Licensing committee hears hospital case for expanded pharmacy technician roles and discusses letting PICs set inpatient ratios

The California State Board of Pharmacy Licensing Committee on June 12 heard presentations from four health systems on how pharmacy technicians are used in hospitals and discussed changing the board's inpatient pharmacist-to-pharmacy-technician ratio to give pharmacy directors more flexibility.

The committee convened in Sacramento for an agenda item on Title 16 of the California Code of Regulations (text listed in the meeting materials) concerning technicians in hospitals with clinical pharmacy programs and received presentations from Stanford HealthCare, Cedars-Sinai Medical Center, UC San Diego Health and Kaiser Permanente.

Hospital presenters described broad technician roles beyond dispensing: sterile compounding, automation oversight, unit-dose and automated-dispensing-machine management, medication-history interviews, benefits checks and prior-authorizations, controlled-substance surveillance, and analytics. Dandry Desai, executive director of pharmacy at Stanford HealthCare, said Stanford verifies roughly "10,000 orders per day" across its system and dispenses about "22,000 doses per day" in the inpatient setting, adding that technicians now perform functions such as Tech-Check-Tech and run automation like box- and pill-pickers to support pharmacists.

Rita Shane, vice president and chief pharmacy officer at Cedars-Sinai, described a long-standing technician career ladder at her institution and said many technicians progress to advanced operational and patient-facing roles. Charles (Chuck) Daniels and Nancy Yam of UC San Diego Health described sterile compounding and automation oversight as technician-led functions that free pharmacists for clinical work. Doug O'Brien of Kaiser Permanente noted the system's scale (37 California hospitals; an average daily census across California hospitals of about 6,000 patients) and said barcode scanning and other automation have cut reported medication errors substantially; he summarized Kaiser's statewide metrics as roughly "35 million medications administered a year" and "50 million orders verified a year," with outpatient fills about "105 to 110 million prescriptions a year."

Speakers repeatedly emphasized three recurring themes: 1) automation (barcodes, RFID, robotics, automated dispensing cabinets) reduces human error and affects how supervision and ratios can be structured; 2) institution-level training, competency testing and career ladders are widely used to ensure technician competence for expanded duties (many institutions require PTCB certification for advanced technician levels); and 3) quality assurance, continuous auditing and documented supervision are essential controls when technicians assume higher-responsibility tasks.

Committee members pressed presenters on where supervision fits and what safeguards should accompany expanded duties. Vice Chair Chandler and other members asked whether different settings or levels of automation justify variable pharmacist-to-technician ratios. Desai and Shane said supervision practices and competency programs — including vendor-led super-user training for automation — are common and that hospitals use internal SOPs and proctoring to ensure safety. Shane also described a now-sunsetted technician residency her institution piloted to formalize advanced training.

Committee discussion and next steps

Committee Chair Seung Oh and members discussed whether California's regulatory framework should allow more institutional flexibility or require petitioning the board. Members expressed interest in letting pharmacists in charge (PICs) set ratios for their institutions provided the PIC documents training, QA and automation safeguards in site policies. Trevor Sandler and others emphasized consumer protection as the guiding principle: any changes should preserve patient safety while enabling operational adaptability.

Seung Oh noted that draft language in the board's sunset-related legislation for noninstitutional settings would allow a PIC to set a higher ratio (the draft referenced up to 1:4 in that context), and the committee indicated that a similar PIC-driven model, paired with clear safeguards (documented training, competency testing, ongoing QA and automation use), is a viable approach to consider for the institutional setting.

Votes at a glance

The committee approved a procedural item earlier in the meeting: approval of the draft minutes of the Oct. 17, 2024 committee meeting (attachment 1). Vice Chair Chandler moved to approve; Satinder Sandhu seconded. Roll call votes recorded: Trevor Sandler (yes), Renee Barker (yes), Jesse Crowley (yes), Claudia Mercado (yes), Satinder Sandhu (yes), Chair Seung Oh (yes). The motion carried.