Pharmacists Can Establish Collaborative Practice Agreements

Collaborative practice agreements (CPAs) are formal arrangements between pharmacists and prescribers that authorize pharmacists to perform certain expanded clinical services under a protocol.¹ Administering vaccines, adjusting drug dosages, prescribing medications, and offering point-of-care testing are a few top examples.¹ All 50 states allow pharmacists to establish CPAs with other health care practitioners.² Pharmacists play a vital role in establishing CPAs as part of medication therapy management (MTM) (Figure^1-7).

CPAs and MTM

Research shows that pharmacists play an integral role on the health care team as MTM experts. Benefits include improved medication adherence, greater health care access, and lower health care costs.¹ Pharmacist clinical interventions through CPAs have improved disease state management of hypertension, diabetes, and cholesterol compared with physician recommendations.¹ Additionally, pharmacy-based immunization programs continue to expand access across the US.

The need for expanded pharmacist services is becoming critical. Approximately 45% of individuals in the US live with at least 1 chronic health condition, such as diabetes, hypertension, or asthma.¹ Approximately 20% of individuals in the US have mental health conditions.¹ Additionally, the number of Medicare beneficiaries is expected to increase from about 50 million to 80 million over the next decade.¹ With physician shortages continuing to rise, this increases the risk of health care needs not being met. Because pharmacists are the most accessible health care professionals, they can expand clinical services and improve patient health outcomes with the help of CPAs.¹

Given these benefits and growing health care needs in the US, educating prescribers about various gaps in the health care system through talking points may help set the stage for establishing a CPA.¹ Keeping the discussion short and answering prescriber questions about CPAs is an important part of pitching the collaboration. Additionally, it is vital to thank the prescriber and follow up after the conversation.

Beyond traditional chronic disease management, CPAs are expanding into other critical areas of care. Pharmacists in at least 10 states can also manage opioid use disorder (OUD) through CPAs by prescribing buprenorphine after receiving training.³ This became possible after the passage of the Mainstreaming Addiction Treatment Act, which eliminated the X-waiver requirement. On December 1, 2025, the SUPPORT for Patients and Communities Reauthorization Act of 2025 was signed into law.⁴ This expands pharmacists’ role in OUD, and it includes language allowing the American Pharmacists Association and the Accreditation Council for Pharmacy Education to provide 8 hours of continuing education (CE) training for pharmacists.⁴ States must authorize pharmacists to prescribe buprenorphine before receiving the CE training. This builds on the Medication Access and Training Expansion Act, which first required OUD training.⁴

Another emerging application of CPAs involves HIV prevention services. One study evaluated pharmacists’ perceptions of initiating preexposure prophylaxis (PrEP) through a CPA in Tennessee.⁵ The study was conducted virtually using 4 focus groups comprising a total of 21 pharmacists.⁵ The study revealed that pharmacists were prepared to advocate for easier access to PrEP in pharmacies across Tennessee through relaxing existing CPA regulations or pursuing pharmacist independent prescriptive authority.⁵ In 2024, the Tennessee governor signed a bill to expand pharmacists’ authority to prescribe postexposure prophylaxis for exposure to HIV.⁶

To practice under CPAs, pharmacists must meet specific state requirements. Requirements for establishing CPAs vary by state, including pharmacist training. For instance, Florida requires pharmacists to complete a 20-hour certification program that is approved by the Florida Board of Pharmacy.⁷ The University of Florida College of Pharmacy offers a CPA certificate program that includes a 12-hour home study component and an 8-hour live session.⁷

The certificate program includes the following topics⁷:

• CPAs in Florida and legal requirements
• Ambulatory setting patient care
• Treating and managing health conditions and chronic diseases
• Hyperlipidemia
• Hypertension
• Obesity
• Anticoagulation
• Nicotine dependence
• Type 2 diabetes
• Asthma
• Chronic obstructive pulmonary disease
• HIV
• Arthritis
• Substance use disorders and opioid reversal
• Hepatitis C
• CPA documentation and communication tips
• Billing and reimbursement

CPAs represent a powerful tool for addressing growing health care demands by leveraging pharmacists' expertise in MTM and expanding their role in chronic disease management, immunizations, and emerging areas like opioid use disorder and HIV prevention. As physician shortages continue and the population ages, CPAs enable pharmacists to improve patient outcomes, increase health care access, and reduce costs while meeting state-specific training requirements that ensure quality care.

MTM Spotlight

In an email interview with Pharmacy Times, Angela Godfrey, PharmD, pharmacist and owner of Gentle Scripts LLC, discussed her role in a collaborative practice at ROOT Wellness Hub in Greer, South Carolina. Godfrey is an expert in hormone therapy, medication management, and supplement safety. “I became a functional pharmacist because traditional pharmacy often ends at dispensing medications, but real wellness requires a deeper look at how everything works together—medications, hormones, stress, nutrition, hydration, and supplements. My goal is to connect those pieces, so clients get a clearer, more complete view of their health,” said Godfrey.

At ROOT Wellness Hub, Godfrey practices with a nutritionist, yoga instructor, and therapists to offer specialized services. As a functional pharmacist, Godfrey provides a variety of pharmacy programs. Through a comprehensive health review and medication optimization, she evaluates patients’ medications and supplements to create a personalized plan. Additionally, Godfrey assesses the pharmacotherapy regimen for drug interactions and appropriate dosing. She also provides a variety of other services, such as hormone support, pharmacogenetic precision panels, and sessions on the use of glucagon-like peptide-1 agonists.

Figure. Pharmacists’ Role in CPAs^1-7

REFERENCES

1. Collaborative practice agreements elevator speech. American Society of Health-System Pharmacists. Updated April 2024. Accessed December 5, 2025. https://www.ashp.org/-/media/assets/new-practitioner/docs/ASHP-NPF-Collaborative-Practice-Agreements-Elevator-Speech.pdf

2. Adams AJ, Eid DD. Toward collaborative practice, not collaborative practice agreements. Am J Health Syst Pharm. 2024;81(7):e157-e158. doi:10.1093/ajhp/zxad280

3. Adams JA, Chopski NL, Adams AJ. Opportunities for pharmacist prescriptive authority of buprenorphine following passage of the Mainstreaming Addiction Treatment (MAT) Act. J Am Pharm Assoc (2003). 2023;63(5):1495-1499. doi:10.1016/j.japh.2023.06.001

4. APhA secures key congressional win allowing pharmacists to prescribe buprenorphine with specialized training. News release. American Pharmacists Association. December 2, 2025. Accessed December 12, 2025. https://www.pharmacist.com/APhA-Press-Releases/apha-secures-key-congressional-win-allowing-pharmacists-to-prescribe-buprenorphine-with-specialized-training

5. Cernasev A, Barenie RE, Wofford BR, Golden J, Walker C. Empowering Tennessee pharmacists to initiate PrEP using collaborative pharmacy practice agreements. Clin Pract. 2023;13(1):280-287. doi:10.3390/clinpract13010025

6. Tennessee governor signs expansion of pharmacy scope of practice into law. National Community Pharmacists Association. May 9, 2024. Accessed December 8, 2025. https://ncpa.org/newsroom/qam/2024/05/09/tennessee-governor-signs-expansion-pharmacy-scope-practice-law

7. Initial collaborative practice agreement certificate program. University of Florida Continuing Pharmacy Education. Accessed December 8, 2025. https://ufcpe.cloud-cme.com/course/courseoverview?P=0&EID=107