Sec. 10.34.29.06. Therapy Management Contracts

A. A therapy management contract shall be signed by the:

(1) Authorized prescriber or authorized prescribers involved in the management of the patient under a prescriber-pharmacist agreement;

(2) Pharmacist or pharmacists involved in the management of the patient under a prescriber-pharmacist agreement; and

(3) Patient receiving care under the therapy management contract.

B. A therapy management contract shall contain:

(1) A list of allowable substitutions of chemically dissimilar drugs, if any;

(2) A statement that:

(a) None of the parties involved in the therapy management contract have been:

(i) Coerced into participating in the therapy management contract;

(ii) Given economic incentives, excluding normal reimbursement for services rendered; or

(iii) Involuntarily required to participate in the therapy management contract; and

(b) The pharmacist shall notify the authorized prescriber under the terms of the prescriber-pharmacist agreement if the pharmacist:

(i) Modifies the dose or agent under the therapy management contract; or

(ii) Detects an abnormal result from an assessment activity;

(3) Notice to the patient stating:

(a) That the patient may terminate the therapy management contract at any time; and

(b) The procedure by which the patient may terminate the therapy management contract;

(4) A procedure for periodic review by the authorized prescriber of the drugs modified under the prescriber-pharmacist agreement or changed with the consent of the authorized prescriber;

(5) A reference to the protocol or protocols under which the pharmacist shall act; and

(6) Exceptions or limitations to the protocol or protocols for the specific patient.