Tennessee’s 2024 expansion of pharmacist's scope of practice authorizes independent prescribing and test-and-treat services, positioning pharmacists as primary care extenders in underserved communities.
As health systems across the United States contend with persistent provider shortages, rising costs, and limited access to timely care, state legislatures have increasingly turned to pharmacists as an underutilized clinical resource. Effective May 1, 2024, Tennessee enacted one of the most comprehensive pharmacist scope-of-practice expansions to date through Public Chapter 824, authorizing pharmacists to independently prescribe, test, and treat for select conditions.
This legislation represents an evolution in pharmacy practice, reinforcing the pharmacist’s role as a frontline health care provider and offering a potential blueprint for other states seeking pragmatic solutions to access-to-care challenges.
Public Chapter 824 authorizes Tennessee pharmacists to independently prescribe—without a collaborative practice agreement—for specific medication classes when statutory criteria are met. These include:
This authority removes a significant administrative barrier that historically delayed care, particularly for acute and preventive services. By allowing pharmacists to initiate therapy at the point of care, the law reduces reliance on urgent care centers and emergency departments for conditions that can be safely managed in the pharmacy setting.
Tennessee pharmacists may now administer all vaccines to adults aged 18 years and older as well as select immunizations to pediatric patients aged 3 to 17 years, including influenza and COVID-19 vaccines
Pharmacists have consistently demonstrated high vaccination capacity, particularly during the COVID-19 public health emergency. Expanding immunization authority builds on this success and supports broader public health goals, including improved vaccination coverage in rural and medically underserved communities.
The legislation further authorizes pharmacists to perform and interpret CLIA-waived diagnostic tests for conditions such as streptococcal infections, influenza, and COVID-19. Following testing, pharmacists may immediately initiate appropriate treatment.
Test-and-treat services represent a practical application of pharmacists’ medication expertise and diagnostic training. When implemented with standardized protocols, these services can shorten time to treatment, reduce disease transmission, and improve patient satisfaction—particularly for patients facing long wait times for primary care appointments.
Although independent prescribing authority has broadened, Public Chapter 824 also enhances collaborative pharmacy practice agreements (CPPAs) by allowing greater flexibility in structure and scope. Pharmacists may now participate in diagnosis-driven or nondiagnosis-driven agreements, as well as patient-specific or population-based protocols.
This flexibility enables pharmacies and health systems to design collaborative models tailored to local needs, including chronic disease management, preventive services, and transitions of care.
Tennessee recognized pharmacists as medical providers since 2017, enabling credentialing, referrals, and reimbursement through commercial insurers and Medicaid. Public Chapter 824 builds on this foundation by expanding the services pharmacists may independently deliver.
The law was signed by Governor Bill Lee (R) with the stated goal of reducing barriers to care, particularly in rural areas where provider shortages are most pronounced. Although some physician organizations expressed concerns regarding scope expansion, existing evidence from multiple states suggests that pharmacist-led prescribing and test-and-treat services are safe and effective when supported by clear regulatory frameworks and appropriate training.
Tennessee’s approach highlights how states can leverage pharmacists to improve access to care without compromising quality or safety. For practicing pharmacists, the legislation underscores the importance of clinical readiness, documentation standards, and workflow integration to support expanded services.
For policymakers and health system leaders, the Tennessee model offers a scalable strategy to address care gaps using an already accessible and trusted health care workforce.
John Marc Tallegrand Jr., PharmD, RPh, is a New York State–licensed clinical pharmacist with experience in independent, community, long-term care, and hospital practice. His professional interests include pharmacy practice advancement, healthcare access, and pharmacist-led clinical services.
Public Chapter 824 marks a significant milestone in the evolution of pharmacy practice in Tennessee. By authorizing pharmacists to independently prescribe, test, and treat for select conditions, the state has strengthened the pharmacist’s role as a primary care extender and improved access to timely, patient-centered care.
As health care systems continue to adapt to workforce shortages and increasing demand, Tennessee’s experience may serve as a practical framework for future scope-of-practice reforms nationwide.
