GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
S D
SENATE BILL DRS45186-NB-17
Short Title: Pharmacists/Collaborative Practice. (Public)
Sponsors: Senators Sawrey, Hise, and Galey (Primary Sponsors).
Referred to:
*DRS45186 -NB-17*
A BILL TO BE ENTITLED 1
AN ACT TO MODERNIZE AND EXPAND PHYSICIAN -PHARMACIST 2
COLLABORATIVE PRACTICE. 3
The General Assembly of North Carolina enacts: 4
SECTION 1.(a) G.S. 90-18(c)(3a) reads as rewritten: 5
"(3a) The provision of drug therapy management by a licensed pharmacist engaged 6
in the practice of pharmacy pursuant to an agreement that is physician, 7
pharmacist, patient, and disease specific when health care services by a 8
licensed pharmacist under a collaborative practice agreement with one or 9
more physicians shall be performed in accordance with rules and rules 10
developed by a joint subcommittee of the North Carolina Medical Board and 11
the North Carolina Board of Pharmacy and approved by both Boards. Drug 12
therapy management shall be defined as: (i) the implementation of 13
predetermined drug therapy which includes diagnosis and product selection 14
by the patient's physician; (ii) modification of prescribed drug dosages, dosage 15
forms, and dosage schedules; and (iii) ordering tests; (i), (ii), and (iii) shall be 16
pursuant to an agreement that is physician, pharmacist, patient, and disease 17
specific.For the purposes of this subdivision, "health care services" means 18
medical tasks, acts, or functions authorized through a written agreement by a 19
physician and delegated to a pharmacist for the purpose of providing drug 20
therapy, disease, or population health management for patients." 21
SECTION 1.(b) G.S. 90-18.4 reads as rewritten: 22
"§ 90-18.4. Limitations on clinical pharmacist practitioners. 23
(a) Any pharmacist who is approved under the provisions of G.S. 90-18(c)(3a) to perform 24
medical acts, tasks, and functions may use the title "clinical pharmacist practitioner". Any other 25
person who uses the title in any form or holds himself or herself out to be a clinical pharmacist 26
practitioner or to be so licensed shall be deemed to be in violation of this Article. 27
(b) Clinical pharmacist practitioners are authorized to implement predetermined drug 28
therapy, which includes diagnosis and product selection by the patient's physician, modify 29
prescribed drug dosages, dosage forms, and dosage schedules, and to order laboratory tests 30
pursuant to a drug therapy management agreement that is physician, pharmacist, patient, and 31
disease specific by physicians to provide health care services in accordance with 32
G.S. 90-18(c)(3a) and subsection (e) of this section under the following conditions: 33
(1) The North Carolina Medical Board and the North Carolina Board of Pharmacy 34
have adopted rules developed by a joint subcommittee governing the approval 35
of individual clinical pharmacist practitioners to practice drug therapy 36
FILED SENATE
Mar 20, 2025
S.B. 357
PRINCIPAL CLERK General Assembly Of North Carolina Session 2025
Page 2 DRS45186-NB-17
management health care services with such limitations that the Boards 1
determine to be in the best interest of patient health and safety. 2
(2) The clinical pharmacist practitioner has current approval from both Boards. 3
(3) The North Carolina Medical Board has assigned an identification number to 4
the clinical pharmacist practitioner which is shown on written prescriptions 5
written by the clinical pharmacist practitioner. 6
(4) The drug therapy management agreement prohibits the substitution of a 7
chemically dissimilar drug product by the pharmacist for the product 8
prescribed by the physician without the explicit consent of the physician and 9
includes a policy for periodic review by the physician of the drugs modified 10
pursuant to the agreement or changed with the consent of the physician. 11
(c) Clinical pharmacist practitioners in hospitals and other health facilities that have an 12
established pharmacy and therapeutics committee or similar group that determines the 13
prescription drug formulary or other list of drugs to be utilized in the facility and determines 14
procedures to be followed when considering a drug for inclusion on the formulary and procedures 15
to acquire a nonformulary drug for a patient may order medications and tests under the following 16
conditions: 17
(1) The North Carolina Medical Board and the North Carolina Board of Pharmacy 18
have adopted rules governing the approval of individual clinical pharmacist 19
practitioners to order medications and tests with such limitations as the Boards 20
determine to be in the best interest of patient health and safety. 21
(2) The clinical pharmacist practitioner has current approval from both Boards. 22
(3) The supervising physician has provided to the clinical pharmacist practitioner 23
written instructions for ordering, changing, or substituting drugs, or ordering 24
tests with provision for review of the order by the physician within a 25
reasonable time, as determined by the Boards, after the medication or tests are 26
ordered. 27
(4) The hospital or health facility has adopted a written policy, approved by the 28
medical staff after consultation with nursing administrators, concerning the 29
ordering of medications and tests, including procedures for verification of the 30
clinical pharmacist practitioner's orders by nurses and other facility employees 31
and such other procedures that are in the best interest of patient health and 32
safety. 33
(5)(c1) Any drug therapy order written by a clinical pharmacist practitioner or order for 34
medications or tests medications, tests, or devices shall be deemed to have been authorized by 35
the physician approved by the Boards as the supervisor of the clinical pharmacist practitioner and 36
the supervising physician shall be responsible for authorizing the prescription order. 37
(c2) Institutional and group practices may implement a site-specific, multi-provider 38
collaborative practice agreement for the care of their patients. The institution or group practice 39
must develop a policy for oversight, and the clinical pharmacist practitioners engaged in the 40
agreement must be evaluated by an appointed supervising physician. 41
(d) Any registered nurse or nurse, licensed practical nurse nurse, or pharmacist who 42
receives a drug therapy therapy, laboratory test, or device order from a clinical pharmacist 43
practitioner for medications or tests is authorized to perform that order in the same manner as if 44
the order was received from a licensed physician. 45
(e) The following requirements apply to clinical pharmacist practitioners and supervising 46
physicians engaging in collaborative practice: 47
(1) A clinical pharmacist practitioner shall have a site-specific supervising 48
physician. 49
(2) The supervising physician shall conduct periodic review and evaluation of the 50
health care services provided by the clinical pharmacist practitioner. 51 General Assembly Of North Carolina Session 2025
DRS45186-NB-17 Page 3
(3) A physician may collaborate with any number of clinical pharmacist 1
practitioners, but when acting as the supervising physician, they shall 2
supervise as many clinical pharmacist practitioners as the supervising 3
physician deems can be safely and effectively supervised. 4
(4) Health care services delegated by a supervising physician, such as initiating, 5
changing, or discontinuing drugs, or ordering tests or devices, to assist with 6
drug therapy, disease, or population health management, must be included in 7
the written agreement between the supervising physician and the clinical 8
pharmacist practitioner. 9
(5) A supervising physician may include a "statement of authorization" in the 10
written agreement to allow the clinical pharmacist practitioner to conduct drug 11
substitutions within the same therapeutic class or for biosimilar medications 12
based upon the health plan's drug formulary for a patient. The clinical 13
pharmacist practitioner shall document and notify the patient's physician of 14
any substitutions made. 15
(6) Supervising physicians may add other advanced practice providers that they 16
supervise to their collaborative practice agreement with a clinical pharmacist 17
practitioner. The evaluation and supervision of the clinical pharmacist 18
practitioner shall remain with the supervising physician. 19
(f) The health care setting location for the provision of health care services by the clinical 20
pharmacist practitioner may be fully or partially embedded for a site-specific practice. The setting 21
location shall be determined by the supervising physician and included in the site-specific 22
collaborative practice agreement." 23
SECTION 1.(c) G.S. 90-85.3(b2) reads as rewritten: 24
"(b2) "Clinical pharmacist practitioner" means a licensed pharmacist who meets the 25
guidelines and criteria for such title established by the joint subcommittee of the North Carolina 26
Medical Board and the North Carolina Board of Pharmacy and is authorized to enter into perform 27
medical acts, tasks, and functions for drug therapy therapy, disease, or population health 28
management agreements with physicians in accordance with the provisions of G.S. 90-18.4." 29
SECTION 2.(a) Part 7 of Article 50 of Chapter 58 of the General Statutes is amended 30
by adding a new section to read: 31
"§ 58-50-296. Pharmacist credentialing. 32
Insurers offering a health benefit plan that delegates credentialing agreements or 33
requirements for pharmacists licensed under Article 4A of Chapter 90 of the General Statutes or 34
the relevant laws of another state to a contracted healthcare facility shall accept the credentialing 35
for all pharmacists employed by, or contracted with, those healthcare facilities." 36
SECTION 2.(b) Article 3 of Chapter 58 of the General Statutes is amended by 37
adding a new section to read: 38
"§ 58-3-241. Healthcare services provided by pharmacists. 39
(a) The following definitions apply in this section: 40
(1) Healthcare services. – Any of the following health or medical procedures or 41
services rendered by a healthcare provider: 42
a. Testing, diagnosis, or treatment of a health condition, illness, injury, 43
or disease. This includes testing, diagnosis, or treatment rendered by a 44
pharmacist acting within the pharmacist's scope of practice. 45
b. Dispensing of drugs, medical devices, medical appliances, or medical 46
goods for the treatment of a health condition, illness, injury, or disease. 47
c. Administration of a vaccine or medication. 48
(2) Pharmacist. – An individual licensed to practice pharmacy under Article 4A 49
of Chapter 90 of the General Statutes or the relevant laws of another state. 50 General Assembly Of North Carolina Session 2025
Page 4 DRS45186-NB-17
(b) A health benefit plan offered by an insurer in this State shall cover healthcare services 1
provided by a pharmacist if all of the following conditions are met: 2
(1) The service or procedure was performed within the pharmacist's licensed 3
lawful scope of practice. 4
(2) The health benefit plan would have covered the service if the service or 5
procedure had been performed by another healthcare provider. 6
(c) The participation of a pharmacy in a drug benefit provider network of a health benefit 7
plan shall not satisfy any requirement that insurers offering health benefit plans include 8
pharmacists in medical benefit provider networks." 9
SECTION 2.(c) G.S. 58-56-26 is amended by adding a new subsection to read: 10
"(e) Notwithstanding any provision of this Article to the contrary, all requirements relating 11
to the coverage of prescription drugs and pharmacy services under this Chapter applicable to 12
health benefit plans are applicable to a third-party administrator in the same way they are 13
applicable to an insurer." 14
SECTION 2.(d) Article 56A of Chapter 58 of the General Statutes is amended by 15
adding a new section to read: 16
"§ 58-56A-55. Health benefit plan requirements applicable. 17
All requirements relating to the coverage of prescription drugs and pharmacy services under 18
this Chapter applicable to health benefit plans are applicable to a pharmacy benefits manager in 19
the same way they are applicable to an insurer." 20
SECTION 2.(e) This section becomes effective October 1, 2025, and applies to 21
contracts entered into, renewed, or amended on or after that date. 22
SECTION 3.(a) The North Carolina Medical Board and the North Carolina Board 23
of Pharmacy may adopt temporary rules to implement the provisions of this act. 24
SECTION 3.(b) This section is effective when it becomes law. 25
SECTION 4. Except as otherwise provided, this act becomes effective October 1, 26
2025. 27