Is technician training pharmacy's next divisive battle? It could be, if major retail employers and state pharmacy boards hold to their present courses.

Earlier this year, the North Dakota Board of Pharmacy voted to require all technicians to complete a training program accredited by ASHP. Techs will also have to pass the certification exam given by the Pharmacy Technician Certification Board (PTCB) or its equivalent. North Dakota's move meets ASHP policy recommendations, which call for completion of a nationally accredited training program and certification by PTCB or its equivalent for all techs in all settings.

"We think ASHP accreditation equates with consistent quality," said Howard Anderson, executive director of the North Dakota board.

But that doesn't mean all NACDS members are solidly behind the association's stance. At least one national chain, Walgreens, is seeking ASHP accreditation for its in-house technician training program, according to PTCB executive director Melissa Murer Corrigan. Twenty-eight state pharmacy boards include PTCB certification by name in their technician regulations, she added. "More and more employers are stating 'certification preferred' or 'certification required' in their announcements," she said.

In 2005, the Wyoming pharmacy board voted to boost its tech training requirements along the same lines as North Dakota. Regulations to implement the changes were vetoed by the Governor over fears that higher education requirements could choke off the supply of technicians. Pharmacy boards in Alaska and South Carolina are also looking at increasing tech training requirements.

"Technician training is an issue we are starting to see on the radar screen," said Carmen Catizone, executive director of the National Association of Boards of Pharmacy. "States like North Dakota, Wyoming, Alaska, and South Carolina are at the very beginning of the issue. The real question is how we provide the most efficient and most effective care for patients."

One reason for the change is the growth in the number of pharmacy technicians. There are about 210,000 licensed R.Ph.s in the United States, Corrigan said, while about 249,000 techs are PTCB-certified. That number should top 250,000 after the July certification exam results are announced.

"Our technicians outnumber our pharmacists," said Wyoming pharmacy board executive director James Carder. "Technicians have become a vital part of pharmacy in Wyoming and across the country."

Alaska and North Dakota also have more techs than pharmacists. "The board has been talking about increasing training requirements for technicians," said Sher Zinn, licensing examiner for the Alaska Board of Pharmacy. "The board wants to increase requirements so they can give techs a greater scope of activity."

That is what happened in North Dakota, which has about 240 pharmacists and 450 techs. In a deal that attracted national attention, the state upped tech education, training, and certification requirements at the same time it increased techs' scope of practice. Pharmacies that are open to the public and have a pharmacist on site can use three techs per pharmacist. Closed-door pharmacies have a 4:1 ratio. Few retail pharmacies have gone beyond 2:1, Anderson said, because the state has an R.Ph. shortage.

A continuing shortage of R.Ph.s led North Dakota to enact broad telepharmacy regulations. Some pharmacies are staffed exclusively by technicians, who are supervised remotely by R.Ph.s using live video and computer links. Telepharmacy techs must have at least one year of job experience under direct R.Ph. supervision before they can work a remote pharmacy on their own.

Opening certification to programs other than PCTB could also blunt NACDS opposition. At least two states, Oregon and Virginia, already accept both PTCB and ExCPT, the Exam for the Certification of Pharmacy Technicians, created by the Institute for the Certification of Pharmacy Technicians.