH/SPHTC SIGNATURE DATE

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PRESCRIPTION PROCESS AND WORKFLOW

When a prescription enters the pharmacy, it goes through five basic steps before it reaches a patient: it is scanned, entered, reviewed, filled, and then verified. As a technician, you will be primarily responsible for completing steps 1, 2, and 4. A pharmacist must complete steps 3 and 5. The next sections of this training course will explain over each of these steps in detail. One important aspect of the prescription process is the management of workflow. Prescriptions are processed most effectively when tasks are divided up among the technicians on duty, and each person knows which stations they are responsible for at any given time. This ensures that patients are quickly greeted and prescriptions are completed as quickly as possible while still ensuring patient safety. On a normal day, we strive for a ten- to fifteen- minute wait time. Sometimes this is not possible if there are multiple waiters or other projects going on in the pharmacy, but with good workflow we are able to achieve this goal most of the time.

The prescription is SCANNED into the system under the patient’s profile.

The prescription is typed (ENTERED) into

the system.

The pharmacist REVIEWS the entered prescription for any

errors.

The prescription is FILLED.

The pharmacist VERIFIES the filled

prescription.

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IN-STORE ACTIVITIES Have a pharmacist or technician explain the different workflow stations with you (in-window, filling counter, and drive through). Learn the responsibilities associated with each station, and how we make sure the pharmacy runs smoothly. RPH/SPHTC SIGNATURE DATE Learn the daily duties assigned to the technician who is opening, closing, and working the mid-shift. We will discuss the specifics of some of these tasks, such as ordering and the patient call list, when we reach the inventory section. RPH/SPHTC SIGNATURE DATE

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FILLING PRESCRIPTIONS We will begin your practical training by teaching you how to properly fill prescriptions. Starting here will allow you to become familiar with common drug names, strengths, and uses. You will learn about drug locations and storage requirements, the differences between filling controlled substances and legend medications, how we deal with insufficient stock, and other aspects of filling prescriptions that may come up while you are working with us. Complete the following in-store activities with a pharmacy team member.

IN-STORE ACTIVITIES Learn the main categories of drug locations and how to recognize where a drug is located. Basic drug locations include: Alpha, Fast Rack, Cell, Unit of Use, Liquid, Recon, and the Fridge. RPH/SPHTC SIGNATURE DATE Learn how to change a drug location in IC+. RPH/SPHTC SIGNATURE DATE Become proficient in filling prescriptions. This includes counting, double-counting (when required), labeling both the bottle and hard copies (when required), and managing “waiters” vs “laters”. Remember to mark open bottles with an X, use amber vials first, and flag labels on unit of use items! RPH/SPHTC SIGNATURE DATE Learn how to mix recons (antibiotics, certain acne creams, etc.) RPH/SPHTC SIGNATURE DATE

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Learn the specific requirements associated with the filling of controlled substances, including the 80% rule, the good faith dispensing procedures, and how to recognize fraudulent prescriptions. RPH/SPHTC SIGNATURE DATE Practice using the work queue to assist in the filling of prescriptions. Learn how to change a manufacturer, partial fill a prescription, mark a drug as out-of-stock, and complete a previously partial-filled prescription. RPH/SPHTC SIGNATURE DATE

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ENTERING PRESCRIPTIONS Entering prescriptions is an important task completed primarily by pharmacy technicians. Carefully reviewing each piece of information you type into the system is very important to make sure as few errors slip through as possible. Medication errors are the most common type of medical error, and they contribute to a significant number of injuries and deaths each year. As a pharmacy technician, you are the first link in this chain. Each prescription you enter will be reviewed by a pharmacist after it is typed; however, the more errors you allow to pass through to a pharmacist, the more likely it becomes that an error will make it through to a patient. As such, it is extremely important to be attentive to the data you are entering, and ask questions if you are unsure about any part of a prescription. Walgreens monitors each technician’s data review error (DRE) rates. In order to become eligible for senior technician status, you must have a DRE rate of 3% or less, meaning that less than 3% of the prescriptions you type contains errors. While learning how to type, it is expected that you will make more errors than an experienced senior technician; however, this is a good benchmark to aim for. As an extern, we will not be able to monitor your exact DRE rate, but asking the reviewing pharmacist to mention errors he or she notices can help you recognize your weaknesses, and allow you to improve in these areas.

IN-STORE ACTIVITIES Learn how to search for a patient’s profile and how to register a new patient. RPH/SPHTC SIGNATURE DATE Complete the tech builder typing exercise on StoreNet. A pharmacist or senior pharmacy technician can access it for you. Spend at least a cumulative total of one

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hour typing on this simulator. (Note: if your error rate at the end of the exercise exceeds 50%, continue until you reach this point.) RPH/SPHTC SIGNATURE DATE After passing the training course, you may begin entering real prescriptions. Work closely with a senior technician and pharmacist to prevent typing errors. You will continue to type prescriptions throughout your externship, but spend at least three full days developing this skill before moving on to the next section. RPH/SPHTC SIGNATURE DATE

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PATIENT INTERACTION Interacting with patients is another integral task of a pharmacy technician. Walgreens’ policy does not allow externs to handle money, so you will not be able to work at the registers. This is unfortunate, because working face-to-face with patients is a great way to develop many important skills, including customer service. The best way we can give you a taste of this interaction is by having you answer patient phone calls. This can be intimidating at first, as patients call for many reasons: from refills, to pricing, to drug information questions. A working knowledge of Intercom Plus will help you assist most patients, but when in doubt, don’t be afraid to ask a pharmacy technician or pharmacist for help. Also be aware that Walgreens does not allow technicians or externs to counsel patients on medical questions, so those phone calls should always be referred to a pharmacist.

IN-STORE ACTIVITY Begin answering phone calls. Pharmacy law requires that you state your name and title when answering the phone. Each pharmacy will have its own preferences, but Walgreens likes the following greeting to be used: “Thanks for calling Walgreens, this is _______, pharmacy extern speaking. How may I help you today?” In order to help as many patients as possible, you should have a pharmacy technician go over a few things with you including how to refill a prescription using a prescription number, how to refill a prescription without a prescription number, what information is necessary to transfer prescriptions from another pharmacy, and how to fax a doctor when there are no refills remaining. Remember that our patients are our

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most important assets; so try to be as polite and courteous as possible on the phone and with any customers you may interact with in person. RPH/SPHTC SIGNATURE DATE At the discretion of your pharmacy manager, you may be able to assist customers in a limited fashion at the front window. Work with your store’s staff to determine the best way to facilitate this interaction. RPH/SPHTC SIGNATURE DATE

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THIRD PARTY BILLING AND REJECTIONS

“Third Party” is the term we use for any company that pays for all or part of the cost of a patient’s medication. This is usually taken to mean insurance companies, but can also include manufacturer’s coupons and discount programs. This is a lengthy and important section, so we will spend several days discussing insurance.

BILLING An important distinction to make here is the difference between medical insurance and prescription drug insurance. Even many patients do not know the difference, so it is important for you to be able to recognize whether the card they hand you has the information needed to process their medications. Some insurance companies issue separate cards for prescriptions and some include the information on the same card. In order to process prescriptions, four basic sets of numbers are needed. Though the procedures for entering this information may vary between pharmacies, the numbers required are the same. These required numbers are the BIN number, PCN number, ID number, and group number. Some insurance companies do not use group numbers, but all of them use the BIN, PCN, and ID. If you cannot find these numbers, very likely the patient has given you their medical insurance card and will need to provide you with their prescription card instead. IN-STORE ACTIVITIES Learn where to add third party information to a patient’s profile. Learn how to signify whether an added plan is a primary insurance, secondary insurance, or coupon. RPH/SPHTC SIGNATURE DATE

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Practice entering all information on our practice insurance cards into IC+. Have a pharmacist or technician review your work when you are finished. RPH/SPHTC SIGNATURE DATE Learn how to know whether a patient’s insurance has been billed for their medication by checking both the work queue and their prescription profile. Learn what information can be found on the “View Claim Information” screen. RPH/SPHTC SIGNATURE DATE

COORDINATION OF BENEFITS Often patients will have more than one insurance company or a coupon they would like to use in addition to their primary insurance. The procedure for billing multiple third parties probably differs a lot between pharmacies but a basic knowledge will be useful no matter where you work. The most common application of dual billing is a patient’s use of manufacturer coupons. Often when a new medication is released, the manufacturer will issue coupons to assist patients with their often-higher copays. As with anything, there is usually fine print associated with them, and there are restrictions that many patients and doctors are unaware of. For example, patients enrolled in a government-funded insurance program, such as Medicare or Medicaid, are ineligible to use most coupons. Failure to adhere to this restriction could result in chargebacks to our pharmacy, which would penalize the store for a previously paid claim. Patients should also be notified that most coupons have a maximum reimbursement rate. This means that coupons advertising “Pay no more than $25 for your medication!” will not always reduce a patient’s price to $25. To ensure that a patient is informed of the actual amount they will be responsible for paying, it is a good practice to complete all billing before a prescription is filled.

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IN-STORE ACTIVITIES

Learn how to differentiate between manufacturer coupons and discount programs (which cannot be used in combination with other insurance companies). RPH/SPHTC SIGNATURE DATE Learn how to bill a COB in IC+ and using the Submit Direct Link (SDL) portal. RPH/SPHTC SIGNATURE DATE Learn how to determine whether a COB was processed successfully using the “View Claim Info” screen and a patient’s profile. RPH/SPHTC SIGNATURE DATE

THIRD PARTY REJECTIONS

There are many reasons why an insurance company might refuse to pay for a prescription. The table below outlines each main type of rejection and provides ways (where possible) to resolve them.

Rejection Type

Abbreviation Definition How to Resolve

Refill too soon RTS A patient has attempted to refill their medication earlier than their plan limits allow.

Usually, inform the patient when the insurance will pay and program the computer to fill on that date. In the case of vacation, many insurances will allow 1-2 RTS overrides per year. Overrides can also be performed if the patient’s dose has changed. In the case of lost medication, patients will usually have to pay the full cash price of their medications. Ask a pharmacy staff member about the differences for controlled substances.

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Prior Authorization Required

N/A (Prior Authorization=PA)

The requested medication is not currently covered by the patient’s insurance. Before reviewing this decision, the insurance company requires the MD’s office to submit information certifying the medical necessity of the drug.

Fax the MD’s office to inform them of the need for a PA. Include information about the patient, their insurance, and which medication has been rejected. It is important to note that sometimes the medication will still not be covered even after the PA is completed. Sometimes the better solution is to request a drug substitution from the physician.

Plan Limits Exceeded

N/A Usually, the plan does not allow for the length of supply being billed for. However, we will see this rejection if any limits set by the plan are exceeded.

Adjust the quantity dispensed to match the days supply required by the plan. Make other adjustments as required by the plan.

Non-matched Recipient ID

N/A The ID number (or other insurance information) is invalid. This can mean it has been entered incorrectly, has expired, or has not yet been activated.

Double-check the information in IC+ against the information on the patient’s card. If the patient is in the pharmacy, verify that we are billing the correct insurance. If they are not, cash out the prescription. We will verify insurance at the point of sale.

Non-matched DOB, Gender Code, or Relation to Planholder

N/A Self-explanatory; the ID number matches but some other information is missing or invalid in IC+.

Often, this just means an adjustment to a person code in IC+. Sometimes, however, a patient’s insurance may have the information incorrect on their end. This situation requires a call to the insurance company to verify what information they have on file.

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If you are on your own and still unsure of how to resolve a specific third-party rejection, a phone call to the insurance company can always help answer any other questions you may have.

HOW IS PRICING DETERMINED BY INSURANCE COMPANIES? Patients will often have questions about the price of their medication. Prescription pricing is determined as follows. First, before patients will pay their normal copays, many plans require a deductible to be met. A deductible is just a set dollar amount that a patient must pay before the insurance will begin covering their claims. Typically, an insurance company does not pay anything to the pharmacy while a patient is working on their deductible. However, patients will usually still receive a discounted price on their medication since their insurance has contracted with us to receive a lower price than we charge our cash-paying patients. Once a deductible is met, the price of a medication is usually determined by the “tier” level and varies with each plan. Typically, an insurance company separates drugs into three tiers, and assigns prices to each tier. Tier 1 medications include inexpensive

Drug Utilization Review

DUR The patient’s insurance has flagged the prescription for being outside its best use; this could mean it is being refilled early, or it could mean there is some type of interaction or dosing issue.

If the DUR is occurring because of an early refill, follow procedure for RTS. If DUR is for an interaction, a pharmacist must review the prescription before it can be dispensed.

Miscellaneous Exception

MSC Not usually an insurance reject, this is an exception created by a staff member for various reasons.

See notes attached to MSC exception.

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generics and reflect the lowest copays. Tier 3 drugs are the pricey brand name medications, and Tier 2 medications are right in the middle with non-preferred generics or certain brand-name items. The only way for us to know a patient’s specific price is to bill their insurance; there is no way for us to give a patient this price before they come in with a prescription. IN-STORE ACTIVITIES Locate the TPR queue in Intercom Plus. Work with a pharmacist or senior pharmacy technician to resolve (or try to resolve) the rejections in the queue. Do this on several days to gain exposure to a variety of rejection types. RPH/SPHTC SIGNATURE DATE Learn how to find third party phone numbers and where to find our pharmacy-specific information (NPI, NABP, DEA, etc.). RPH/SPHTC SIGNATURE DATE Learn how to fax a physician (helpful when working on prior authorizations). RPH/SPHTC SIGNATURE DATE Learn how to create a miscellaneous exception and view other prescriptions in the MSC queue. RPH/SPHTC SIGNATURE DATE

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GOVERNMENT FUNDED INSURANCE

MEDICARE VS MEDICAID

In this section, we will discuss the two main types of government-funded insurance plans: Medicare and Medicaid. Both of these plans have special requirements that are different from those of commercial insurance companies. We will discuss the specific requirements of each plan below.

MEDICARE Medicare is a government-funded insurance program for people over the age of 65. Medicare coverage is divided into several subgroups or “parts”. Traditional Medicare includes Part A and Part B, which are primarily responsible for the reimbursement of medical procedures and devices. We use Part B in the pharmacy when billing for certain vaccines, diabetic testing supplies, and other medical devices. Medicare patients are eligible to purchase supplemental insurance to cover what traditional Medicare does not—including prescription drugs. Patients purchase Medicare Part D plans to pay for their medications. The nuances of Medicare can be complicated, so we will only cover the very basics. MEDICARE PART D Since Part D plans are primarily responsible for claims on medications, these plans are what we see most often in the pharmacy. Not much needs to be said about these plans, since the billing is very similar to commercial insurance plans. Only a few differences should be mentioned. First, like commercial insurance plans, most Medicare Part D plans have deductibles. Unlike regular insurance plans however, Medicare supplements also have what is known as the coverage gap or “donut hole”. After Medicare has paid a certain dollar amount to the pharmacy in a given year, the patient enters the coverage gap. This means that instead of their normal copays, they will pay a percentage of the cost of

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their medication, which usually results in significantly higher prices. It is possible to come out of the “donut hole”, but only after the patient has paid a significant amount out of his/her own pocket. If a patient reaches the end of the coverage gap, they enter “Catastrophic Coverage”, and Medicare begins paying for the majority of a prescription’s cost. Another important difference is the formulary that determines whether or not a medication is covered. Every year, Medicare reviews and compiles a list of “CMS exclusions”. These are drugs that Medicare has deemed unsafe or unfit for use in their population of patients. Regardless of the company a patient has chosen for their Part D coverage, these medications will not be covered-- not even with a Prior Authorization. If they still want to pick up the prescription, they are responsible for the entire cost. MEDICARE PART B The two biggest applications of Part B in the pharmacy are diabetic testing supplies and vaccines. Usually, Medicare Part B covers the flu and pneumonia vaccines, and Part D covers the rest. We will cover vaccines in greater detail in the next section. The other big application is diabetic testing supplies. This can include meters, blood glucose test strips, and lancets. Medicare Part B billing is done differently than prescription billing. Since they are considered medical devices, the billing is done similarly to billing at a doctor’s office. Namely, the system only verifies that a patient is actively covered by the provided insurance company, and does not actually submit a bill until later. This can be problematic as we have to decide what to charge a patient at the point of sale, and incorrect information can result in chargebacks that our pharmacy is responsible for. To prevent as many chargebacks as possible, a few things are required when billing for diabetic supplies to ensure we get paid. First, a doctor must fill out a Certification of Medical Necessity (CMN) form. This form has a start date, a diagnosis (type I or type II diabetes), and a testing frequency, and must be signed by the prescribing physician. Next, a patient must sign our Assignment of Benefits (AOB) form. This form is an authorization from the patient that allows Walgreens to bill

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Medicare on their behalf. Also, when patients come in to pick up their testing supplies, the sale is often capped until the pharmacist informs or reminds patients to keep a log of their sugar levels each time they test. Should we be audited on a claim, Medicare can request these logs as proof of testing frequency. Diabetic supplies billed through Medicare require an electronic agreement and signature on our pinpad, making them ineligible for home delivery. Only specialized diabetic supply companies are allowed to deliver directly to a patient’s home. IN-STORE ACTIVITIES Learn how to enter a Medicare Part B plan into IC+. RPH/SPHTC SIGNATURE DATE Learn what information is found on a CMN and AOB form. Have a pharmacist or senior technician point out what information needs to be included and show you how to fax it to the prescriber’s office. RPH/SPHTC SIGNATURE DATE

MEDICAID It is important to note that Medicare and Medicaid are NOT the same. While Medicare is an insurance program for the elderly, Medicaid is a program intended to help the poor and needy. Both are government funded, so just as there are certain requirements to be aware of when billing Medicare, there are similar requirements for Medicaid. First, all prescriptions for Medicaid must be written on tamper-proof paper. They must also include a diagnosis code for the condition that requires a patient to take the medication. This cannot be just any diagnosis code; Medicaid will only pay for certain diagnoses for each medication. Prescriptions must also be written by a doctor who has registered with Medicaid’s network of providers—this means no out-of-state prescriptions will be covered. Similarly, since Medicaid is funded by each individual state, prescriptions filled at pharmacies in other states will not be covered. Patients are

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also restricted to certain NDC’s and must usually wait the full 30 days (90-day prescriptions are not covered) before coming in for a refill. IN-STORE ACTIVITIES Practice entering our sample Medicare and Medicaid insurance cards into IC+. These are very similar to commercial insurance plans, so this should seem very familiar. One difference to point out is that individuals in a family will usually have different ID numbers, even if they are covered by the same plan. This means that entering a different family member’s ID number will not result in a paid claim. RPH/SPHTC SIGNATURE DATE Learn where to look in the work queue to find out if a patient is working on a deductible or is in the “donut hole”. RPH/SPHTC SIGNATURE DATE

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VACCINES With the changing healthcare system, more and more health services are being offered by pharmacies. Perhaps the biggest example of this is the addition of pharmacist-administered vaccinations. All Walgreens pharmacists are licensed to immunize within the restrictions set up by their individual state law. The types of vaccines we can give and restrictions associated with them are decided by state law and company policy. The specific immunization procedures may vary at different pharmacies, but a basic knowledge about vaccines is critical for a technician at any pharmacy. At Walgreens, we offer all kinds of vaccinations, ranging from standard immunizations like the flu shot to travel-related vaccines like typhoid. Each vaccine has its own approved age range, dosing instructions, and restrictions. As a general policy, we don’t immunize anyone under the age of 7, although some vaccines have different age requirements. Federal law also requires a pharmacy to contract with a Standing Order Prescriber. This is a doctor contracted with our pharmacy to “write the prescriptions” for our patients to receive vaccines. Individual states can set more strict requirements than outlined in this contract (called a Collaborative Practice Agreement), and what pharmacies are allowed to do as far as immunizations are concerned varies greatly from state to state. For Utah’s protocols and procedures, see the state-specific information page on StoreNet (a staff member can access this for you).

THE VACCINE PROCESS When a patient comes in for a vaccine, the first step is to enter their information into IC+ and bill their insurance. We will not focus a lot on the specifics of entering vaccines, as every pharmacy will be different, but a pharmacist or technician can show you the basics. Once this information is entered, the patient must fill out what is called a Vaccine Administration Record (VAR). The information we need filled in on a VAR differs

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depending on whether a vaccine is live or inactive. Live vaccines contain an altered or weakened, but still alive, form of the virus that the immunization protects against. Inactive vaccines contain viruses that are “dead” or no longer active. Since live vaccines carry a higher risk of infecting a patient with the disease they are immunizing against, more information is required to determine a patient’s eligibility to receive the vaccine. For example, patients who are receiving a live vaccine must not be taking any type of steroid or other immunosuppressing therapy. Once a VAR has been filled out, if the patient has a copay, they are rung up at the register. The pharmacist is then ready to administer the vaccine. He/she will also copy the lot number and expiration date of the vaccine on the opposite side of the VAR. Once the pharmacist’s portion of the VAR is completed, a technician will scan the image into the patient’s profile and fax a copy of it to their primary care physician. IN-STORE ACTIVITIES Learn where to find a VAR and what information is needed for live and inactive vaccines. RPH/SPHTC SIGNATURE DATE Learn how to print a Vaccine Information Sheet (VIS). RPH/SPHTC SIGNATURE DATE Have a pharmacist or technician show you the vaccine section in the refrigerator and freezer, and discuss storage requirements for the various immunizations we carry. RPH/SPHTC SIGNATURE DATE

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INVENTORY MANAGEMENT This section deals with our inventory: the medications we keep on the shelf in the pharmacy. Inventory management is an advanced but important task for pharmacy technicians in any pharmacy. We will discuss insufficient and excess stock as well as procedures for expired medication. Again, the specifics will vary between pharmacies, but potential employers will be impressed with your experience in this area.

INSUFFICIENT STOCK Often, prescriptions come in for medications that we either do not have enough of or do not have at all. You saw this during the filling section when we created partial-fill or out-of-stock exceptions in the computer. Now we will discuss how we make sure that we receive the medication to complete these prescriptions. Walgreens contracts with a drug warehousing company called Amerisource Bergen for our medication orders. We receive an auto-generated order every weekday that contains a replenishment of our most commonly used medications, as well as any medications in our PFL or OOS queue. Sometimes, it is necessary to add a drug to the order that is not auto-generated. Before 5:00 pm each day, a technician ensures that all PFL/OOS exceptions are represented on our order. If anything is missing, it is added through our SIMS program. A technician can show you the basics of this process. When the order comes in the following morning, we tell the computer we have received the order by scanning it in. Once it has been posted, the medication can be used to finish the PFL/OOS prescriptions. IN-STORE ACTIVITY Learn how to add medications to an Rx Quick Order. Go through the PFL and OOS queues and make sure each one is represented on the order for the next day. RPH/SPHTC SIGNATURE DATE

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If possible, complete a morning shift to gain exposure to receiving a shipment and completing out-of-stock and partial-filled prescription orders. RPH/SPHTC SIGNATURE DATE Learn how to complete a “Smart Count”. RPH/SPHTC SIGNATURE DATE

EXCESS INVENTORY When we receive a drug we do not need, or one that a patient decides not to pick up, we generate a return to Amerisource. The specifics of this are not necessary for you to know, as it will most likely be much different in another setting. However, it is important to be aware that we try to keep only the things we will use on hand to minimize costs and prevent the need for salvage returns later. SALVAGE RETURNS A salvage return is completed for medications that have expired or are unusable for any other reason. We do not get full credit back for these items, but it is still important to do as it keeps our stock in good dating and our inventory numbers correct. Expired medications are pulled and returned three months before they expire. Each section should be checked for outdates once a month. IN-STORE ACTIVITIES Learn the proper way to return medications to stock if a patient does not pick them up. This is done nightly through the completion of a delete report. RPH/SPHTC SIGNATURE DATE Learn how to complete a salvage return. RPH/SPHTC SIGNATURE DATE