Sec. 10.34.29.03. Content of Prescriber-Pharmacist Agreement

A. The prescriber-pharmacist agreement shall contain the following:

(1) The names and signatures of the physicians, podiatrists, or certified advanced practice nurses with prescriptive authority and pharmacists authorized to act under a therapy management contract;

(2) The locations where the pharmacists may provide therapy management services;

(3) The titles of the protocols to which the prescriber-pharmacist agreement pertains;

(4) The methods and time frames by which documentation and routine communication will occur between the physicians, podiatrists, or certified advanced practice nurses with prescriptive authority and the pharmacists, including the time frames in which the pharmacist will fully update the patient’s record in writing;

(5) The name, address, and telephone number of the party to the prescriber-pharmacist agreement who is to receive correspondence from the Boards related to the prescriber-pharmacist agreement;

(6) A statement that the physicians, podiatrists, or certified advanced practice nurses with prescriptive authority and pharmacists shall comply with all State and federal laws relating to patient confidentiality; and

(7) A list of devices available to the pharmacists performing under the prescriber-pharmacist agreement, which are relevant to the disease-states or conditions to be managed.

B. Technical modifications to the prescriber-pharmacist agreement shall be registered with the Board of Pharmacy within 30 days of the technical modification.

C. The party designated as the contact person to receive correspondence from the Boards shall ensure that the parties to the prescriber-pharmacist agreement are notified in a timely manner of the information received from the Boards.

D. If the contact information for the party to the agreement designated to receive correspondence from the Boards changes, the designee shall notify the Boards of the change within 30 days of the change.