Scope of practice refers to the boundaries within which a health professional may practice. For pharmacists, the scope of practice is established by state legislatures and regulated by a board or agency, most commonly the state board of pharmacy.
The National Alliance of State Pharmacy Associations (NASPA) supports and enhances collaboration between state pharmacy associations advocating for expanded scope of practice that aligns with the pharmacists’ education and training. State scope of practice resources can be found on their website along with additional helpful information. For more about your state board of pharmacy, visit the National Association of Boards of Pharmacy website.
Pharmacists are trained to optimize medication use and improve population health outcomes. When pharmacists are a member of the health care team, they can help improve medication use and adherence, expand access to care, and reduce health care costs. Pharmacy practice is increasingly shifting from dispensing medications and counseling patients, to providing patient-centered, team-based care across a variety of health care settings.
States have adopted various strategies to facilitate access to pharmacist-provided clinical services by expanding pharmacists’ scope of practice to align with the education and training pharmacists receive. “The continuum of pharmacist prescriptive authority” (Adams AJ, Weaver KK) describes how these strategies fit along a continuum that relates to the ease with which the pharmacist is able to prescribe medications for patients. Collaborative practice agreements require a voluntary agreement between pharmacists and providers and can be the most burdensome to implement, whereas autonomous prescribing models give the pharmacist authority at the state level to prescribe specified medications or medication classes.
Mechanisms to Expand Pharmacists' Scope of Practice
Collaborative Practice Agreements (CPAs) are voluntary agreements that create a formal practice relationship between a pharmacist and a prescriber, whereby the prescriber delegates certain functions to the pharmacist, often initiating, modifying, and discontinuing medication therapy and ordering laboratory tests according to the terms of the agreement. The prescriber is most often a physician, although a growing number of states are allowing for CPAs between pharmacists and other prescribers such as nurse practitioners. The agreement specifies the functions that can be delegated to the pharmacist by the collaborating prescriber beyond the pharmacist’s typical scope of practice. The terms used and the functions that pharmacists can provide under a CPA vary from state to state.
Advancing Team-Based Care Through Collaborative Practice Agreements emphasizes how team-based care and utilization of CPAs can lead to more effectively managed chronic disease, particularly hypertension and cardiovascular disease. This resource was developed by APhA in collaboration with the CDC Division for Heart Disease and Stroke Prevention and NASPA.
Statewide protocols are issued by a state board or agency that authorizes pharmacists to prescribe a medication or category of medications under a protocol. Under statewide protocols, all licensed pharmacists in the state who meet the protocol requirements, such as completing a continuing education program, are authorized to prescribe certain medications under authority granted by the state through laws and regulations.
Statewide standing orders usually prescribe the actions to be taken in caring for patients related to specific conditions or procedures. At the state level, they are most often signed by a physician within a state agency or state public health department and can be carried out by the pharmacist when predetermined conditions have been met. A single physician signs the standing order and all pharmacists in the state can provide care according to the specifications in the standing order to all patients in need. A challenge can arise if the physician leaves his or her position, requiring the creation of a new standing order.
Category-specific prescribing is when a state authorizes pharmacists to prescribe certain categories of medications without the need for a statewide protocol. Pharmacists, like other prescribers, are given the authority to prescribe a category of medications based on clinical guidelines and professional judgment.
Credentialing and Privileging
Credentialing and privileging are additional methods to enhance pharmacists’ authority to provide patient care services. These programs were introduced by the Joint Commission to establish a process by which health care institutions can expand practice authority for providers within their organization, independent from federal and state law, while maintaining a high standard of quality and safety. The credentialing process verifies and assesses an individual’s qualifications to provide services, and the privileging process is by which organizations authorize that an individual performs a specific scope of care within that facility. Credentialing in the Pharmacy Profession provides a comprehensive overview of the current environment.