Collaborative practice agreements between pharmacists and physicians template

As of Noon on October 14, 2022, the Kansas Statewide Immunization Protocol is no longer effective and should not be used to immunize Kansas patients. If you have previously signed and provided vaccines under the protocol, please retain a copy of the dually signed protocol for at least five years at the location where any vaccine was provided under the authority of the protocol.

Pharmacists planning to continue providing immunizations to patients may use the following methods:

1. Pharmacists may enter into an immunization protocol with a Kansas-licensed physician to administer vaccines or authorize pharmacist interns to administer vaccines. A sample immunization protocol is provided below. The 2021 updates to the Kansas Pharmacy Practice Act require any immunization protocol be signed by the authorizing physician and the administering pharmacist. Copies of the signed protocol should be retained for five years at the location(s) where immunizations are provided, but do not need to be sent to the Board office.
Sample Immunization Protocol (Word)
Sample Immunization Protocol (pdf)

2. Under the Federal PREP Act, pharmacists may independently order and administer FDA-approved vaccines to children ages 3-18 years, influenza vaccines to persons 19 years and older pursuant to the CDC/ACIP standard immunization schedule, and order and administer FDA-authorized or FDA-licensed COVID-19 vaccines to persons 3 years or older. Furthermore, pharmacist interns and pharmacy technicians may administer these immunizations under the direct supervision of the pharmacist who has ordered the immunization. Participating pharmacists, interns, and technicians must:

• Complete an ACPE immunization certification course;
• Have a current CPR certificate;
• Complete a 2-hour, ACPE-approved continuing education course in immunizations within the current state license period;
• Comply with Kansas immunization recordkeeping and reporting requirements, including informing the patient’s primary-care provider, submitting to Kansas WebIZ, reporting adverse events, and complying with requirements whereby the person administering a vaccine must review the vaccine registry or other vaccination records prior to administering a vaccine. See K.S.A. 65-1635a; and
• Inform any pediatric patient and the patient’s adult caregivers of the importance of a well-child visit with a pediatrician or other licensed primary care provider and refer patients as appropriate.

3. To alleviate any potential for patient harm, patients needing a second vaccine to complete a series initiated under the previous statewide protocol should be administered that vaccine in accordance with that protocol.  For example, this means that those patients who need the second in the Zoster series should be able to receive the vaccine.

Erick Axcell, PharmD, Non-Voting Chair
Meghan Haftman, PharmD
Anthony Caracci, PharmD
Chad Ullom,RPh
Michael Machen, MD
Lynn Fisher, MD
G. Aron Fast, MD

Benefits to Practice

While CPAs are not a prerequisite for collaborative care delivery, they can serve to improve the efficiency and effectiveness of collaborative care delivery. When used to their full potential, CPAs have the ability to increase access to care, expand available services to patients, increase the efficiency and coordination of care, and leverage pharmacists’ medication expertise to complement the skills and knowledge of the other health care team members.

For example, CPAs can decrease the number of phone calls required to authorize refills or modify prescriptions, thus allowing each member of the health care team to complement the skills and knowledge of the other member(s), more effectively facilitate patient care, and improve patient outcomes.

Applications of CPAs

A variety of patient care functions---such as initiating, modifying, or discontinuing medication therapy---can be delegated to a pharmacist using a CPA. These functions can facilitate the delivery of services such as:

• Chronic Care Management
• Refill Authorization
• Formulary Management

Toolkit: Advancing Team-Based Care through CPAs

Pharmacists looking to develop a collaborative practice agreement may need assistance figuring out where to start. To help with that process, a toolkit entitled "Advancing Team-Based Care through Collaborative Practice Agreements" has been developed. The toolkit is a resource for pharmacists to use in developing and executing collaborative practice agreements in the spirit of advancing team-based care. It provides a customizable template that can be used as a starting point to developing a collaborative practice agreement.

This toolkit was developed by ChangeLab Solutions, the Centers for Disease Control and Prevention (CDC), the National Alliance of State Pharmacy Associations (NASPA), and the American Pharmacists Association (APhA) through a cooperative agreement with ChangeLab Solutions.

Download the Toolkit

Where to Learn More

For more information on CPA's and related pharmacist-provided services, check out the following resources.

From NASPA:

• Key Elements for CPA Legislative and Regulatory Authority
• Collaborative Practice Agreement Infographic

From APhA:

• Consortium recommendations for advancing pharmacists’ patient care services and collaborative practice agreements
• Physician-Reported Factors that Encourage Collaboration with Community Pharmacists

From CDC:

• Collaborative Practice Agreements and Pharmacists’ Patient Care Services: A Resource for Pharmacists
• Select Features of State Pharmacist Collaborative Practice Laws
• Using the Pharmacists’ Patient Care Process to Manage High Blood Pressure: A Resource Guide for Pharmacists
• Collaborative Practice Agreements and Pharmacists’ Patient Care Services: A Resource for Doctors, Nurses, Physician Assistants, and Other Providers
• Collaborative Practice Agreements and Pharmacists’ Patient Care Services: A Resource for Government and Private Payers
• Collaborative Practice Agreements and Pharmacists’ Patient Care Services: A Resource for Decision Makers
• From Policy to Implementation: Collaborative Drug Therapy Management at a Federally Qualified Health Center
• From Policy to Implementation: Collaborative Drug Therapy Management in an Independent Pharmacy

Support for Pharmacists Services:

• The Expanding Role of Pharmacists in a Transformed Health Care System, National Governors Association
• The Role of the Pharmacist in Public Health, American Public Health Association, American Public Health Association
• Access to Tobacco Cessation Medication through Pharmacists, Association of State and Territorial Health Officials
• Improving Patient and Health System Outcomes through Advanced Pharmacy Practice, A Report to the Surgeon General

KPhA appreciates the generous support provided by

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