Washington’s term for a collaborative practice agreement (CPA) is a “collaborative drug therapy agreement” (CDTA).

WASH. ADMIN. CODE § 246-945-001(11) (2024).

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

• The definition of the “practice of pharmacy” in Washington law does not expressly include prescribing drugs or medications. WASH. REV. CODE ANN. § 18.64.011(32) (West 2024).

• The practice of pharmacy definition does allow for “the initiating or modifying of drug therapy in accordance with written guidelines or protocols previously established and approved for his or her practice by a practitioner authorized to prescribe drugs.” WASH. REV. CODE ANN. § 18.64.011(32) (West 2024).

• However, Washington regulations indicate that for a pharmacist to have “prescriptive authority,” the pharmacist must have a collaborative drug therapy agreement (CDTA) on file with the state pharmacy commission. WASH ADMIN. CODE §§ 246-945-011(11), 246-945-350(1) (2024).

• DEA information last updated in November 2024 indicates that registered pharmacists in Washington can obtain the DEA’s mid-level practitioner registration to “Prescribe Only.” However, based on the information in Washington laws and regulations described in the response to the question “Can a pharmacist prescribe buprenorphine collaboratively via a CPA”below, this authority applies only to pharmacists acting under CDTAs, even though that limitation is not specified by DEA. (Mid-level Practitioners Authorization by State,DRUG ENFORCEMENT ADMIN. 1 (Nov. 7, 2024))

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

• The definition of the “practice of pharmacy” in Washington expressly authorizes “the initiating or modifying of drug therapy in accordance with written guidelines or protocols previously established and approved for his or her practice by a practitioner authorized to prescribe drugs.” WASH. REV. CODE ANN. § 18.64.011(32) (West 2024). Although this provision does not expressly refer to prescribing drugs or medications, Washington regulations make clear that it can include prescribing authority. Washington regulation provides that a CDTA is “a written guideline or protocol previously established and approved by a practitioner authorized to prescribe drugs that enables a pharmacist to exercise prescriptive authority.” WASH ADMIN. CODE § 246-945-011(11) (2024). The regulation governing content of CDTAs also expressly provides that modification or initiation of drug therapy includes prescriptive authority. WASH ADMIN. CODE § 246-945- 350(2) (2024).

• Washington laws and regulations governing drug therapy and CDTAs do not expressly address prescribing controlled substances or the need for a pharmacist to obtain the federal DEA mid-level practitioner registration to do so.

• However, a WDOH website on general pharmacy practice provides that “a pharmacist working under a [CDTA] may prescribe controlled substance (CS) prescriptions under the following conditions: (1) the scope of the CDTA must permit this activity; and (2) the pharmacist must have a Drug Enforcement Administration (DEA) registration (unless exempted from obtaining a DEA registration, for example see the FAQ on use of the hospital DEA with a suffix).” (Pharmacy Commission – General Pharmacy Practice Frequently Asked Questions, WASH. STATE DEPT. OF HEALTH (last accessed Nov. 11, 2024), https://doh.wa.gov/licenses-permits-and-certificates/facilitiesz/pharmaceutical-firms/general-pharmacy-practice-faqs (see first FAQ listed)

• This conclusion is consistent with DEA information that registered pharmacists in Washington can obtain a mid- level practitioner registration. (Mid-level Practitioners Authorization by State, DRUG ENFORCEMENT ADMIN. 1 (Nov. 7, 2024))

• Short Answer: Yes, based on the information described below.
  
  The definition of the “practice of pharmacy” includes “administering . . . drugs and devices.” WASH. REV. CODE ANN. § 18.64.011(32) (West 2024). This provision does not limit the drugs or medications associated with administering and could mean that a pharmacist has authority to administer buprenorphine generally.

• Unlike the laws and regulations of several other states with general language about administration in the practice of pharmacy definition, there are no other Washington laws or regulations that address administration of a small subset of drugs or medications (such as immunizations) that would give the impression that the legislature does not view the “administering . . . drugs and devices” language as a broad authorization.

• Moreover, a Washington Department of Health (WDOH) website entitled “Who Can Prescribe and Administer Prescriptions in Washington State” indicates, within the category of “professions that may administer drugs ordered by authorized prescribers,” that pharmacists can administer prescribed drugs without any further caveat. (Who Can Prescribe and Administer Prescriptions in Washington State, WASH. STATE DEPT. OF HEALTH (last accessed Nov. 11, 2024), https://doh.wa.gov/licenses-permits-and-certificates/facilities-z/pharmaceutical-firms/whocan-prescribe-and-administer-prescriptions-washington-state.)

Short Answer: As described in the information below, Washington laws and regulations do not clearly answer this question. However, due to the answer to the question “Can a pharmacist administer buprenorphine without entering a CPA?”, the answer is likely “yes.”

• The definition of the “practice of pharmacy” in Washington law expressly authorizes “the initiating or modifying of drug therapy in accordance with written guidelines or protocols previously established and approved for his or her practice by a practitioner authorized to prescribe drugs.” WASH. REV. CODE ANN. § 18.64.011(32) (West 2024). Although this provision refers to “initiating or modifying,” it does not expressly refer to administering drugs and medications.

• The Washington regulation governing CDTAs indicates that a CDTA must detail the type of prescriptive authority authorized as well as include “a general statement of the training required, procedures, decision criteria, or plan the pharmacist is to follow when making therapeutic decisions, particularly when modification or initiation of drug therapy is involved.” WASH ADMIN. CODE § 246-945-350(2) (2024). The provision does not expressly address administering drugs and medications, however.

• In summary, Washington laws and regulations are unclear about the extent to which a pharmacist can administer drugs and medications under a CDTA. However, given the response to the question “Can a pharmacist administer buprenorphine without entering a CPA?” above that a pharmacist has general authority to administer any prescribed drug or medication outside of CDTA, the logical answer to this question is “yes.”

Short Answer: Yes, but based on the information described below the authorization could be limited slightly.

• The definition of the “practice of pharmacy” in Washington law does not expressly refer to ordering or evaluating lab tests. WASH. REV. CODE ANN. § 18.64.011(32) (West 2024).

• The practice of pharmacy definition does allow for “the monitoring of drug therapy and use.” WASH. REV. CODE ANN. § 18.64.011(32) (West 2024).

• Washington regulation provides that “in the absence of a CDTA,” the phrase “monitoring drug therapy” as used in the practice of pharmacy definition includes “ordering, administering or reviewing laboratory tests, imaging, and social evaluation related to an existing diagnosis and drug therapies for optimization of drug therapy.” WASH ADMIN. CODE § 246-945-355 (2024). This regulation indicates that a pharmacist can order and evaluate lab tests outside of a CDTA.

• No other Washington pharmacy laws or regulations expressly address ordering or evaluating lab tests.

Short Answer: As described in the information below, Washington laws and regulations do not clearly answer this question. However, due to the answer for the question “Can a pharmacist order and/or evaluate the results of lab tests independently?”, the answer is likely “yes,” at least to the same extent. 

• The definition of the “practice of pharmacy” in Washington law expressly authorizes “the initiating or modifying of drug therapy in accordance with written guidelines or protocols previously established and approved for his or her practice by a practitioner authorized to prescribe drugs.” WASH. REV. CODE ANN. § 18.64.011(32) (West 2024). Although this provision refers to “initiating or modifying,” it does not expressly refer to ordering or evaluating lab tests.

• The Washington regulation governing CDTAs indicates that a CDTA must detail the type of prescriptive authority authorized as well as include “a general statement of the training required, procedures, decision criteria, or plan the pharmacist is to follow when making therapeutic decisions, particularly when modification or initiation of drug therapy is involved.” WASH ADMIN. CODE § 246-945-350(2)(2024). The provision does not expressly address ordering or evaluating lab tests, however.

• In summary, Washington laws and regulations are unclear about the extent to which a pharmacist can order and evaluate lab tests under a CDTA. However, given the response to the question “Can a pharmacist order and/or evaluate the results of lab tests independently?” above that a pharmacist has authority to order, administer, or review lab tests as part of monitoring drug therapy outside of a CDTA, the logical answer to this question is that a pharmacist has the same authority under a CDTA.

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

• Washington’s general telehealth/telemedicine practice law authorizes a “health care practitioner” to provide telehealth services to a patient located in Washington “if the services are consistent with the health care practitioner’s scope of practice in this state, applicable professional practice standards in this state, and requirements and limitations of federal law and law of this state.” WASH. REV. CODE ANN. § 18.134.030(1) (West 2024).

• The definition of “health care provider” does not expressly include pharmacists. However, it also includes “a person who is otherwise authorized to practice a profession regulated under the authority of [§] 18.130.040 to provide health care in this state, to the extent the profession’s scope of practice includes health care that can be provided through telehealth.” WASH. REV. CODE ANN. § 18.134.010(4)(a)(vii) (West 2024).

• The state pharmacy quality assurance commission, established in chapter 18.64 of the Washington statutory code, is included in the list of boards and commissions having authority under § 18.130.040. WASH. REV. CODE ANN. § 18.130.040(2)(b)(viii) (West 2024). As a result, it appears that pharmacists fall within the provision for professions regulated under § 18.130.040.

Short Answer: Yes.

• Commercial health insurance plans, including managed care Medicaid plans offered through commercial insurers are required to include pharmacists in provider networks and cover pharmacist-provided services. WASH. REV. CODE ANN. § 48.43.094 (West 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

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

• Commercial health insurance plans, including managed care Medicaid plans offered through commercial insurers are required to include pharmacists in provider networks and cover pharmacist-provided services. WASH. REV. CODE ANN. § 48.43.094 (West 2024). The above provision does not include Medicare or Medicaid fee-for-service plans, however.

• Under the Medicaid program, researchers conclude that some pharmacist services are covered including vaccines, HIV/AIDS counseling/testing, tobacco/nicotine cessation counseling, and reproductive health.

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.

No

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

There are Washington regulations for a variety of health care professionals governing the co-prescribing of opioids to patients receiving “medication assisted treatment” (MAT). WASH ADMIN. CODE §§ 246-817-976, 246-840-4970, 246-853-780, 246-918-925, 246-919-975, 246-922 780 (2024).

There are Washington regulations for a variety of health care professionals that prohibit the discontinuing of MAT when treating acute pain, particularly as to pregnant patients. WASH ADMIN. CODE §§ 246-817-913, 246-817-970, 246-840-4661, 246-840-4950, 246-853-695, 246-853-765, 246-918-835, 246-918-840, 246-918-910, 246-919-885, 246-919-890, 246-919-960, 246-922-695, 246-922-765 (2024).