Medication Dispensing Strategies

COLLABORATIVE DRUG THERAPY AGREEMENT

Definitions

  • Authorizing prescriber (also referred to as the prescriptive authority): a licensed healthcare provider who enters into a CDTA with a pharmacist, who has legal independent prescriptive authority of medications (e.g. a physician or a nurse practitioner) in the state in which the CDTA will be filed.
  • Collaborative drug therapy agreement (CDTA): sometimes referred to as a Collaborative Practice Agreement or Collaborative Practice Protocol, is an agreement between pharmacists and authorized prescribers that lawfully allows for the initiation, modification and/or discontinuance of drug therapy by pharmacists directly to patients, so that patients, in most states, do not need to make a prior visit or consult with a physician.
    • A CDTA should contain a protocol, also called the prescriptive protocol, which a pharmacist will follow, and must clearly describe which patients, disease states, medications, and circumstances under which the pharmacist may initiate, modify or discontinue drug therapy.
    • A CDTA for emergencies may be implemented upon a written determination by the local health officer, who establishes the necessity for emergency procedures on medication dispensing in response to the emergency event.
  • Memorandum of understanding (MOU); not to be confused with a CDTA, is the operational component of defining the contractual relationship between a health department and a pharmacy. It details interactions, decisions, agreements, and responsibilities of the various agencies that enter into the MOU prior to the emergency event to ensure effective response at the time of the event. By defining the responsibilities of personnel during emergency response, an MOU serves to ensure that there will be no conflict between agencies by accounting for the liabilities that are inherent with practicing under a CDTA, medication dispensing, and reimbursement for pharmacy services. An MOU can be entered into between a public health agency and a pharmacy and is viewed as complimentary to a CDTA.
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  • Pharmacist: a healthcare provider responsible for the interpretation of prescription orders; the compounding, dispensing, labeling, administering, and distribution of medication and devices; and the initiation, monitoring and modification of drug therapy.  Pharmacists are licensed by state boards of pharmacy/department of health.
    • As healthcare providers, pharmacists dispense medications and advise patients, physicians, and other health practitioners on the selection, dosages, interactions, and side effects of medications. The entry level degree for a pharmacist in the U.S. is the Doctor of Pharmacy (PharmD) degree.
  • Pharmacy technician: assists licensed pharmacists in preparing prescription medicines and providing customer service. Pharmacy technicians may be responsible for receiving prescription requests, counting tablets, and labeling bottles.  Responsibilities may vary, depending on state rules and regulations.
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  • Pharmacy assistant: provides administrative support by handling transactions, answering phones, preparing claim forms and other record keeping under the supervision of a licensed pharmacist.
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  • Pharmacy intern: a student enrolled in an accredited college or school of pharmacy that under the supervision of a licensed pharmacist may do functions of a pharmacist for which they have been trained in accordance with state law.
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  • Community pharmacy: is a pharmacy or drug store that dispenses medications for individuals in the outpatient setting. There are several different types of pharmacies:
    • Mass merchandiser pharmacy: a pharmacy that is part of a large retail establishment, usually a chain megastore, such as Wal-mart or Target.
    • Chain pharmacies:  a collection of 11 or more pharmacy stores that are centrally owned, organized, and managed, as defined by the U.S. Department of Commerce. Chain pharmacies usually sell a much larger variety of non-health related goods than an independent pharmacy. Examples of these types of pharmacies are CVS, Walgreens and Rite Aid.
    • Independent pharmacy: a privately-held business. Generally, these are stand-alone pharmacies or a small collection of pharmacies.
    • Grocery store pharmacy: a pharmacy situated in and owned and managed by a grocery store retailer.