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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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