Oncology pharmacists find success with collaborative practice agreement

Abstract

Provider status will open the door for pharmacists to be compensated for advanced services they provide. At the same time, it can be used as a springboard for certain instances of prescriptive authority. As the march to provider status continues, pharmacists can use collaborative practice agreements (CPAs) to achieve a more advanced level of practice. While pharmacists can differ in familiarity with CPAs, it's important to hear the success stories. One such example is the CPA oncology pharmacists entered into at St. Luke's Cancer Institute in Boise, ID. St. Luke's Cancer Institute has a history of using CPAs. Oncology pharmacists in the facility have been able to prescribe antiemetic therapy after meeting with oncology patients and reviewing their treatment plans. After identifying new barriers—prescription approvals were taking longer than hoped—the oncology pharmacists were able to enter into a new CPA that allowed them to prescribe certain treatments to eliminate delays. “It took an average of 7 minutes for the [CPA group] to turn around one medication adjustment, compared to 3,311 minutes for the control group. It was a no-brainer after that,” said Amanda Wright, PharmD, oncology pharmacist at St. Luke's Cancer Institute, in a July 27 blog post from the Association of Community Cancer Centers. This new CPA gave oncology pharmacists at St. Luke's Cancer Institute the authority to sign refill prescriptions, adjust or round doses, and adjust dosing regimens if toxicities surfaced. Wright said these pharmacists now have higher job satisfaction and have reduced their workday by 20 minutes. A CPA is a document that specifically details which actions a pharmacist can take under the authority of another's license—typically that of a medical doctor. It clearly defines the pharmacist's scope of practice and specifies instances that fall outside of the pharmacist's expertise. Some issues persist that slow the adoption of CPAs throughout the country. One barrier relates to state law—some states allow CPAs to exist for pharmacists, and others are silent on the issue. Silence creates ambiguity and often has the same chilling effect as a state explicitly prohibiting CPAs. The other barrier relates to payment. Even if a pharmacist can enter into a CPA, getting paid for their time and service is fraught with uncertainty. Because pharmacists are not recognized as providers at the national level, inconsistent payment practices exist across states where CPAs are allowed. In a state that allows CPAs and also recognizes pharmacists as providers, more pharmacists will be able to enter into a CPA and also collect payment. However, in states that allows CPAs but don’t recognize pharmacists as providers, the adoption and implementation of CPAs are exceedingly low because pharmacists cannot receive compensation for their expertise. Until pharmacists win provider status nationally, CPAs are a great way to bridge the gap between where pharmacists are and where they need to be. As CPAs are put into practice more often, the case for provider status becomes stronger.