From Dispensing to Clinical Care: The Power of Clinical Practice Agreements

Overview

Collaborative Practice Agreements (CPAs) are a foundational regulatory tool that enable pharmacists to deliver clinical patient care services in coordination with authorized prescribers. CPAs support the safe expansion of pharmacy practice while maintaining clear accountability, quality standards, and patient protections.
‍
As healthcare delivery evolves, CPAs are a critical mechanism that allow pharmacies to function as clinical access points within the healthcare system.

What Is a Collaborative Practice Agreement and What Role does it Play in My Pharmacy?

A Collaborative Practice Agreement is a legally recognized agreement between a pharmacist and a licensed prescriber that authorizes the pharmacist to perform specific patient care functions that would otherwise fall outside the pharmacist’s independent scope of practice. CPAs are authorized under state pharmacy and medical practice laws and are overseen by State Boards of Pharmacy.
‍
CPAs directly enable pharmacists to provide billable, outcomes-driven clinical services like chronic disease management. Through CPAs, pharmacists may assume ongoing responsibility for medication-related outcomes, rather than delivering one-time interventions.

How do I obtain a Collaborative Practice Agreement?

To expand into clinical services and medical billing, a pharmacist must first obtain a Collaborative Practice Agreement. Here’s some guidance to do so:

• Step 1: Confirm your state allows CPAs
• • Check with your State Board of Pharmacy or Office of Professions.
  • Every state with the exception of Alaska, Oregon, Wyoming, Iowa, Arizona, New Mexico, Louisiana, South Carolina, West Virginia, Vermont and New Hampshire are allowed to obtain a CPA.
• Step 2: Find a licensed prescriber within your state to partner with
• • Primary Care prescribers are the best choice for a CPA because they treat all the health concerns you will discuss with your patient population.
  • Reach out to your top prescribers in primary care.
  • Do you have a strong personal or professional relationship with a prescriber in your community?
• Step 3: Defining which clinical services the pharmacist can manage
• • Propose the agreement using a state-provided template for a CPA, typically available on your state’s pharmacy board website
  • Here’s an example list of services you will want to manage under the agreement:
  • Chronic disease management (e.g., diabetes, hypertension, hyperlipidemia)
  • Medication therapy management (MTM and CMRs)
  • Anticoagulation management
  • Preventive care and wellness services
  • Medication initiation, adjustment, or discontinuation
  • Ordering, reviewing, and acting on laboratory results
  • Care coordination and transitions of care

Why CPAs Are Required for Clinical Services

From a regulatory perspective, CPAs:

• Authorize advanced clinical decision-making: Many clinical services require prescriptive authority or therapy modification, which must be delegated through statute or agreement.
• Establish defined clinical protocols: CPAs outline disease states, treatment guidelines, documentation standards, and escalation procedures.
• Ensure patient safety and continuity of care: Prescriber collaboration ensures clinical oversight and integration with the broader care team.
• Support compliance and audit readiness: CPAs create clear records demonstrating that services are provided lawfully and within scope.

Without a CPA (or a state-authorized alternative), pharmacists may be prohibited from performing key clinical functions, even when clinically appropriate.

Value of CPAs to the Practice of Pharmacy

CPAs strengthen the profession by:

• Enabling pharmacists to practice at the top of their license
• Supporting sustainable clinical service models
• Improving patient access to care, especially in underserved areas
• Reducing system-wide healthcare costs through optimized medication use
• Demonstrating pharmacists’ role as recognized healthcare providers

National organizations such as the National Association of Boards of Pharmacy (NABP) have consistently emphasized CPAs as a mechanism to advance patient-centered pharmacy practice while maintaining regulatory oversight.