Collaborative Practice Agreements (CPAs) allow pharmacists to enter into formal agreements with prescribers to perform expanded clinical functions — initiating, modifying, or discontinuing drug therapy within defined parameters.
What CPAs can cover
Depending on state law and agreement terms, CPAs may authorize pharmacists to: initiate drug therapy, modify doses within established parameters, conduct laboratory monitoring and adjust therapy, manage chronic conditions (anticoagulation, diabetes, hypertension), and provide immunizations.
States with the broadest CPA authority
California: Advanced Practice Pharmacist (APh) designation allows broad independent practice including ordering labs, initiating drug therapy, and managing conditions — with or without a CPA.
New Mexico: Clinical Pharmacist Practitioners can prescribe independently without a CPA under certain conditions.
North Carolina: Broad CPA statute that allows significant scope expansion with appropriate prescriber agreement.
CPA documentation requirements
Most states require CPAs to be in writing, signed by both parties, and kept on file. Many require periodic review and renewal. Some states require filing with the state board.
CPA vs. standing orders
Standing orders (issued by health departments) allow pharmacists to act without a specific prescriber relationship. Many naloxone and hormonal contraceptive programs use standing orders rather than individual CPAs.