SUBCHAPTER 32t – clinical pharmacist practitioner
section .0100 – clinical pharmacist practitioner
21 NCAC 32T .0101 CLINICAL PHARMACIST PRACTITIONER
(a) Definitions as used in the Rule:
(1) "Medical Board" means the North
Carolina Medical Board.
(2) "Pharmacy Board" means the North
Carolina Board of Pharmacy.
(3) "Joint Subcommittee" means the
subcommittee composed of four members of the Pharmacy Board and four members of
the Medical Board to whom responsibility is given by G.S. 90-6(c) to develop rules
to govern the provision of drug therapy management by the Clinical Pharmacist
Practitioner in North Carolina.
(4) "Clinical Pharmacist Practitioner or
CPP" means a licensed pharmacist who is approved to provide drug therapy
management under the direction of, or under the supervision of a licensed
physician who has provided written instructions for a patient and disease
specific drug therapy which may include ordering, changing, substituting
therapies or ordering tests. Only a pharmacist approved by the Pharmacy Board
and the Medical Board may legally identify himself as a CPP.
(5) "Supervising Physician" means a
licensed physician who, by signing the CPP agreement, is held accountable for
the on-going supervision and evaluation of the drug therapy management
performed by the CPP as defined in the physician, patient, pharmacist and
disease specific written agreement.
(6) "Approval" means authorization by
the Medical Board and the Pharmacy Board for a pharmacist to practice as a CPP
in accordance with this Rule.
(7) "Continuing Education or CE" is
defined as courses or materials which have been approved for credit by the
American Council on Pharmaceutical Education.
(8) "Clinical Experience approved by the
Boards" means work in a pharmacy practice setting which includes
experience consistent with the following components as listed in Parts
(b)(2)(A), (B), (C), (D), (E), (H), (I), (J), (N), (O), and (P) of this
Rule. Clinical experience requirements must be met only through
activities separate from the certificate programs referred to in Parts
(b)(1)(B) of this Rule.
(b) CPP application for approval.
(1) The requirements for application for CPP
approval include that the pharmacist:
(A) has an unrestricted and current license to practice
as a pharmacist in North Carolina;
(B) meets one of the following qualifications:
(i) has earned Certification from the Board of
Pharmaceutical Specialties, is a Certified Geriatric Pharmacist as certified by
the Commission for Certification in Geriatric Pharmacy, or has completed an
American Society of Health System Pharmacists (ASHP) accredited residency
program, which includes two years of clinical experience approved by the
(ii) has successfully completed the course of study
and holds the academic degree of Doctor of Pharmacy and has three years
of clinical experience approved by the Boards and has completed a North
Carolina Center for Pharmaceutical Care (NCCPC) or American Council on
Pharmaceutical Education (ACPE) approved certificate program in the area of practice
covered by the CPP agreement; or
(iii) has successfully completed the course of study
and holds the academic degree of Bachelor of Science in Pharmacy and has five
years of clinical experience approved by the Boards and has completed two NCCPC
or ACPE approved certificate programs with at least one program in the area of
practice covered by the CPP agreement;
(C) submits the required application and the fee to the
(D) submits any information deemed necessary by the
Medical Board in order to evaluate the application; and
(E) has a signed supervising physician agreement.
If for any reason a CPP
discontinues working in the approved physician arrangement, the clinical
pharmacist practitioner shall notify both Boards in writing within ten days and
the CPP's approval shall automatically terminate or be placed on an inactive
status until such time as a new application is approved in accordance with this
(2) All certificate programs referred to in
Subpart (b)(1)(B)(i) of this Rule must contain a core curriculum including the
(A) communicating with healthcare professionals and
patients regarding drug therapy, wellness, and health promotion;
(B) designing, implementing, monitoring, evaluating, and
modifying or recommending modifications in drug therapy to insure effective,
safe, and economical patient care;
(C) identifying, assessing and solving
medication-related problems and providing a clinical judgment as to the
continuing effectiveness of individualized therapeutic plans and intended
(D) conducting physical assessments, evaluating patient
problems, ordering and monitoring medications and laboratory tests;
(E) referring patients to other health professionals as
(F) administering medications;
(G) monitoring patients and patient populations
regarding the purposes, uses, effects and pharmacoeconomics of their medication
and related therapy;
(H) counseling patients regarding the purposes, uses, and
effects of their medication and related therapy;
(I) integrating relevant diet, nutritional and
non-drug therapy with pharmaceutical care;
(J) recommending, counseling, and monitoring patient
use of non-prescription drugs, herbal remedies and alternative medicine
(K) ordering of and educating patients regarding proper
usage of devices, and durable medical equipment;
(L) providing emergency first care;
(M) retrieving, evaluating, utilizing, and managing data
and professional resources;
(N) using clinical data to optimize therapeutic drug
(O) collaborating with other health professionals;
(P) documenting interventions and evaluating
pharmaceutical care outcomes;
(Q) integrating pharmacy practice within healthcare
(R) integrating national standards for the quality of
(S) conducting outcomes and other research.
(3) The completed application for approval to
practice as a CPP shall be reviewed by the Medical Board upon verification of a
full and unrestricted license to practice as a pharmacist in North Carolina.
(A) The application shall be approved and at the time of
approval the Medical Board shall issue a number which shall be printed on each
prescription written by the CPP; or
(B) the application shall be denied; or
(C) the application shall be approved with restrictions.
(c) Annual Renewal.
(1) Each CPP shall register annually on the
anniversary of his or her birth date by:
(A) verifying a current Pharmacist license;
(B) submitting the renewal fee as specified in
Subparagraph (j)(2) of this Rule;
(C) completing the Medical Board's renewal form; and
(D) reporting continuing education credits as specified
by the Medical Board.
(2) If the CPP has not renewed within 30 days of
the anniversary of the CPP's birth date, the approval to practice as a CPP
(d) Continuing Education.
(1) Each CPP shall earn 35 hours of practice
relevant CE each year approved by the Pharmacy Board.
(2) Documentation of these hours shall be kept
at the CPP practice site and made available for inspection by agents of the
Medical Board or Pharmacy Board.
(e) The supervising physician who has a signed agreement
with the CPP shall be readily available for consultation with the CPP; and
shall review and countersign each order written by the CPP within seven days.
(f) The written CPP agreement shall:
(1) be approved and signed by both the
supervising physician and the CPP and a copy shall be maintained in each
practice site for inspection by agents of either Board upon request;
(2) be specific in regards to the physician,
the pharmacist, the patient and the disease;
(3) specify the predetermined drug therapy
which shall include the diagnosis and product selection by the patient's
physician; any modifications which may be permitted, dosage forms, dosage
schedules and tests which may be ordered;
(4) prohibit the substitution of a chemically
dissimilar drug product by the CPP for the product prescribed by the physician
without first obtaining written consent of the physician;
(5) include a pre-determined plan for emergency
(6) include a plan and schedule for weekly
quality control, review and countersignature of all orders written by the CPP
in a face-to-face conference between the physician and CPP;
(7) require that the patient be notified of the
collaborative relationship; and
(8) be terminated when patient care is
transferred to another physician and new orders shall be written by the
(g) The supervising physician of the CPP shall:
(1) be fully licensed with the Medical Board
and engaged in clinical practice;
(2) not be serving in a postgraduate medical
(3) be approved in accordance with this
Subchapter before the CPP supervision occurs; and
(4) supervise no more than three pharmacists.
(h) The CPP shall wear a nametag spelling out the words
"Clinical Pharmacist Practitioner".
(i) The CPP may be censured or reprimanded or the CPP's
approval may be restricted, suspended, revoked, annulled, denied or terminated
by the Medical Board or the Pharmacy Board and the pharmacist may be censured
or reprimanded or the pharmacist's license may be restricted, suspended,
revoked, annulled, denied, or terminated by the Pharmacy Board, in accordance
with provisions of G.S. 150B if either Board finds one or more of the
(1) the CPP has held himself or herself out or
permitted another to represent the CPP as a licensed physician;
(2) the CPP has engaged or attempted to engage
in the provision of drug therapy management other than at the direction of, or
under the supervision of, a physician licensed and approved by the Medical
Board to be that CPP's supervising physician;
(3) the CPP has performed or attempted to
provide medical management outside the approved drug therapy agreement or for
which the CPP is not qualified by education and training to perform;
(4) The CPP commits any act prohibited by any
provision of G.S. 90-85.38 as determined by the Pharmacy Board or G.S.
90-14(a)(1), (a)(3) through (a)(14) and (c) as determined by the Medical Board;
(5) the CPP has failed to comply with any of
the provisions of this Rule.
Any modification of treatment for financial gain on the part
of the supervising physician or CPP shall be grounds for denial of Board
approval of the agreement.
(1) An application fee of one hundred dollars
($100.00) shall be paid at the time of initial application for approval and
each subsequent application for approval to practice.
(2) The fee for annual renewal of approval, due
on the CPP's anniversary of birth date is fifty dollars ($50.00).
(3) No portion of any fee in this Rule is
History Note Authority G.S. 90-6(c); 90-18(c)3a;
Eff. April 1, 2001;
Amended Eff. March 1, 2007; October 1, 2001.