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SB 357

DMV rule relating to actions affecting driving privileges

2025 Regular Session Introduced by Jack Woodrum

Creates clinical pharmacist practitioner (CPP) role, enabling qualified pharmacists to manage drug therapy and order tests under physician supervision, expanding access to care.

Reported in Com. Sub. for S. B. 358
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Bill Summary · SB 357

SB 357 — Pharmacists / Collaborative Practice

Status: Introduced Feb 12, 2025 — Passed 1st Reading (filed Mar 20, 2025)
Primary sponsors: Senators Sawrey, Hise, Galey

Purpose / Intent

Modernize and expand physician–pharmacist collaborative practice in North Carolina by creating a clearer statutory framework for “clinical pharmacist practitioners” (CPPs). The bill authorizes qualified pharmacists, under physician-supervised collaborative practice agreements, to provide defined drug-therapy and related clinical services to improve access, continuity, and efficiency of care.

Key provisions (summary of substantive changes)

  • Defines and authorizes “drug therapy management” by a licensed pharmacist under a physician–pharmacist written agreement that is physician-, pharmacist-, patient-, and disease-specific. Drug therapy management may include:
    • Implementing predetermined drug therapy (based on physician diagnosis/product selection),
    • Modifying prescribed dosages, dosage forms, and schedules,
    • Ordering laboratory tests.
  • Establishes the professional title “clinical pharmacist practitioner” (CPP) for pharmacists approved to perform these delegated medical acts; unauthorized use of the title is prohibited.
  • Requires joint rules (and approval) developed by a subcommittee of the North Carolina Medical Board and the North Carolina Board of Pharmacy to govern CPP approvals and practice limitations.
  • Approval conditions for CPPs include:
    • Current approval from both Boards,
    • An identification number assigned by the Medical Board that must appear on CPP prescriptions,
    • A collaborative agreement that prohibits substitution of chemically dissimilar drugs without explicit physician consent and requires periodic physician review of modified drugs.
  • Hospital / institutional practice:
    • CPPs may order medications, tests, and devices in hospitals/health facilities that have pharmacy & therapeutics (or equivalent) committees and adopt policies governing such orders.
    • Supervising physician must provide written instructions and timely review mechanisms; facilities must adopt verification and safety policies.
  • Group practice / institutional model:
    • Site‑specific, multi‑provider collaborative practice agreements permitted for institutions and group practices; oversight and evaluation policies required.
  • Delegation & performance:
    • Registered nurses, licensed practical nurses, and pharmacists who receive CPP orders are authorized to carry them out as if ordered by a physician.
  • Supervising physician responsibilities:
    • Must be site-specific, conduct periodic reviews, and may supervise multiple CPPs as deemed safe.
    • Agreements may include authorization for substitutions within therapeutic class or biosimilars based on payer formularies; CPP must document and notify physician of substitutions.

Who is affected

  • Pharmacists: pathway to practice as CPPs, expanded clinical responsibilities.
  • Physicians: may delegate tasks; responsible for supervision, review, and oversight.
  • Hospitals, clinics, group practices: must adopt policies, may use site-specific collaborative agreements.
  • Nurses and dispensing pharmacists: permitted to act on CPP orders.
  • Patients and payers: potential for increased access to medication management and testing; impacts on continuity, prescribing patterns, and reimbursement arrangements.

Implementation / Operational notes

  • Requires rulemaking by the NC Medical Board and NC Board of Pharmacy (joint subcommittee) to set approval criteria, safety limits, and oversight details.
  • Institutions must create policies (formularies, verification procedures, oversight) before CPPs can order medications/tests.
  • Supervising physicians must document oversight and periodic review protocols.

Potential impacts

  • Clinical: could improve access to medication management, chronic disease management, and reduce physician burden.
  • Administrative: boards and health care entities will need to develop rules, procedures, credentialing, and oversight mechanisms.
  • Legal/quality: increases delegated medical acts—necessitates clear standards for scope, documentation, liability coverage, and periodic review.

Procedural status & next steps

  • Introduced Feb 12, 2025; filed in Senate (Mar 20, 2025). Passed 1st Reading.
  • Subject to rulemaking and approvals by the North Carolina Medical Board and Board of Pharmacy before full implementation; further committee hearings and subsequent legislative readings required for enactment.

Compiled from official sources — confirm details with the bill’s official record.

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