As part of Connecticut’s budget implementer bill (Act) signed into law earlier this month, the state made significant revisions to its laws concerning collaborative drug therapy management agreements between pharmacists and certain prescribing practitioners to expand the (1) types of permitted arrangements; (2) prescribers eligible to participate in the collaborative arrangements with pharmacists; and (3) scope of pharmacists’ authority under these arrangements. These revisions are effective as of July 1, 2022.
Collaborative Drug Therapy Agreements – Background
Collaborative drug therapy management (CDTM) agreements are agreements between one or more pharmacists and certain prescribing practitioners for the purpose of managing an individual patient’s drug therapy. Under current law, only physicians and advanced practice registered nurses may enter into CDTM agreements with pharmacists. Existing law sets forth various requirements related to CDTM agreements and the relationship between a pharmacist and collaborating practitioner. For example, a patient’s drug therapy must be managed pursuant to a protocol established by the collaborating practitioner, and the collaborating practitioner must have an established provider-patient relationship with the patient whose drug therapy is being managed. These requirements remain largely unchanged by the Act, but now generally apply to the additional types of CDTM arrangements authorized by the Act.
Expansion of Permitted Arrangements
The Act makes changes to the scope of permitted CDTM arrangements. In addition to CDTM agreements, the Act authorizes a new category of arrangement called a “collaborative drug therapy management policy,” which is a written policy adopted by a care-giving institution (discussed further below) for the management of a patient’s drug therapy or device and which is based on a written protocol or “collaborative drug therapy care plan.” A collaborative drug therapy care plan is a written document agreed upon between the prescribing practitioner and pharmacist outlining the agreed-upon approach to achieving a patient’s desired health outcome.
Expansion of Eligible Practitioners
Furthermore, the Act expands the types of providers permitted to enter into these agreements with pharmacists to include “prescribing practitioners” and “care-giving institutions.” Prescribing practitioners are practitioners licensed in any United States jurisdiction authorized to write prescriptions within the individual’s scope of practice. Care-giving institutions are institutions that provide medical services and are licensed, operated, certified or approved by one of the Departments of Public Health, Developmental Services, or Mental Health and Addiction Services.
Importantly, while the Act expands the types of collaborating practitioners, it provides that only “qualified” pharmacists may enter into CDTM arrangements. The Act does not define this term, but instead requires the Department of Consumer Protection to issue regulations establishing competency requirements for pharmacists who wish to enter into CDTM arrangements.
Scope of Pharmacist Authority
Current law limits a pharmacist to managing the drug therapy of individual patients under CDTM agreements. The Act allows pharmacists, in accordance with applicable CDTM agreement or CDTM policy and care plan, to manage not only drug therapy for individual patients, but also (1) drug therapy of patient populations; (2) devices prescribed to individuals and patient populations; and (3) therapeutic classes of drugs with respect to the applicable patient or patient population. Existing law permits pharmacists to modify, continue, discontinue and deprescribe a drug therapy. Under the Act, pharmacists may now also initiate a drug therapy or device. Notably, the Act expressly prohibits pharmacists under CDTM arrangements from establishing a port to administer parenteral drugs.