CPAs Give Community Pharmacists More Active Roles in Health Care

Collaborative practice agreements (CPAs) give pharmacists a more active role in providing access to medications as well as improving patient safety and medication management, according to a study published in the Journal of the American Pharmacists Association.¹ Although these findings were uncovered amid minimal impacts to their workflow, researchers encouraged pharmacy professionals to begin and continue establishing CPAs across the community.

“To improve care delivery to patients, community pharmacists have begun to implement CPAs,” wrote the authors of the study. “The CDC defines a CPA as an agreement between a prescriber and a pharmacist that designates the pharmacist to perform specific patient-care activities.”

READ MORE: From Policy to Practice: Elevating Pharmacy’s Role in Quality and Patient Safety

A Brief History of CPAs

According to a study in Pharmacy (Basel), CPAs were first adopted by the Indian Health Service in 1973. They have since reached all 50 states and continue to be a key factor in advancing public health services today across multiple health care destinations. After the first official collaborations between pharmacists and physicians in the 1970s, clinical pharmacists have since developed doctorate programs for continued education and a significantly greater ability to stand out as medical providers.²

However, despite pharmacists’ universal move toward clinical roles, CPAs continue to exhibit nuance when exploring them state by state.

“CPAs vary by state with respect to pharmacist-initiated prescribing activities; there is little uniformity between states regarding pharmacists’ ability to commence, modify, monitor, and discontinue medication therapies, along with heterogeneity in their ability to order laboratory tests,” wrote the authors.²

The US pharmacy community has come a long way in its ability to prescribe, now providing patients with FDA-approved medications, medical devices, emergency epinephrine, and more in states like Idaho. In Nevada, however, patients can only access pharmacist-prescribed immunizations, birth control, and HIV pre- and post-exposure prophylaxis.³

There’s also no telling what the federal government might do regarding pharmacists and prescribing. Just over a month ago, President Trump signed HR 2483, giving pharmacists the proper training fulfillments to become buprenorphine prescribers for opioid use disorder.⁴

Real-World Integration of CPAs

In Ohio, where the current study was conducted, CPA laws allow pharmacists to work with physicians, nurse practitioners, and physician assistants for specific patients. Ohioan community pharmacists, since 2021, have been able to host patient visits and assess lab testing, as well as initiate, adjust, or discontinue medications for predetermined disease states.¹

Since the introduction of CPAs into the state of Ohio, few pharmacies have utilized them because of their failure to collaborate and essentially provide a benefit to those involved.

“The primary objective of the study is to describe and quantify the usage of the Community CPA at 5 community pharmacies integrated within a clinic,” they continued.¹ “The secondary objective of the study is to evaluate the impact of the Community CPA on pharmacists and other providers at the practice.”

As part of the study, the Community CPA was introduced on February 20, 2024, giving pharmacists within clinics the ability to provide primary care, mental and dental health, HIV treatment and prevention, and recovery services. Participating pharmacists operated under either an ambulatory care CPA or the Community CPA reserved for community pharmacists addressing medication issues.

To assess the usage and impact of CPAs, researchers conducted a retrospective review of all prescriptions written by pharmacists for the primary objective. Participants were then given a survey to address the agreement’s impact on pharmacists and providers.

The Usage and Impact of CPAs

Researchers’ final analysis included a total of 954 prescriptions filled at a community pharmacy within an Ohio medical clinic between February 20, 2024, and January 15, 2025. The most frequent areas pharmacists encountered were gender-affirming care (65.9%), diabetes (23%), and chronic obstructive pulmonary disease (9.1%).¹

After participating, pharmacists wrote an average of 80 prescriptions per month. This and the rest of their duties within each clinic made pharmacists support the CPA and its ability to improve medication access and patient safety. Furthermore, highlighting the program’s success within day-to-day provider responsibilities, it was found to add minimal to no burden on provider workflow.

“These results provide important insight into the role community pharmacists play in improving medication access, safety, and efficiency of the care provided by other health care professionals,” they concluded.¹ “Leveraging pre-existing relationships with ambulatory care pharmacists can improve provider perception of a community pharmacist CPA. This familiarity assisted in successfully implementing the CPA.”

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REFERENCES

1. Hill L, Kissel J, Pauvlinch P, et al. Description and impact of a community pharmacy-based collaborative practice agreement. JAPhA. 2025;66(1):102998. https://doi.org/10.1016/j.japh.2025.102998

2. Cernasev A, Aruru M, Clark S, et al. Empowering public health pharmacy practice-moving from collaborative practice agreements to provider status in the U.S. Pharmacy (Basel). 2021 Mar 9;9(1):57. doi: 10.3390/pharmacy9010057.

3. Flowers-Kelvin E. Can a pharmacist prescribe medications? Know the regulations. BuzzRx. October 10, 2024. Accessed January 9, 2026. https://www.buzzrx.com/blog/can-a-pharmacist-prescribe-medications

4. Nowosielski B. Pharmacists now authorized to independently prescribe buprenorphine. Drug Topics. December 3, 2025. Accessed January 9, 2026. https://www.drugtopics.com/view/pharmacists-now-authorized-to-independently-prescribe-buprenorphine