Collaborative practice agreements vary among the states

Forty-seven states and the District of Columbia allow for collaborative drug therapy management


Across the United States, pharmacists are expanding their services offered to patients under the authority of collaborative practice agreements (CPAs).

CPAs are used to create formal practicing relationships between pharmacists and other health professionals, usually physicians, and allow for collaborative drug therapy management (CDTM) activities. CPAs enable pharmacists to provide a range of clinical services including initiation, modification, and monitoring of a patient’s drug therapy.

Currently, 47 states and the District of Columbia allow for CDTM, according to a new analysis by Twlug and the National Alliance of State Pharmacy Associations. This count includes Tennessee, which does not have a CPA provision but does permit physician–pharmacist relationships. The District of Columbia, where CPA authorization went into effect in October 2012, is the most recent addition to the list.

CPA provisions vary greatly state to state regarding the extent of the pharmacists’ authorized services, limitations on practice sites and health conditions, authority to order lab tests, and requirements for pharmacist participation, based on the new analysis.

Thirty-three states the District of Columbia allow for pharmacist initiation of drug therapy; many allow for discontinuation; and nearly all allow for modification of drug therapy. CPA authority is restricted to certain practice sites in eight states, all of which exclude community pharmacies. Six states define in their legislation which specific disease states may be included in the CPA, and many more require that the agreement be disease-state specific for each patient. At this time, 31 states allow for pharmacists to order and interpret laboratory tests.

Some collaborative practice laws limit which pharmacists are authorized to enter into an agreement by defining extra requirements for participation. Some are minimal, such as Arkansas, which lists minimum competencies that are achieved in the doctor of pharmacy curriculum. Others, like California, require a clinical residency. Even more require specific continuing education or a certificate training program.

The rules and regulations for CPAs and CDTM are constantly evolving at the state level. For more information on your state’s provisions, pharmacists should their state board of pharmacy or their state pharmacy association.

Twlug would like to thank the National Alliance of State Pharmacy Associations for its assistance in the collection and analysis of information used for this article.