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

• Massachusetts pharmacy laws and regulations do not clearly define the “practice of pharmacy.”

• However, in the Massachusetts regulation governing controlled substance registration requirements, the only reference to a pharmacist prescribing drugs or medications is to “prescribe and dispense hormonal contraceptive patches and self-administered oral hormonal contraceptives.” 105 MASS. CODE REGS. 700.004(B)(15) (2024).

• Moreover, according to a scope of practice policy issued by the Massachusetts Board of Registration in Pharmacy (Board), “in order for a pharmacist to . . . prescribe medications, a CDTM [collaborative drug therapy management] agreement with a physician is required.” (Policy 2020-15: Scope of Practice, Board of Registration in Pharmacy, Mass. Dept. of Public Health 1 (Dec. 7, 2023)

• DEA information last updated in November 2024 indicates that registered pharmacists in Massachusetts can obtain the DEA’s mid-level practitioner registration, but subject to the limitations of “Prescribe only[,] Institutional pharmacist only, [and] No Retail.” (Mid-level Practitioners Authorization by State, Drug Enforcement Admin. 1; Nov. 7, 2024)

• However, as described above and in the response to the question “Can a pharmacist prescribe buprenorphine under a CPA?” below, this authority applies only to pharmacists acting under CDTM agreements, called CPAs in regulation, even though that limitation is not specified by DEA.

Short Answer: It depends, based on the information described below.

• The answer is “no” if the CDTM practice setting is within a community/retail pharmacy, but “yes” if the practice setting is within one of the other allowed types.

• Massachusetts law provides that CDTM is “the initiating, monitoring, modifying and discontinuing of a patient's drug therapy by a pharmacist in accordance with a [CPA].” MASS. GEN. LAWS ANN. ch.112, § 24B ½(a) (West 2024).

• Massachusetts laws and regulations authorize CDTM in five types of settings: (1) hospitals; (2) long-term care facilities; (3) inpatient or outpatient hospice settings; (4) ambulatory care clinics; and (5) community/retail pharmacies. MASS. GEN. LAWS ANN. ch.112, § 24B ½(c) (West 2024); 247 MASS. CODE REGS. 16.03 (2024).

• In general, a CPA can grant prescriptive authority to a pharmacist that includes prescribing controlled substances. Massachusetts regulation provides that if a CPA grants prescriptive authority, the pharmacist must “maintain a current controlled substance registration issued by the Department during the term of the agreement.” 247 MASS. CODE REGS. 16.02(1)(f) (2024). However, “no [CPA] in the retail drug business setting may permit the prescribing of schedule II through V controlled substances.” MASS. GEN. LAWS ANN. ch.112, § 24B ½(c) (West 2024); 247 MASS. CODE REGS. 16.03(5)(e)(3) (2024).

• Along with prohibiting pharmacists from prescribing buprenorphine under a CPA in a community pharmacy setting, the implication of this provision is that pharmacists can prescribe buprenorphine under a CPA in the other allowed CDTM settings.

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

• Massachusetts regulation expressly authorizes a pharmacist “to dispense by administration FDA approved mental health or substance use disorder treatment drugs to persons 18 years of age or older.” 105 MASS. CODE REGS. 700.004(B)(9) (2024).

• However, this activity must be conducted in accordance with guidelines adopted by the Massachusetts Department of Public Health (Department), “which shall include, but not be limited to, requirements for . . . specific drugs permitted to be administered.” 105 MASS. CODE REGS. 700.004(B)(9)(d)(1) (2024).

• According to a circular letter issued by the Department in April 2023, the only drug or medication for SUD that a pharmacist can administer currently is naltrexone. (Circular Letter: DCP 23-04-118, Exec. Off. of Health & Human Servs., Mass. Dept. of Public Health 2 (Apr. 21, 2023))

Short Answer: Based on the information described below, the answer is “no” if the CDTM practice setting is within a community/retail pharmacy, and “unclear” if the practice setting is within one of the other allowed types.

• Massachusetts law provides that CDTM is “the initiating, monitoring, modifying and discontinuing of a patient’s drug therapy by a pharmacist in accordance with a [CPA].” MASS. GEN. LAWS ANN. ch.112, § 24B ½(a) (West 2024).

• Although this provision uses the phrase “initiating, monitoring, [and] modifying,” it does not expressly refer to administering drugs or medications. However, the phrase could be interpreted to include administration of drugs and medications generally.

• Massachusetts laws and regulations authorize CDTM in five types of settings: (1) hospitals; (2) long-term care facilities; (3) inpatient or outpatient hospice settings; (4) ambulatory care clinics; and (5) community/retail pharmacies. MASS. GEN. LAWS ANN. ch.112, § 24B ½(c) (West 2024); 247 MASS. CODE REGS. 16.03 (2024).

• Massachusetts laws and regulations governing CPAs place more restrictions on CPAs in community/retail pharmacies than in the other allowed settings. A pharmacist operating under a CPA in a community/retail pharmacy may administer vaccines, but can only “initiate, modify, or discontinue dosages of medications prescribed by the supervising physician” for eight identified conditions, none of which is SUD. 247 MASS. CODE REGS. 16.03(e)(1)(b) (2024). This provision appears to prevent community pharmacists from administering buprenorphine under a CPA.

• Massachusetts laws and regulations governing CPAs do not expressly address administering drugs or medications under a CPA in the four other types of practice settings besides a community/retail pharmacy.

• The scope of practice policy issued by the Board expressly notes that a pharmacist can administer vaccines as part of CDTM but does not indicate if CDTM can involve administration of any other type of drug or medication beyond that allowed outside of a CPA.
  (Policy 2020-15: Scope of Practice, Board of Registration in Pharmacy, Mass. Dept. of Public Health 1 (Dec. 7, 2023))

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

• Massachusetts pharmacy laws and regulations do not clearly define the “practice of pharmacy.”

• According to a scope of practice policy issued by the Board, a pharmacist can “administer, process, read, and report the results” of two types of tests, but in neither case may the pharmacist interpret test results. The two types of tests are Health Promotion Screening tests and COVID-19 tests.

• Otherwise, the Board policy notes that “in order for a pharmacist to order drug-related laboratory tests . . . a CDTM agreement with a physician is required.” (Policy 2020-15: Scope of Practice, Board of Registration in Pharmacy, Mass. Dept. of Public Health 1 (Dec. 7, 2023))

Short Answer: Yes, based on the information described below.

• Massachusetts law expressly provides that CDTM performed pursuant to a CPA may include “ordering and evaluating the results of laboratory tests directly related to drug therapy.” MASS. GEN. LAWS ANN. ch.112, § 24B ½(a) (West 2024).

• The actions must be performed “under the supervision of, or in direct consultation with, a physician,” in accordance with approved protocols applicable to the practice setting, and “the evaluation shall not include a diagnostic component.” MASS. GEN. LAWS ANN. ch.112, § 24B ½(a) (West 2024).

Short Answer: Yes, based on the information described below.

• Massachusetts does not have a general telehealth/telemedicine practice act. However, the telehealth provision for physicians requires the state board of medicine to “allow a physician licensed by the board to obtain proxy credentialing and privileging for telehealth services with other health care providers, as defined in section 1 of chapter 111.” MASS. GEN. LAWS ANN. ch.112, § 5O(b) (West 2024). The referenced definition of health care providers expressly includes pharmacists. MASS. GEN. LAWS ANN. ch.111, § 1 (West 2024).

• Moreover, Massachusetts insurance laws and Medicaid program laws, require coverage for health care services delivered by telehealth by a “health care provider.” MASS. GEN. LAWS ANN. ch.118E, § 79 (West 2024); MASS. GEN. LAWS ANN. ch.175, § 47MM (West 2024). The health care insurance provisions do not define “health care provider,” but as noted above, public health law does define the term to include pharmacists.

• The definition of “telehealth” expressly includes services for a patient’s mental health or SUD condition. MASS. GEN. LAWS ANN. ch.118E, § 79(a) (West 2024); MASS. GEN. LAWS ANN. ch.175, § 47MM(a) (West 2024).

• The scope of pharmacist practice policy issued by the Board, however, notes that “in Massachusetts, the scope of telepharmacy is limited to remote pharmacist clinical activities and verification of final patient-specific products.” (Policy 2020-15: Scope of Practice, Board of Registration in Pharmacy, Mass. Dept. of Public Health 1 (Dec. 7, 2023))

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: 

• Jonathan Hughes, State of the Union: A Review of State-based Laws and Regulations Supporting Pharmacist Payment for Clinical Services, Clinical Pharmacy Forum (July 26, 2024) at https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/jac5.2008.

• Pharmacist Authority to Initiate PrEP & PEP and Participate in Collaborative Practice Agreements, Nat’l Alliance of State & Territorial AIDS Directors (Aug. 10, 2023) at https://nastad.org/sites/default/files/2023-08/PDF-Pharmacist-Authority-Initiate-PrEP-PEP.pdf

Short Answer: It depends, based on the information described below.

MA Medicaid (MassHealth) covers certain medication therapy management services provided by clinical pharmacists in community health centers.

• Jonathan Hughes, State of the Union: A Review of State-based Laws and Regulations Supporting Pharmacist Payment for Clinical Services, Clinical Pharmacy Forum (July 26, 2024) https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/jac5.2008.

• Memorandum from Amanda Cassel Craft, Asst. Sec. for MassHealth to Community Health Centers Participating in MassHealth (Jan. 2022)

MA Medicaid also reimburses pharmacists for vaccine administration

• Pharmacist Authority to Initiate PrEP & PEP and Participate in Collaborative Practice Agreements, Nat’l Alliance of State & Territorial AIDS Directors at 22 (chart related to “reimbursement for pharmacist clinical services”) (Aug. 10, 2023)

• MassHealth Pharmacy Covered Professional Services List, MassHealth (Aug. 2024)

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