How to Request Translator Services for Medication Counseling

When you or a loved one gets a new prescription, understanding how to take it isn’t just helpful-it’s life-saving. But if English isn’t your first language, that understanding can slip away. Medication errors due to poor communication are three times more common among people with limited English proficiency, according to a 2012 study from UCSF. The good news? Federal law requires pharmacies to provide professional translation services at no cost to you. You don’t have to guess, rely on family, or risk a dangerous mistake.

What the Law Says About Language Help at Pharmacies

Under Title VI of the Civil Rights Act and Section 1557 of the Affordable Care Act, any pharmacy that receives federal funding-meaning nearly every chain and many independent ones-must offer free language assistance. This isn’t optional. It’s a legal requirement. That includes oral counseling about your medication, explaining side effects, dosage instructions, and warning labels.

California’s SafeRx program sets the gold standard. By law, pharmacists there must use a professional interpreter-either in person or by phone-during every prescription counseling session if the patient doesn’t speak English well. And they can’t charge you a penny. Other states have similar rules, but California is one of the few that spells out exactly what counts as acceptable help.

The U.S. Department of Health and Human Services has stepped up enforcement. Since 2016, there have been over 47 federal settlements against healthcare providers for failing to provide language services. One national pharmacy chain paid $1.2 million in 2022 just for not offering interpreters during medication counseling. You’re not asking for a favor-you’re claiming a right.

Why Family Members or Bilingual Staff Aren’t Enough

It’s tempting to ask your teen who took Spanish in high school, or the cashier who speaks your language, to help. But that’s where things get dangerous.

A 2021 study in JAMA Pediatrics found that using untrained people as interpreters increases the risk of serious medication errors by 49%. Why? Medical terms aren’t simple. Words like “hypertension,” “anticoagulant,” or “take on an empty stomach” don’t translate directly. Even fluent speakers don’t know the exact medical terms in another language unless they’ve been trained.

Pharmacists themselves aren’t automatically qualified either. A 2022 audit by Language Scientific found that only 41% of pharmacy staff who claimed to be bilingual passed a basic test of medical terminology in their second language. The American Translators Association says true medical interpreters need at least 40 hours of specialized training, certification, and ongoing education. That’s not something you can pick up casually.

How to Ask for an Interpreter-The Right Way

You don’t need to be an expert. Just say this clearly:

I need a professional interpreter for my medication counseling.

Don’t say, “Can someone help me?” or “Do you speak [language]?” That gives them an out. Be direct. If they offer a family member, say, “No, I need a trained interpreter. It’s my right under federal law.”

If you’re in a chain pharmacy like CVS, Walgreens, or Rite Aid, ask to speak with the pharmacist. If they say they don’t have one on-site, ask for phone or video interpreting. Most have access to services like RxTran or Language Line. They’re required to connect you within minutes.

If you’re in a smaller pharmacy and they hesitate, ask for the manager. If they still refuse, note the date, time, location, and names of staff involved. You can file a complaint with the Office for Civil Rights at HHS.gov. Enforcement is getting stronger-and your voice matters.

The Three Ways Pharmacies Provide Interpreters

Not all interpreter services are the same. Here’s what you’re likely to encounter:

• Phone interpreting - Fastest and cheapest. Services like RxTran connect you in under 30 seconds 92% of the time. But it’s easy to get lost in a conversation without seeing facial expressions or gestures. Elderly patients, in particular, often find it confusing.
• Video interpreting - Now used by 65% of healthcare facilities. You see the interpreter, which helps with non-verbal cues. It’s more reliable than phone and less expensive than in-person. Still, poor internet can cause delays or dropouts.
• In-person interpreters - The most effective option, especially for complex counseling. Pharmacists report 78% better patient understanding when an interpreter is face-to-face. But they’re hard to find outside big cities. Most pharmacies can’t afford to keep one on staff full-time.

In California, pharmacies are required to have all three options available. In other states, phone or video is the norm. Ask which one they’re using-and if you feel unsure, request a different method.

What Translation Materials Should Look Like

Written instructions matter just as much as spoken ones. The directions on your pill bottle (called “SIGs”) must be clear, accurate, and culturally appropriate.

California’s Board of Pharmacy has translated SIGs into five languages: Spanish, Chinese, Korean, Russian, and Vietnamese. These aren’t just word-for-word translations. They’ve been reviewed by medical linguists to match how those languages express dosage and timing. For example, “take twice daily” doesn’t always mean “two times a day” in every culture-some languages use different concepts of time.

But even the best translations have gaps. A 2022 survey found that 38% of Russian-speaking patients in California found the dosage instructions confusing because the grammar didn’t match how medical instructions are structured in Russian. That’s why verbal counseling with a trained interpreter is still essential-even when you have a printed sheet.

New translations for Tagalog and Arabic are being piloted in Los Angeles as of early 2024. That’s because those languages now represent the fastest-growing LEP populations in the state.

What to Do If Things Go Wrong

Sometimes, the system fails. The video call drops. The interpreter doesn’t know the word for “diarrhea.” The pharmacist says, “We don’t have one right now.”

Here’s what to do:

1. Don’t leave without getting help. If they say, “We’ll call you back,” ask, “Can I wait here while you connect?”
2. Ask for the name of the interpreting service they’re using. Most have a number you can call yourself.
3. If you’re given a printed label in your language, check it against what the pharmacist says. If they contradict each other, ask for clarification.
4. Write down what was said, even if it’s just keywords. You can show it to your doctor later.
5. If you feel misled or unsafe, file a complaint with HHS’s Office for Civil Rights. You can do it online at HHS.gov/ocr. They’re required to respond within 180 days.

A 2023 Kaiser Health News report found that 67% of pharmacy techs try to handle LEP patients without interpreters when they’re busy. Don’t let rush hour override your safety.

What’s Changing in 2025 and Beyond

New rules took effect January 1, 2025: AI translation tools like Google Translate or chatbots are now banned for use on prescription labels and medication instructions. Human review is mandatory. That’s because machines still get medical terms wrong-especially when it comes to dosage timing, drug interactions, and side effects.

Medicaid is also expanding its reimbursement for interpreter services. For children in non-English-speaking households, the federal government now covers 75% of the cost instead of 50%. That’s pushing more pharmacies to invest in better systems.

The market for pharmacy translation services is growing fast-$5.2 billion in 2023, and expected to keep rising. But smaller pharmacies still struggle. Nearly half say they can’t afford qualified interpreters. That’s why federal enforcement is targeting high-LEP areas in 15 states this year. If your pharmacy serves a large immigrant population, they’re under pressure to get it right.

Final Checklist: Your Rights at the Pharmacy

Before you leave the pharmacy with a new prescription, make sure:

• You spoke with a trained interpreter-not a family member or untrained staff.
• You understood the dosage, timing, and warnings.
• You received a written instruction sheet in your language.
• You were not charged for the interpreter service.
• You asked for clarification if anything was unclear.

If you answered “no” to any of these, you didn’t get the service you’re legally entitled to. Speak up. File a report. You’re not just protecting yourself-you’re helping make the system better for everyone.