Ohio’s term for a collaborative practice agreement (CPA) is a “consult agreement”.

OHIO REV. CODE ANN. § 4729.01(D) (West 2024).

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

• The definition of the “practice of pharmacy” in Ohio law does not expressly include prescribing drugs or medications. OHIO REV. CODE ANN. § 4729.01(B) (West 2024).

• In addition, the definition of “licensed health professional authorized to prescribe drugs” (aka “prescriber”) in Ohio law does not include a pharmacist. OHIO REV. CODE ANN. § 4729.01(I) (West 2024).

• DEA information indicates that registered pharmacists in Ohio can obtain the DEA’s mid-level practitioner registration to “Administer, Prescribe, and Dispense” controlled substances without condition. (Mid-level Practitioners Authorization by State, DRUG ENFORCEMENT ADMIN. 1 (Nov. 7, 2024))

• However, Ohio Board of Pharmacy information makes clear that an Ohio “controlled substance prescriber registration is deemed void if the pharmacist no longer has a valid consult agreement authorizing the prescribing of a controlled substance. Failure to obtain or maintain a valid controlled substance prescriber registration prohibits a pharmacist from prescribing controlled substances.” (Pharmacist Consult Agreements with Providers, OHIO BOARD OF PHARMACY (updated Mar. 7, 2023), https://www.pharmacy.ohio.gov/Documents/Pubs/Special/Consult/Pharmacist%20Consult%20Agreements%20with%20Providers.pdf.)

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

• The definition of the “practice of pharmacy” in Ohio law expressly includes “acting pursuant to a consult agreement.” OHIO REV. CODE ANN. § 4729.01(B)(8) (West 2024).

• Under a consult agreement a pharmacist may “add[] a drug to the patient’s drug therapy.” OHIO REV. CODE ANN.§ 4729.39(D)(1)(a)(v) (West 2024). This provision does not expressly refer to “prescribing.”

• However, Ohio regulations make clear that a consult agreement can authorize a pharmacist to prescribe controlled drugs. OHIO ADMIN. CODE 4729:1-6-02(C) (2024).

• To prescribe controlled substances under a consult agreement, a pharmacist must both:

  • (1) maintain a valid controlled substance prescriber registration issued by Ohio’s Board of Pharmacy; and

  • (2) prescribe using a valid DEA registration. OHIO ADMIN. CODE 4729:1-6-02(C)(6) (2024).

• Under a consult agreement, a pharmacist “shall comply with the same requirements for the prescribing dangerous drugs [sic] pursuant to Chapter 4731 of the Administrative Code.” OHIO ADMIN. CODE 4729:1-6- 03(C) (2024). A “dangerous drug” includes all prescription drugs. OHIO REV. CODE ANN. § 4729.01(F) (West 2024).

• Chapter 4731 is the administrative code section for the state medical board. This appears to be an express provision that Ohio pharmacists prescribing under a consult agreement are subject to the same restrictions that apply to Ohio physician prescribers.

Short Answer: Yes, but based on the information described below, it only applies to certain forms of buprenorphine.

• The definition of the “practice of pharmacy” in Ohio law expressly includes “engaging in the administration of drugs to the extent authorized by section 4729.45.” OHIO REV. CODE ANN. § 4729.01(B)(10) (West 2024).

• In the referenced law, among the list of authorized drugs is “an addiction treatment drug administered in a long- acting or extended-release form.” OHIO REV. CODE ANN. § 4729.45(B)(1)(a) (West 2024).

• Note that a pharmacist may not delegate to any person the pharmacist’s authority to administer drugs or medications under OHIO REV. CODE ANN. § 4729.45. OHIO REV. CODE ANN. § 4729.45(G)(2) (West 2024).

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

• The definition of the “practice of pharmacy” in Ohio law expressly includes “acting pursuant to a consult agreement.” OHIO REV. CODE ANN. § 4729.01(B)(8) (West 2024).

• Ohio law governing consult agreements provides that a pharmacist can “manage drug therapy for treatment of specified diagnoses or diseases.” OHIO REV. CODE ANN. § 4729.39(D)(1)(a) (West 2024).

• The phrase “manage drug therapy” expressly includes “administering a drug.” OHIO REV. CODE ANN. § 4729.39(D)(1)(a)(iv) (West 2024). This provision does not limit the types of drugs or medications a pharmacist can administer.

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.

• The definition of the “practice of pharmacy” in Ohio law does not expressly refer to ordering or evaluating lab tests. OHIO REV. CODE ANN. § 4729.01(B) (West 2024).

• However, Ohio regulation authorizes a pharmacist to administer CLIA-waved ”diagnostic laboratory testing,” and evaluate the results of such tests, subject to certain specified conditions. OHIO ADMIN. CODE 4729:1-3-01 (2024).

• Short Answer: Yes, based on the information described below.
  
  The definition of the “practice of pharmacy” in Ohio law expressly includes “acting pursuant to a consult agreement.” OHIO REV. CODE ANN. § 4729.01(B)(8) (West 2024).

• Ohio law governing consult agreements provides that a pharmacist can “order laboratory and diagnostic tests, including blood and urine tests, that are related to the drug therapy being managed, and evaluate the results of the tests that are ordered.” OHIO REV. CODE ANN. § 4729.39(D)(1)(b) (West 2024).

• However, a pharmacist’s authority to evaluate test results under a consult agreement “does not authorize the pharmacist to make a diagnosis.” OHIO REV. CODE ANN. § 4729.39(D)(1)(b)(ii) (West 2024).

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

• Ohio pharmacy law provides that “a pharmacist may provide telehealth services in accordance with section 4743.09 of the Revised Code.” OHIO REV. CODE ANN. § 4729.285 (West 2024).

• The referenced Ohio law contains the general telehealth standards for all medical occupations and professions. OHIO REV. CODE ANN § 4743.09 (West 2024).

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: Yes, based on the information described below.

Ohio Medicaid covers the following pharmacist services

• Managing drug therapy under a consult agreement pursuant to OHIO CODE ANN. § 4729.39. OHIO REV. CODE ANN. § 5164.14(A) (West 2024).

• Administering immunizations in accordance with OHIO CODE ANN. § 4729.41. OHIO REV. CODE ANN. § 5164.14(B) (West 2024).

• Administering drugs and medications in accordance with OHIO CODE ANN. § 4729.45. OHIO REV. CODE ANN. § 5164.14(C) (West 2024).

• In addition, Ohio regulations do not preclude a Medicaid managed care organization (as defined in Ohio law) from paying pharmacists for additional purposes, within scope of practice, including care management services that are rendered by a pharmacist without a consult agreement. OHIO ADMIN. CODE 5160-8-52 (2024).

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

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? Such topics might include training/educational requirements for the practitioners providing buprenorphine, information that must be shared to patients, dosage limits, counseling requirements, etc.

• Short Answer: No
  

Are there any such laws/regulations that currently apply to non-pharmacists?

• Ohio law and regulations set forth four types of medical providers who can provide MOUD: (1) physicians; (2) physician assistants; (3) advanced practice registered nurses designated as a clinical nurse specialist or certified nurse practitioner; and (4) certified nurse midwifes.

  • There are separate sets of regulations for each type of provider, although the content is largely consistent among the types. OHIO ADMIN. CODE 4731-33-01 to 4731-33-04 (2024) (physicians); OHIO ADMIN. CODE 4730-4-01 to 4730-4-04 (2024) (physician assistants); OHIO ADMIN. CODE 4723-9- 13 (2024) (nurses and nurse midwifes).

• The regulations referenced above cover the following topics, among other things: educational requirements, patient assessment, drug testing, patient counseling, medication form/dosage, and provider visit requirements.

• Before initiating MOUD, a prescriber must give the patient (or patient’s representative) information about all drugs approved by FDA for MAT both orally and in writing. The prescriber must note in the patient’s medical record when this information was provided and make the record available for state board inspection. OHIO REV. CODE ANN. § 3719.064 (West 2024). Prescriber means the four types of providers identified above.