Collaborative Practice Agreements

Collaborative Practice Agreements (CPAs) will typically not be a stand-alone program, but rather a mechanism to enhance the services that pharmacists deliver and/or increase efficiencies in the care provided to patients. CPA’s are used in MTM, Disease State Management, Immunization, or other patient care programs.

Regulations vary by state but most follow this scenario:

An agreement or contract is signed between a specific pharmacist or pharmacists and a specific provider or providers. These contracts or agreements are not a blanket approval for ‘any pharmacist’ at a particular pharmacy or ‘any provider’ of a particular clinic and typically a copy must remain on file with the pharmacist and the provider and sometimes with a state agency.

The agreement will specify which patients, which disease states, and for which medications the pharmacist can alter the plan of care including adding or discontinuing medications and altering dosages, dosage forms, or frequency of use. The agreement will be specific about the medications and the appropriate ranges the pharmacist is to use as well as the communication steps necessary to document the changes in the patient medical record and inform the prescriber of the changes. CPA’s can also provide the pharmacist the authority to order specific laboratory tests.

Some states limit which types of practitioners and/or practice settings can be involved in these agreements, what the agreements must specifically contain, for how long the agreements are valid or must be renewed, and documentation of the agreement and any actions taken pursuant to the agreement.

Immunization programs typically will have some sort of practice agreement (again, depending on the state) that allows the pharmacist to administer a vaccine without a patient specific prescription and includes which patients and ages of patients will be covered, as well as an emergency protocol for an adverse reaction or allergic reaction that may occur.

Look for specific agreements, communication and documentation requirements, how the agreement will be renewed, and what types of information is gathered for QA regarding activity using a collaborative practice agreement. Discuss how the agreement(s) are working in the practice, what are the advantages to the practice and the barriers to implementation.

Another example of a collaborative practice agreement is a physician and a pharmacist work out a plan where the physician sends patients with a seasonal allergy diagnosis to a pharmacist for management. The collaborative practice agreement states which medications and appropriate dosage ranges to use. The pharmacist works with the patient using prescription antihistamines and prescription nasal sprays to achieve symptom control in the patient. The pharmacist documents the encounters and treatment strategy/goals along with the products prescribed under the agreement and any alteration of the treatment plan on subsequent contact with the patient and communicates this to the physician for review and inclusion in the patient’s medical record or in some cases, the pharmacist may have access to document directly in the patient’s medical record.