Pharmacists have been asking ValuePharmacists “Where do I go to find out how to start a collaborative practice?”  Our answer – the CDC’s Advancing Team-Based Care Through Collaborative Practice Agreements: Resource and Implementation Guide for Adding Pharmacists to the Care Team, we’ll call it “the guide”. This resource guide provides pharmacists with information and resources to help them initiate collaborative practice agreements (CPAs) with collaborating prescribers.

Collaborative practice agreements enhance team-based care and formalize practice relationships between pharmacists and collaborating prescribers. Team-based care is enhanced by pharmacists being able to authorize refills, initiate, modify and discontinue prescriptions, initiate therapeutic interchanges and order and interpret laboratory tests, while keeping the prescriber apprised of the pharmacist’s actions through established communication mechanisms.

In 2013, the CDC issued Collaborative Practice Agreements and Pharmacists’ Patient Care Services: A Resource for Pharmacists. This document provided an overview of what a CPA is, strategies for advancing patient care services, and case examples of CPAs used in various states. It was an excellent resource for individuals to better understand the infrastructure and process changes required to integrate pharmacists’ patient care services into a team-based model and the components of the framework for successful CPAs.

In 2017 to develop the guide, the CDC collaborated with the National Alliance of State Pharmacy Associations (NASPA), American Pharmacists Association (APhA), American Medical Association (AMA), the American Association of Nurse Practitioners (AANP), the Network for Public Health Law – Eastern Region, and University of Maryland Francis King Carey School of Law with the stated purpose to “empower community pharmacists and collaborating prescribers to initiate CPAs focused on caring for patients with chronic diseases, including cardiovascular disease.”

The guide provides a review of what a CPA is, the factors to consider in establishing a CPA, how to develop relationships to establish a collaborative care practice model, and steps necessary to develop a CPA.

Step One: Consult state laws and regulations before drafting CPA.

Forty-eight states allow some degree of collaboration via a CPA. Delaware and Alabama are the exceptions. Each state has the following variables:

  • CPA Participants
  • Authorized Functions
  • Requirements and Restrictions

Some states permit CPAs only in inpatient settings and some states prohibit initiation of therapy to be delegated under a CPA. The guide’s Appendix A provides details on each of these three variables state by state. To obtain the most current status of laws and regulations in your state, please visit the National Association of Boards of Pharmacy website.

Step 2:  Initiate the Relationship

The pharmacist must play an active role in this important step, identifying partners, establishing face to face meetings and anticipating prescriber questions. A great deal of the guide’s focus on this step is anticipating the concerns of the prescriber. These can include the pharmacist’s training, credentialing and experience with collaborative practice. The pharmacist needs to be prepared to address two of the most common questions – what will be the method of communication and what costs associated with this relationship are anticipated.

Step 3: Draft the CPA

The guide provides examples of language that can be used, sample agreements to review and analysis of the 15 components of a CPA.

Step 4: Establish Sustainability of Services.

The guide’s Appendix B identifies potential payers for pharmacists’ patient care services, funding opportunities in new models for delivering care and formulating value propositions. It provides examples and suggestions of sustainable business models to support pharmacists services under CPAs.

It also includes a list of services that pharmacists can currently provide such as:

  • Medication Therapy Management.
  • Training in diabetes self-management.
  • A service incident to physician services in a physician-based practice or hospital outpatient clinic.
  • Transitional care management as part of a team-based bundled payment.
  • Chronic care management.
  • Annual wellness visit.

Only medication therapy management and training in diabetes self-management have direct payment opportunities. The other services listed are Medicare Part B services, where qualified providers bill for the pharmacist’s services.

Appendix C is a reminder that if pharmacists will be signatories on prescriptions that are initiated or modified under CPAs, it is beneficial to obtain an updated National Provider Identifier (NPI). NPIs are important to billing and will indicate to pharmacy benefit managers that the pharmacist has the authority to write prescriptions. The guide provides instructions if applying for an NPI for the first time or if there is a need for a taxonomy code update. It is recommended pharmacists in the community setting who are participating in medication initiation and/or modification should consider the pharmacist clinician (PhC)/clinical pharmacy specialist as their primary taxonomy.

To access the guide, click here. If you are looking for even more information, APhA offers a free 1.5 hour ACPE accredited presentation  “Pharmacist Collaborative Practice Agreements: Who, What, Why, and How.” The presentation discusses the guide in greater detail and provides more information that is helpful in developing CPAs.

How do I start a collaborative practice?

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