Until pharmacists achieve provider status, the only way to get paid for a variety of services is through a legal partnership with providers.
A collaborative practice agreement, or CPA, is an agreement between a physician and a pharmacist to work together to improve patient care. The physician makes a diagnosis and writes any needed prescriptions, and then refers patients to a pharmacist who can help to manage their care.
A 2011 report on the effect of CPAs between pharmacists and physicians found that they reduced fragmentation of care, lowered costs, and improved outcomes for patients. Because the prescriber and the pharmacist are actively communicating about patient health, it’s easier to identify appropriate interventions for patients.
In the United States, the ability to enter into a CPA is governed on a state level, and 36 states allow pharmacists to provide drug therapy management in any setting. Other states may allow some form of collaborative practice, but with more limitations. You can visit NASPA’s website to find out where your state stands.
What a CPA entails
Some of the services your pharmacy already provides — like medication synchronization or medication therapy management — could fall under the umbrella of a CPA. You don’t have to have a CPA to do those things, but with a CPA in place you could have greater cooperation from prescribers.
However, there are other services that you can perform under a CPA that you may not be able to do otherwise. These include:
- Extending refills: If a patient runs out of refills, the pharmacist may be authorized to extend the prescription without calling to obtain authorization from the prescriber.
- Therapeutic interchange: A pharmacist may be able to substitute another drug of the same class rather than dispensing the drug that was initially prescribed. The pharmacist may also make the decision to discontinue medication therapy.
- Physical assessments: A CPA may authorize a pharmacist to assess a patient’s health through a physical examination to help define any health problems.
- Ordering and interpreting laboratory tests: The pharmacist may be authorized to order lab tests to help monitor chronic conditions and interpret the results of those tests. In some states, pharmacists may be able to perform those laboratory tests themselves.
- Condition-specific management: A pharmacist may be authorized to manage specific conditions like hypertension, diabetes, arthritis, and other chronic health conditions.
How to secure a CPA
The first step to entering into a CPA is identifying prescribers you can work with.
The easiest place to start is with prescribers you already have a relationship with. If you don’t already know, find the prescriber with the most mutual patients.
If you know prescribers socially, grab a coffee with them to talk about what their practice needs and how you could solve that by entering into a CPA.
Recognize that prescribers are busy and may not have time for an in-person meeting. In a tip sheet for connecting with prescribers, Simplify My Meds recommends dropping off some written material or sending material via email to give prescribers a chance to review when they have time. These materials should lay out what a CPA could entail.
The CDC recommends a three-part framework for a CPA that works for both you and prescribers: aligning incentives, improving outcomes, and controlling costs.
A CPA should not just bring benefits to you and the prescriber — it should also benefit patients, too.
For pharmacists, a collaborative practice agreement can mean increased compensation for providing additional services. CPAs typically include a fee-for-service payment structure, with the prescriber paying the pharmacist for services performed.
A CPA could lead to a steady stream of patient referrals coming from the prescriber, and therefore a greater prescription volume.
For a prescriber, when pharmacists provide clinical services, it lessens their own work burden and helps them improve their quality-of-care metrics.
And for patients, it means more people are actively invested in their health.
You and the prescriber should be working together to track progress and outcomes for the patients that you share.
Sharing electronic health records will play a big part in this collaboration. Your computer system should be able to interact with prescribers’ computer systems so you can communicate clearly and securely.
If outcomes are improved using a CPA, the overall cost of healthcare should decrease for patients and the third-party payers covering their care.
Writing a CPA
Once a prescriber and pharmacist have agreed to enter into a CPA, the next step is to put it in writing.
Because this is a complicated contract, both you and the prescriber will want to get your attorneys involved to ensure the terms make sense for each party and to make sure you’re following all the laws and regulations in your state.
According to the CDC, a collaborative practice agreement should include these parts:
- Explanation of the purpose of the agreement
- A list of the parties to the agreement
- The patients who are included in the agreement (either a specific list of patients or a group of patients)
- Care functions authorized by the agreement
- Training and education requirements for the pharmacist
- Details about liability insurance
- Patient informed consent
- How care will be documented
- How parties will communicate
- A quality assurance plan
- Length of the agreement
- Records retention details
- Explanation for how the agreement can be rescinded or amended
- Clinical references
- Signatures from each party
Depending on your state requirements, you may have to take additional steps like registering your CPA with state agencies or updating your NPI number.
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