Pharmacist scope of practice has been on a one-directional trend for the better part of a decade — more prescriptive authority, more test-and-treat programs, more independent clinical services — and 2026 hasn’t broken that pattern. Legislatures continued expanding what pharmacists can do without physician sign-off, but the expansions are landing unevenly, and a pharmacist who assumes their state matches a neighboring state’s authority is taking on real risk.
The general direction of 2026 legislation
Several states advanced bills this session extending pharmacist authority in a few recurring categories:
- Test-and-treat protocols — Expanding beyond the COVID-era flu/strep/COVID model to cover additional conditions like uncomplicated UTIs, allowing pharmacists to test and initiate treatment without a separate physician visit, typically under a statewide protocol rather than a case-by-case collaborative agreement.
- Independent prescribing for specific drug classes — Continued expansion of pharmacist authority to prescribe hormonal contraceptives and naloxone without a prescriber order, and in a smaller number of states, extension to additional categories like PrEP continuation or smoking cessation therapy.
- Statewide protocol orders replacing case-by-case CPAs — A shift in several states from requiring an individual collaborative practice agreement with a specific physician toward statewide standing orders or protocols that any licensed pharmacist can practice under, which meaningfully lowers the administrative barrier to using expanded authority.
- Pharmacist-administered long-acting injectables — Growing authority to administer long-acting injectable medications (including certain antipsychotics and contraceptives) without requiring a separate physician order for each administration.
None of this is uniform. A handful of states remain restrictive, requiring individual collaborative practice agreements for nearly all expanded clinical services, while others have moved to broad statewide protocols that functionally give pharmacists autonomy comparable to nurse practitioners for a defined set of conditions.
Why this matters more for multi-state pharmacists
A pharmacist licensed in two or three states can find themselves with meaningfully different authority depending on which state they’re standing in. Test-and-treat for strep throat might be routine, protocol-based practice in one state and entirely unavailable without a collaborative practice agreement in another. This is a bigger issue for locum tenens and telepharmacy pharmacists than it might first appear, since remote and traveling practice means the scope-of-practice question changes every time the practice location changes. See our guide on collaborative practice agreements by state for how the underlying agreement structures differ, and our deeper look at pharmacist prescriptive authority expansion for the broader trend line.
Test-and-treat authority specifically
Test-and-treat is the fastest-moving category. States that authorized pharmacist test-and-treat for flu, strep, and COVID during the pandemic have largely made that authority permanent, and several extended it in 2026 to cover uncomplicated UTIs and, in a smaller set of states, additional conditions like streptococcal pharyngitis in adults with expanded age ranges. The mechanics matter here: some states require the pharmacist to hold a specific certification or complete additional training before using test-and-treat authority, while others authorize it under general licensure. For a state-by-state breakdown, see our companion piece on pharmacist test-and-treat authority by state.
Immunization and point-of-care testing authority keep expanding too
Alongside prescribing authority, several states expanded pharmacist authority to order and interpret point-of-care tests independent of a test-and-treat protocol, and immunization authority continued its steady expansion in age ranges and vaccine types pharmacists can administer without a prescriber order. These changes often move through separate legislation from prescriptive authority bills, so tracking one doesn’t mean you’ve tracked the other — see our guides on immunization authority by state and point-of-care testing pharmacist authority for the current landscape.
What to watch for the rest of 2026
Bills expanding scope of practice typically move on state legislative calendars that run January through May or June, with effective dates that can lag signing by several months — meaning authority granted this session may not be usable until later in the year or even into 2027. Boards of pharmacy also frequently need to promulgate implementing regulations after a statute passes, which can create a gap where the law technically permits an activity but the board hasn’t yet issued the operational rules a pharmacist needs to actually practice under it.
This overview reflects general 2026 legislative trends and is not a substitute for confirming your specific state’s current scope of practice statute and any implementing board regulations, since authority can differ significantly even between neighboring states and can change again in the next legislative session. If you practice in states like Ohio, Colorado, or North Carolina where scope expansion has been particularly active, check current board guidance before relying on newly granted authority.
RxByState tracks scope of practice changes, prescriptive authority, and test-and-treat protocols as they’re enacted across all 50 states, so you always know what you’re actually authorized to do. Start a free 14-day trial →