PURPOSE: This rule clarifies authorized duties that may be delegated to a Missouri registered pharmacy technician.

1. (1) A pharmacist may delegate tasks to a registered pharmacy technician within the practice of pharmacy, as defined in the pharmacy’s policies and procedures. Pharmacy technicians must be competent and properly trained to perform delegated duties. Pharmacy technicians must be under the direct supervision of a pharmacist when assisting in the practice of pharmacy, as required by Chapter 338, RSMo, and the board’s rules.

2. (2) Except as otherwise authorized by law/rule or section (3) of this rule, pharmacy technicians shall not perform any activity that requires the professional judgment of a pharmacist, including but not limited to—

   1. (A) Patient counseling on medication or medical therapy, provided a pharmacy technician may read directions or information exactly as printed on a prescription label, medication container, or other pharmacist-approved written communication, if authorized by the delegating pharmacist and the pharmacy has a written policy and procedure detailing allowed activities;
   2. (B) Prospective drug use review required by 20 CSR 2220- 2.195;
   3. (C) Advising on therapeutic duplications, drug-disease contraindications, drug interactions, drug-allergy interactions, or prescription and non-prescription drug recommendations;
   4. (D) Recommending any prescription, non-prescription, or homeopathic medication, provided a technician may inform patients of available vaccine services, vaccine eligibility, or past patient vaccine dates if authorized by a pharmacist;
   5. (E) Final prescription verification, except as otherwise authorized for technicians using technology-assisted medication verification under 20 CSR 2220-2.012;
   6. (F) Any activity required by law or rule to be performed by a pharmacist; and
   7. (G) Any other activity prohibited by law or board rule.
3. (3) Dually Licensed Pharmacy Technicians/Intern Pharmacists. This rule does not prohibit Missouri registered pharmacy technicians or intern pharmacists who also hold a Missouri professional license or registration issued by another Missouri state board or agency from providing services authorized by such other license or registration. The pharmacy must develop and maintain current written policies and procedures governing the use of dually licensed licensees/registrants when assisting in the practice of pharmacy, including but not limited to ensuring appropriate supervision.

4. (4) Community Health Workers. This rule does not prohibit Missouri registered pharmacy technicians or intern pharmacists who hold a community health worker (CHW) certification issued by a CHW training provider approved/recognized by the Missouri Department of Health and Senior Services from providing services authorized by their CHW certification.

   1. (A) Pharmacies/pharmacists must establish and maintain written policies and procedures governing pharmacy technicians/intern pharmacists providing CHW activities for or on behalf of a pharmacy or pharmacist. At a minimum, required policies/procedures must include but are not limited to pharmacy technician/intern pharmacist supervision and training, and communicating with a pharmacist when appropriate or necessary.
   2. (B) Pharmacies or pharmacists engaging a pharmacy technician or intern pharmacists to provide CHW activities must ensure compliance with all applicable state and federal pharmacy and drug laws/regulations. For purpose of 20 CSR 2220- 6.055(6), pharmacy technicians/intern pharmacists providing CHW activities must be appropriately supervised to ensure activities are safely and properly performed. A pharmacist must be available to respond to pharmacy technician/intern pharmacist questions regarding CHW activities, as defined in the engaging pharmacy’s or pharmacist’s written policies/ procedures.
   3. (C) Pharmacy technicians/intern pharmacists must wear an identification badge or similar identifying article that identifies their name and title when practicing or assisting in the practice of pharmacy as a CHW for or on behalf of a pharmacy.

AUTHORITY: sections 338.013, 338.240, and 338.280, RSMo 2016, and sections 338.140, 338.210, and 338.215, RSMo Supp. 2024.* Original rule filed June 20, 2024, effective Jan. 30, 2025. *Original authority: 338.013, RSMo 1997, amended 2004, 2009; 338.140, RSMo 1939, amended 1981, 1989, 1997, 2011, 2019; 338.210, RSMo 1951, amended 2001, 2011, 2020; 338.215, RSMo 2020; 338.240, RSMo 1951, amended 2011; and 338.280, RSMo 1951, amended 1971, 1981.