                                 CODE OF VIRGINIA

PARTICIPATION IN COLLABORATIVE AGREEMENTS; REGULATIONS TO BE PROMULGATED BY THE
BOARDS OF MEDICINE AND PHARMACY (§ 54.1-3300.1)

A. A pharmacist and his designated alternate pharmacists involved directly in
patient care may participate with (i) any person licensed to practice medicine,
osteopathy, or podiatry together with any person licensed, registered, or
certified by a health regulatory board of the Department of Health Professions
who provides health care services to patients of such person licensed to
practice medicine, osteopathy, or podiatry; (ii) a physician&#8217;s office as
defined in &#xA7; 32.1-276.3, provided that such collaborative agreement is
signed by each physician participating in the collaborative agreement; (iii) any
licensed physician assistant working in accordance with the provisions of &#xA7;
54.1-2951.1; or (iv) any licensed advanced practice registered nurse working in
accordance with the provisions of &#xA7; 54.1-2957, involved directly in patient
care in collaborative agreements which authorize cooperative procedures related
to treatment using drug therapy, laboratory tests, or medical devices, under
defined conditions or limitations, for the purpose of improving patient outcomes
for patients who meet the criteria set forth in the collaborative agreement.
However, no person licensed to practice medicine, osteopathy, or podiatry, or
licensed as an advanced practice registered nurse or physician assistant, shall
be required to participate in a collaborative agreement with a pharmacist and
his designated alternate pharmacists, regardless of whether a professional
business entity on behalf of which the person is authorized to act enters into a
collaborative agreement with a pharmacist and his designated alternate
pharmacists.

B. A patient who meets the criteria for inclusion in the category of patients
whose care is subject to a collaborative agreement and who chooses to not
participate in a collaborative procedure shall notify the prescriber of his
refusal to participate in such collaborative procedure. A prescriber may elect
to have a patient not participate in a collaborative procedure by contacting the
pharmacist or his designated alternative pharmacists or by documenting the same
on the patient&#8217;s prescription.

C. Collaborative agreements may include prescribing, modification, continuation,
or discontinuation of drug therapy pursuant to written or electronic protocols,
provided implementation of drug therapy occurs following diagnosis by the
licensed physician, podiatrist, advanced practice registered nurse, registered
nurse, or physician assistant; the ordering of laboratory tests; or other
patient care management measures related to monitoring or improving the outcomes
of drug or device therapy. No such collaborative agreement shall exceed the
scope of practice of the respective parties. Any pharmacist who deviates from or
practices in a manner inconsistent with the terms of a collaborative agreement
shall be in violation of &#xA7; 54.1-2902; such violation shall constitute
grounds for disciplinary action pursuant to &#xA7;&#xA7; 54.1-2400 and
54.1-3316.

D. Collaborative agreements may only be used for conditions which have protocols
that are clinically accepted as the standard of care, or are approved by the
Boards of Medicine and Pharmacy. The Boards of Medicine and Pharmacy shall
jointly develop and promulgate regulations to implement the provisions of this
section and to facilitate the development and implementation of safe and
effective collaborative agreements between the appropriate practitioners and
pharmacists. The regulations shall include guidelines concerning the use of
protocols, and a procedure to allow for the approval or disapproval of specific
protocols by the Boards of Medicine and Pharmacy if review is requested by a
practitioner or pharmacist.

E. Notwithstanding the provisions of &#xA7;&#xA7; 54.1-3303 and 54.1-3408, a
pharmacist may prescribe, modify, continue, or discontinue Schedule II through
VI controlled substances in accordance with this section.

F. Prior to a pharmacist prescribing, modifying, continuing, or discontinuing a
Schedule II through V controlled substance in accordance with this section, the
pharmacist shall submit proof of the signed collaborative practice agreement to
the Board and obtain authorization from the Board for such activity.

HISTORY: 1999, cc. 895, 1011; 2013, c. 192; 2018, c. 776; 2020, cc. 46, 232,
731; 2023, c. 183; 2025, c. 117.