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Two More States Enact CDTM Laws

Donna Young

Pennsylvania and Hawaii are the latest states to enact laws allowing pharmacists to practice a broader range of pharmaceutical care under agreements with physicians and other health care professionals. As of August 1, 39 states have collaborative drug therapy management (CDTM) laws.

Pennsylvania’s law, signed by Governor Mark Schweiker (R) on June 29, gives pharmacists in institutional settings the authority to adjust the dosage or route of administration of a prescribed medication and to order related laboratory or diagnostic tests under a protocol established by the facility’s pharmacy and therapeutics (P&T) committee and the patient’s physician. Pharmacists involved in CDTM must have enough professional liability insurance to cover a claim of $1 million.

Hawaii’s legislation, signed into law by Governor Benjamin Cayetano (D) on July 5, has broadened the existing CDTM law, which previously pertained only to pharmacists in acute care facilities, to cover pharmacists practicing in all settings, including community pharmacies.

Both states’ laws give pharmacists who have met the practice guidelines set by their respective state board of pharmacy and completed training programs approved by the American Council on Pharmaceutical Education the authority to administer medications, including injectable drugs and vaccines, to adults.

A six-year effort in Pennsylvania. Robert Patti, clinical coordinator for Wellspan Health in York, Pennsylvania, said pharmacists in his state who intend to administer drugs must complete at least two hours of continuing education specifically on medication and vaccine administration and must maintain a cardiopulmonary resuscitation certificate from a program approved by the board of pharmacy.

Patti has served for eight years as legislative chair for the Pennsylvania Society of Health-System Pharmacists. It took six years, he said, to get CDTM legislation passed in his state.

Representatives from Pennsylvania’s pharmacy community, including statewide associations and the deans of the state’s six pharmacy schools, helped construct the legislation, Patti said.

"The process brought the pharmacy community together in a manner not previously seen because we had a common objective," he said.

Representative Bob Allen (R-Pottsville) and Senator James J. Rhoades (R-Mahanoy City) were strong supporters of the legislation and introduced it into the House and Senate, respectively, Patti said. When Pennsylvania’s medical community opposed the legislation, he added, Representative Mario J. Civera Jr. (R-Upper Darby) stepped in to negotiate. The medical community dropped its opposition after a series of meetings.

Expansion in Hawaii. Jerry Smead, pharmaceutical services manager for Kaiser Permanente in Kailua, Hawaii, and governmental affairs committee chair for the Hawaii Pharmacists Association (HPA), said his state’s CDTM bill faced opposition from the state board of medical examiners and a local medical association.

"Our largest barrier was that most people didn’t understand what pharmacists do," he said. "Most people see us as only putting pills in a bottle and don’t understand why we should be involved in drug therapy."

But after a group of Kaiser pharmacists and HPA representatives met with the opposing groups to "educate them about pharmacy training and a pharmacist’s expertise about medications," Smead said, "things went much more smoothly" with the bill’s passage.

Representative Marilyn Lee (D-Mililani), a nursing supervisor at Wahiawa General Hospital in Wahiawa, and Senator David Matsuura (D-South Hilo), whose mother is a pediatrician, supported the bill and helped move it through the legislative process, Smead said.

Ron Taniguchi, a member of HPA’s governmental affairs committee, credits his boss, Kaiser Pharmaceuticals Services Director Barbara Kashiwabara, with organizing efforts to get the bill passed.

"The bill changed quite a bit as it moved along through the various [legislative] committees, and it took a lot of work to make sure the right passages were in there," he said. "Barbara did most of the organizing work with the lobbyists and a lot of the work putting the language into the bill."

Now that Hawaii’s CDTM law applies to all pharmacists in the state, regardless of practice setting, the next challenge is executing the bill’s objectives, said Taniguchi.

"There is no ready-made template of how the protocol should be structured," he said.

Most hospitals and health systems have P&T committees that establish agreements between physicians and pharmacists. But Taniguchi expects pharmacists who practice in a community pharmacy to have a more difficult time implementing CDTM because they may have to seek relationships with physicians.

"It’s not impossible," he said. "But whatever success [community pharmacists] had in communicating with physicians before, all of that is now going to come to bear, and they will know whether they have cultivated good relationships or not."