Collaborative Practices

Collaborative practice agreements (CPAs) create a formal practice relationship between a pharmacist and a prescriber. The agreement specifies what functions, in addition to the pharmacist’s typical scope of practice, are delegated to the pharmacist by the collaborating prescriber. The collaborating prescriber is most often a physician, but a growing number of states are allowing for CPAs between pharmacists and nurse practitioners or other non-physicians. The functions provided under the agreement vary from state to state based on the pharmacist’s scope of practice and the state’s collaborative practice laws. Most often, CPAs are used in the context of authorizing pharmacists to initiate, modify, or discontinue medication therapy. These changes may be as part of a disease management CPA. Functions performed under a CPA may also include ordering and interpreting laboratory tests if those services are not already authorized in the pharmacist’s scope of practice. Certain states allow pharmacists to prescribe under protocol for specific conditions such as Lyme Disease.   Other states allow pharmacists to enter into a collaborative practice agreement with a provider to managed specific conditions.  Check with state board of pharmacy for details. See Appendices\Collaborative Practicefor guidelines, sample agreement, and competency.

Sample Types of Collaborative Services

Delays in providing medicationCollaborativeBenefit for community
Limited availability of medications (formulary system) requiring contacting provider for changeTherapeutic InterchangePrescription fill on initial visit
Patient returning to pharmacy more than monthly for prescriptionsSynchronized refills and 90-day refillsIncreased compliance when patient gets all maintenance refills at one time
Lag time between pharmacy request for refill and response from provider; patient without maintenance medicationShort supply dispensed when no refillAllows time for pharmacist/patient to contact provider and maintain compliance
No appointment availability or conflict with patient schedulePoint of care testing: Checking A1Cs, blood pressure, cholesterol, and evaluating depressionNo appointment requirements and on time lab check-ins
Need for additional medical supplies to fully utilize a prescriptionDispensing a glucometer and supplies with an insulin prescription; Dispensing a chamber with an inhaler for pediatricsConvenience for patient and no lag time in receiving proper care
Lack of disease prevention programsEnvironmental approaches to diabetes prevention program managed with lifestyle modificationsReduces risk of developing diabetes and heart disease
Lack of access to quality community resources for chronic disease management and polypharmacyMedication therapy review, personal medication record, medication-related action, intervention/referral, documentation, and follow upAddition or removal of necessary medications