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Technicians Thrive in MCOs

Kate Traynor

When one of Darlene Johnson’s colleagues left hospital work to join the prior-authorization department at a managed care company, the pharmacy technician asked, "What do [technicians] do if they don’t have medications? How can they be a technician?"

Johnson, who followed her colleague and is now the pharmacy technician supervisor in the prior-authorization department at Health Net of California, now knows the answer. Health Net’s pharmacy technicians take calls from pharmacies and prescribers and determine whether the plan will cover nonformulary medications and drugs requiring prior authorization.

"This job is different every day," Johnson says. "I deal with different medications, different situations as far as what the diagnosis is….It’s a lot different from…the hospital and retail environment."

"It’s a job you won’t get bored in," she adds.

At Health Net, Johnson says, pharmacy technicians screen calls using organizational guidelines based on drug-use indications approved by the Food and Drug Administration. "We are kept up-to-date on the medications and what they are used for," she says. Johnson contrasts this with her hospital work, which she describes as "passing out the medications, filling the cart, doing i.v.’s."

Omar E. Nuno, a pharmacy technician and supervisor in the prior-authorization department of California-based Prescription Solutions, also has high praise for his job.

"One of the biggest rewards is that…you get a lot of clinical information," Nuno says. "You are speaking with the provider on a one-on-one basis. You’re learning a lot of names, a lot of clinical information—the diagnosis, drug interactions," he says.

Although pharmacy technicians at both health plans have the authority to approve coverage of a prescription for a specific indication, veto power is reserved for the department’s clinical pharmacists. "If [a request] meets the criteria, the technician can approve the medication," Nuno says. "If it doesn’t, they refer that over to our clinical pharmacist."

Nuno says that his organization’s clinical pharmacists spend a lot of time keeping the department’s 45 pharmacy technicians up-to-date on medication-related issues. "Our pharmacists do a lot of educational pieces for our technicians—giving them updates on the newest medications, our newest guidelines, and a lot of education and training," he says.

Both Nuno and Johnson are enthusiastic about the career possibilities for pharmacy technicians in a managed care environment—possibilities of which they say many technicians are unaware.

"When I was working in the pharmacy," Nuno says, "the only thing I knew was just pharmacy." But when he first came to Prescription Solutions, Nuno "couldn’t believe the different types of departments—information systems, auditing, claims, clinical services, account managers—that provide growth for pharmacy technicians." Nuno says he has already moved four rungs up the advancement ladder during his three and a half years at Prescription Solutions.

Johnson, who has been with Health Net for seven years, says her organization offers similar advancement opportunities for pharmacy technicians. "If you go into a job as a prior auth tech, I think you get…training that can open up avenues for other jobs."