Trends in Collaborative Drug Therapy Management

Karen E. Koch, PharmD

Disclosures
In This Article

Regulatory Status

The movement to attain collaborative management authority is supported by many national pharmacy organizations. In 1996, the ASHP developed a position statement, "CDTM and Reimbursement for Pharmaceutical Care," and in 1998 produced an issue paper, "CDTM." The AACP, in addition to issuing a position statement on CDTM,[7] has conducted numerous CDTM educational sessions at their national meetings. In September 1997, the National Association of Chain Drug Stores developed the "Collaborative Practice Briefing Book," and in February 1998 the Pharmaceutical Research and Manufacturers of America (PhRMA) published statements on CDTM agreements and payment for pharmacists' professional services. The American Pharmaceutical Association (APhA) is conducting the previously mentioned project ImPACT.[29] ASHP has an attorney with state advocacy experience who assists states on legislative issues and has compiled a CDTM advocacy packet.

Twenty-five states currently have authorized CDTM, and 20 states are pursuing legislative or regulatory changes to permit it (Table 1). This reflects the currency of the legislative efforts, because before 1993 only seven states recognized pharmacists' abilities to provide collaborative care.

Twenty-two states have statutes authorizing some form of CDTM. Most states have passed bills that enable the state's board of pharmacy to write regulations. Kansas and Michigan have interpretations of their Physician Practice Acts that permit delegation to pharmacists. Three states, however, provide collaborative management ability only through regulations.

Although the ASHP and the National Association of Boards of Pharmacy (NABP) have developed model CDTM language for state pharmacy acts (Table 2), there is no standard format for the legislative acts passed by individual states or for their pharmacy practice act interpretation. As a bill passes through the state legislative bodies, it is subject to significant debate and compromise. The passed bill may look very different from the original proposal. As a result, collaborative management agreements vary significantly from state to state on the following points:

  • Types of agreements. There may be requirements for protocols, agreements, or guidelines.

  • Level of review or approval. Some states require variations of pharmacist, protocol, and perhaps even patient registration with the state boards of pharmacy or medicine, whereas other states require just facility review or simply an agreement between the individual pharmacist and physician.

  • Type of medications. Many states do not allow pharmacists to prescribe narcotics, but three states permit pharmacists to register with the Drug Enforcement Agency as midlevel providers.

  • Practice environments. States are more likely to start with institutional settings (because of built-in oversight) and then make a transition to ambulatory settings once inpatient credibility is established.

  • Education or competency. They may be specified in the agreement but are often left to be determined between physician and pharmacist.

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