**5. Conclusions**

Overall, a majority of states (41) were found to include language that prohibits administration of immunizations by pharmacy technicians. Nine (9) states were found to be Not Expressly Prohibited by the peer-review triangulation process. Two (2) (Idaho, Utah) of these nine (9) states currently allow pharmacy technician immunization administration with others undergoing discussion. This is of paramount importance when considering the seven remaining Not Expressly Prohibited states: Kentucky, Michigan, Minnesota, Nebraska, New Mexico, Tennessee, and Washington. Proponents

of pharmacy technician administration of immunizations may consider these key states to explore implementation with opportunities for expansion of practice. Given the legal judgement needed to navigate the proximity of Prohibited Indirectly and Not Expressly Prohibited, stakeholders of pharmacy technician administered immunizations may wish to closely examine the wording in both statute and regulation in these states. Boards of Pharmacy have mixed responses when asked about the topic and discussions seem to be growing in prevalence throughout the country.

**Author Contributions:** Conceptualization D.E.; methodology, D.E.; software, D.E.; validation, D.E., J.O., B.B.; formal analysis, D.E., J.O., B.B.; investigation, J.O., B.B.; resources, D.E.; data curation, D.E., J.O., B.B.; writing—original draft preparation, D.E., J.O., writing—review and editing, D.E., B.B.; visualization, D.E.; supervision, D.E.; project administration, D.E.

**Funding:** This research received no external funding.

**Acknowledgments:** Michael E. Klepser, PharmD, FCCP, FIDP: for administrative support and guidance. Stephanie Zagordo, PharmD: for support with protocol development. Andrew Saul, PharmD: for administrative support.

**Conflicts of Interest:** The authors declare no conflict of interest.
