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Toolkit: Collaborative Practice Agreements And Protocols

Below please find some sample collaborative practice agreements.

 

Please note these agreements are being provided as samples only.  Collaborative Practice Agreements (CPAs) should be carefully developed to appropriately characterize the particular physician-patient-pharmacist relationship.  Appropriate legal review is also recommended to reduce liability.

 

Law and Regulations on CPAs in Pennsylvania

Pennsylvania pharmacists are permitted to enter into Collaborative Practice agreements. Until recently when the regulations were finalized (2015) this was restricted to the Institutional setting.

Click here for a short summary of the Act and Regulations.

This is the link to the current enabling regulations. Be sure to specifically see Section 27.302 for information on collaborative practice agreements in the non-institutional setting.  Section 27.301 provides information on protocols in an institutional setting.

 

Liability Insurance

Pharmacists participating in Collaborative Practice agreements must submit a form to the State Board of Pharmacy verifying they have $1,000,000 in professional liability insurance.  There is a separate form for institutional setting and for the non-institutional setting.  Please click here for the PA State Board of Pharmacy webpage which has links for these forms.  Scroll down to the listings for Management of Drug Therapy listings.

General Drug Therapy Management Agreement

Here is an example of a Collaborative Practice Agreement for Drug Therapy Management.

Please click here to see this sample agreement.

 

Sample CPAs Based on Specialty Area

- Anti-coagulation

This example of an anti-coagulation management agreement comes from Duquesne University Center for Pharmacy Care.  Please click here to see this sample agreement.

 

This example of an anti-coagulation protocol comes from the Duquesne University Center for Pharmacy Care.  Please click here to see this sample protocol.

 

- Flu Testing

This example of influenza screening services protocol comes from the Duquesne University Center for Pharmacy Care.  Please click here to see a sample of this protocol.

 

- Immunization

This is a sample standing order and Immunization Protocol, which gives the authority to provide immunizations as outlined.  This document is from Duquesne University Center for Pharmacy Care.  Please click here to see this sample.

 

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