Alabama

LAPPA Legal Analysis (as of October 2024)

  • Short Answer: No, based on the information described below.

    • There is no definition of the “practice of pharmacy” in Alabama law. The definition of the “practice of pharmacy” in Alabama regulation does not expressly include prescribing by a pharmacist. ALA. ADMIN. CODE R. 680-x-2-.14(1) (2024).

    • There are no provisions in Alabama pharmacy laws or regulations expressly authorizing a pharmacist to prescribe drugs or medications generally or to obtain state/DEA registrations to prescribe controlled substances.

    • The above points are consistent with DEA information that registered pharmacists in Alabama cannot obtain the DEA’s mid-level practitioner registration to prescribe controlled substances. (Mid-level Practitioners Authorization by State, Drug Enforcement Admin. 1; Nov. 7, 2024)

  • Short Answer: No, based on the information described below.

    • Under Alabama regulation, a CDTMA covers “collaborative drug therapy management” (CDTM) which includes having a pharmacist “monitor, modify, and discontinue drug therapy as directed by the physician.” ALA. ADMIN. CODE R. 680-X-2-.44(1)(d) (2024).

    • Alabama regulation expressly provides that the scope of a CDTMA “shall NOT include . . . the prescribing of controlled substances listed or to be listed in the schedules under federal law and in [Alabama law and regulation].” ALA. ADMIN. CODE R. 680-X-2-.44(5)(a) (2024).

  • Short Answer: As described in the information below, Alabama laws and regulations do not clearly answer this question. However, given the answer to “Can a pharmacist administer buprenorphine under a CPA?”, the answer is likely “no.”

    • The definition of “dispense” in Alabama law includes to “administer . . . a drug or medicine” to an ultimate user. ALA. CODE § 34-23-1(5) (West 2024). In addition, the description of the “practice of pharmacy” in Alabama regulation includes “administering . . . drugs and devices.” ALA. ADMIN. CODE R. 680-x-2-.14(1) (2024). Neither of these provisions limits the drugs or medications for which a pharmacist can administer and therefore supports the conclusion that a pharmacist can administer buprenorphine outside of a collaborative drug therapy management agreement (CDTMA).

    • However, while there is an Alabama regulation expressly covering the administration of immunizations, including training necessary to do it, there are no provisions expressly addressing administration of any other kinds of drugs or medications, including controlled substances. ALA. ADMIN. CODE R. 680-X-2-.46 (2024). This could mean a pharmacist cannot administer buprenorphine as a matter of general practice.

    • The deciding factor may be the response to the question “Can a pharmacist administer buprenorphine under a CPA?”, which calls into question whether an Alabama pharmacist can administer a controlled substance outside of a CDTMA. As detailed in “Can a pharmacist administer buprenorphine under a CPA?”, an Alabama pharmacist cannot administer buprenorphine under a CDTMA without submitting a special request that can be approved or rejected. Given this limitation, the most logical conclusion is that an Alabama pharmacist would not have more authority to administer buprenorphine outside of a CDTMA than within one.

    • Short Answer: No, based on the information described below.

      • [However, there exists a process whereby Alabama’s Joint Committee on Pharmacy Collaborative Practice (Joint Committee) could approve a special request. The Joint Committee involves the Alabama Board of Medical Examiners (BME) and Alabama Board of Pharmacy (BOP)]

    • Under Alabama regulation, a CDTMA covers CDTM which includes having a pharmacist “monitor, modify, and discontinue drug therapy as directed by the physician.” Ala. Admin. Code r. 680-X-2-.44(1)(d) (2024). Although the regulation uses the words “monitor” and “modify,” it does not expressly refer to administering drugs or medications.

    • Alabama regulation requires BME/BOP to “promulgate standard protocols consistent with the recommendation of the Joint Committee establishing the patient care services that may be rendered under [a CDTMA].” Ala. Admin. Code r. 680-X-2-.44(14)(a) (2024). Moreover, BME/BOP “shall promulgate a standard formulary of legend drugs and/or drug classes consistent with the recommendations of the Joint Committee that may be utilized” under a CDTMA. Ala. Admin. Code r. 680-X-2-.44(15)(a) (2024).

    • As of October 2024, the CDTMA formulary does not include buprenorphine. In addition, the formulary and standard CDTMA protocol only list the following “disease states” as potentially coverable by a CPA: anticoagulation, asthma, chronic obstructive pulmonary disease, chronic heart failure, diabetes, hyperlipidemia, hypertension, osteoporosis, point-of-care testing, and smoking cessation. (Collaborative Practice Agreement Submission: Standard Formulary, Ala. Board of Medical Examiners & Ala. Board of Pharmacy (last accessed Oct. 7, 2024), https://albop.com/oodoardu/2022/02/Standard-Formulary-Fillable.pdf; Collaborative Practice Agreement Submission: Standard Protocol, Ala. Board of Medical Examiners & Ala. Board of Pharmacy (last accessed Oct. 7, 2024), https://albop.com/oodoardu/2022/02/Standard-Protocol-Fillable.pdf.)

    • CDTMA parties can submit protocols/formularies deviating from the standard CDTMA protocol/formulary to the Joint Committee for approval. The Joint Committee can approve or reject such requests in whole or in part. Ala. Admin. Code r. 680-X-2-.44(14)(c) (2024).

  • Short Answer: No, based on the information described below.

    • The description of the “practice of pharmacy” in Alabama regulation does not expressly include either ordering or evaluating lab tests. ALA. ADMIN. CODE R. 680-x-2-.14(1) (2024).

    • Moreover, Alabama pharmacy laws and regulations do not expressly address ordering or evaluating lab tests by pharmacists outside of CDTMAs.

  • Short Answer: Yes, based on the information described below. However, the authorization is limited and may not cover the types of tests necessary for patients undergoing SUD treatment with buprenorphine.

    • Alabama regulation provides that a pharmacist can “perfom[] testing or screening for and treatment of acute, uncomplicated illness or injury conditions.” ALA. ADMIN. CODE R. 680-X-2-.44(4)(a)(3)(ii) (2024).

    • Within the definition of “acute, uncomplicated illness or injury,” Alabama regulation notes that a pharmacist can use “any” CLIA-waived tests. ALA. ADMIN. CODE R. 680- X-2-.44(1)(q) (2024).

    • The list of tests that a pharmacist can order and evaluate is in the standard CDTMA protocol developed by BME/BOP. (Collaborative Practice Agreement Submission: Standard Formulary, Ala. Board of Medical Examiners & Ala. Board of Pharmacy (last accessed Oct. 7, 2024), https://albop.com/oodoardu/2022/02/Standard-Formulary-Fillable.pdf; Collaborative Practice Agreement Submission: Standard Protocol, Ala. Board of Medical Examiners & Ala. Board of Pharmacy (last accessed Oct. 7, 2024), https://albop.com/oodoardu/2022/02/Standard-Protocol-Fillable.pdf.) This list may not include all types of tests desired for a patient initiated or maintained on buprenorphine.

    • CDTMA parties can submit protocols deviating from the standard CDTMA protocol to the Joint Committee for approval. The Joint Committee can approve or reject such requests in whole or in part. ALA. ADMIN. CODE R. 680-X- 2-.44(14)(c) (2024).

  • Short Answer: No, based on the information described below.

    • Alabama does not have a general telehealth/telemedicine practice law. Alabama also does not have a Medicaid or other health insurance law addressing telemedicine/telehealth.

    • Alabama laws/regulations reference telehealth/telemedicine only with respect to physicians (and other practitioners of healing arts), optometrists, nurses, and several professions in which Alabama is a part of interstate compacts (audiologists/speech pathologists, counselors, social workers, dieticians, and occupational therapists).

    • Alabama pharmacy laws and regulations do not expressly address telehealth, telemedicine, or telepharmacy.

  • Short Answer: It depends.

    Commercial insurance may cover a limited set of pharmacist services - coverage will vary based on each insurance plan’s policies.

    References: 

  • “Medicaid may reimburse for professional services provided by licensed pharmacists” which “may include vaccine administration, medication maintenance therapy adherence and other clinical services as designated by the [Alabama Medicaid] Agency.” Ala. Admin. Code r. 560-X-16-.06(6) (2024).

    References: 

  • Beyond the topics covered above (and excluding methadone) are there any other laws/ regulations governing the way MOUD is provided to patients that currently apply to pharmacists?

    No

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Suggestions for Policy Makers:

Updating state laws to empower community pharmacists to independently prescribe, monitor, and bill for MOUD would eliminate the cumbersome hurdles of collaborative practice agreements (CPA) —each of which requires forging and maintaining a unique partnership with every patient’s prescriber—and unlock immediate access to care at the neighborhood pharmacy. By removing the need for a formal CPA with a distant clinician, pharmacists could leverage their deep expertise and accessibility to initiate lifesaving treatment the moment someone is ready for help. This approach honors pharmacists working at the top of their license, slashes unnecessary administrative barriers, and expands capacity for evidence-based OUD care exactly where patients already go for health services.

    • Expand the Alabama practice of pharmacy to include prescribing drugs and medications, or at least prescribing buprenorphine for SUD treatment.

    • Allow Alabama pharmacists to obtain the federal DEA mid-level practitioner registration needed to prescribe controlled substances.

    • Expand the practice of pharmacy in Alabama to expressly include administering buprenorphine for SUD treatment.

    • Expand the practice of pharmacy in Alabama to allow pharmacists to order and evaluate the results of the types of lab tests necessary for patients undergoing SUD treatment with buprenorphine.

    • Revise Alabama laws and/or regulations to allow pharmacists to prescribe controlled substances under CDTMAs.

    • Expressly specify in Alabama laws and/or regulations how prescriptions for controlled substances (or at least buprenorphine) work under CDTMAs.

    • Allow Alabama pharmacists to obtain the federal DEA mid-level practitioner registration needed to prescribe controlled substances.

    • Expressly specify in Alabama laws and/or regulations that the activities allowed by a pharmacist under a CDTMA include administering medications, or at least administering buprenorphine for SUD treatment.

    • Revise Alabama laws and/or regulations to expressly allow Alabama pharmacists to order and evaluate the types of tests necessary for patients undergoing SUD treatment with buprenorphine under a CDTMA.

    • Allow pharmacists to have “full provider” status under the Alabama Medicaid program.

    • Expressly specify in Alabama laws and/or regulations that pharmacist services provided under a CDTMA are covered under the Alabama Medicaid program.

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State Links and Resources (coming soon!)

  • Examples: Quick access for implementation questions. Board of Pharmacy contact; Medicaid pharmacy help desk; state MAT/MOUD coordinator. 

  • Examples:  PDMP statutes; board PDMP FAQs; registration portal. 

  • Lists state-mandated opioid or MOUD CE for pharmacists. Board CE rule; opioid-management CE links.

  • Contextual info patients/pharmacists may need. Syringe-service programs; state naloxone sites; recovery hotline(s). 

  • University or health-system toolkits; state opioid response project resources.

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