ADVANCED PRACTICE-EXPANDED SCOPE GENERAL 

Today the health care system is undergoing a transformation.  Pharmacists play a key role in this transformation by providing services to expand their scope of practice and fill the gaps that currently face patients in regards to access to care.

Pharmacists can provide medications based upon legally written prescriptions they receive from a prescriber, standing orders issued by the state, under collaborative practice agreements with designated prescribers, or in some states, by prescriptions initiated by the pharmacist themselves.

Each state is responsible for determining the scope of practice through laws and rules for licensed professionals, including pharmacists.  These regulations are made to meet specific needs of the states and their populations. 

On January 17, 2017, CMS’s Center for Medicaid and CHIP Services (CMCS) issued an Informational Bulletin that encouraged states to expand the scope of pharmacy practice.  Expanding pharmacists’ roles, including the power to dispense drugs under certain arrangements, such as pharmacists’ prescriptions, can be an important tool for addressing national public health challenges and gaps in medical care. 

The Informational Bulletin does stress that this is a state decision. However, by expanding the scope of practice, it can “facilitate easier access to medically necessary and time-sensitive drugs for Medicaid beneficiaries.”

Specific national public health examples cited include:  tobacco cessation, influenza immunizations, emergency contraceptives and pharmacist provision of naloxone to combat the opioid epidemic.

 The Informational Bulletin in its entirety is available at Medicaid.gov.

COLLABORATIVE PRACTICE AGREEMENT (CPA)

Collaborative practice agreements (CPAs) are used to create formal relationships between pharmacists and physicians or other providers that allow for expanded services the pharmacist can provide to patients and the healthcare team. Collaborative practice agreements are used in MTM, immunization, or other patient care programs such as smoking cessation and contraceptive prescribing.

The agreements can vary from state to state.  Some agreements allow pharmacists to “manage” care, initiate new therapy, order lab tests and/or perform physical assessments. The agreements outline specific protocols, documentation and training required. The extent of the services authorized under the collaborative agreement depends on the state’s CPA provisions and the terms of the specific agreement itself. Currently, 48 states and the District of Columbia allow for some degree of collaborative practice agreements between pharmacists and other health care providers.

State laws and regulations are constantly evolving and changing.  Therefore, pharmacists should know and understand the requirements and provisions in their specific state. State pharmacy associations and the state board of pharmacy are useful resources.

As a Health Mart Member Benefit, you have access to collaborative practice agreement templates. Learn more and access them HERE.

STANDING ORDER 

A standing order allows for a prescription to be written by an institution, physician, or other authorized practitioner, for any patient that meets outlined criteria and if allowed by state law.  The standing order should be written with specific details of who it authorizes, who it covers and any reporting documentation that is needed.  Pharmacists use standing orders in such instances as immunizations and naloxone therapy.