MTM Collaborative Practice Agreements 3 — Questions and Answers
Question 1: A pharmacist working under a CPA in a diabetes clinic wants to start insulin therapy for a newly diagnosed patient. The CPA covers 'glucose-lowering medication initiation.' What should the pharmacist verify first?
- Whether insulin is cheaper than oral agents
- That the patient meets the inclusion criteria specified in the CPA (Correct answer)
- That the physician is present in the building
- That the patient has already tried metformin for at least 5 years
Correct answer: That the patient meets the inclusion criteria specified in the CPA
Before acting under a CPA, the pharmacist must confirm the patient meets the CPA's defined inclusion criteria.
Question 2: In which care setting have CPAs historically been LEAST utilized?
- Ambulatory care clinics
- Hospital inpatient units
- Community independent pharmacies (Correct answer)
- Veterans Affairs (VA) facilities
Correct answer: Community independent pharmacies
Community independent pharmacies have historically had the lowest CPA utilization, often due to lack of physician relationships and reimbursement barriers.
Question 3: When documenting a pharmacist intervention made under a CPA, which is the MOST important piece of information to record?
- The brand name of every drug the patient takes
- Clinical rationale for the action taken and the outcome (Correct answer)
- The pharmacist's license expiration date
- The patient's insurance copay amount
Correct answer: Clinical rationale for the action taken and the outcome
Clinical rationale and outcomes documentation demonstrates that the pharmacist acted within the CPA scope and supports continuity of care.
Question 4: A state pharmacy board is considering expanding CPA authority. Which argument BEST supports this expansion?
- Pharmacists will replace physicians in all clinical roles
- CPAs improve medication adherence, outcomes, and healthcare access (Correct answer)
- CPAs eliminate the need for patient consent
- Expanded CPAs reduce pharmacist liability entirely
Correct answer: CPAs improve medication adherence, outcomes, and healthcare access
Evidence shows CPAs improve medication adherence, clinical outcomes, and access to care, especially in underserved areas.
Question 5: Which of the following would be OUTSIDE the scope of a standard CPA for a clinical pharmacist?
- Monitoring lab values related to drug therapy
- Ordering a drug level (pharmacokinetic monitoring)
- Diagnosing hypertension de novo without physician input (Correct answer)
- Adjusting antihypertensive doses per protocol
Correct answer: Diagnosing hypertension de novo without physician input
Diagnosis of a new condition is a physician function and is excluded from pharmacist scope even under a CPA.
Question 6: A pharmacist declines to treat a patient because the patient's condition is not listed in the CPA. This is an example of:
- Negligence
- Practicing within authorized scope (Correct answer)
- Breach of the CPA
- Unauthorized practice of medicine
Correct answer: Practicing within authorized scope
Refusing to act outside the CPA's defined scope demonstrates appropriate adherence to authorized boundaries.
Question 7: What is the pharmacist's obligation if a patient covered by a CPA experiences an adverse drug reaction requiring urgent medical attention?
- Continue therapy and document the reaction next visit
- Immediately notify the collaborating physician and provide appropriate first response (Correct answer)
- Terminate the CPA immediately
- Consult only the pharmacy board before taking action
Correct answer: Immediately notify the collaborating physician and provide appropriate first response
Patient safety requires immediate physician notification and appropriate response to adverse events under any CPA.
MTM Collaborative Practice Agreements 3
A pharmacist working under a CPA in a diabetes clinic wants to start insulin therapy for a newly diagnosed patient.
The CPA covers 'glucose-lowering medication initiation.' What should the pharmacist verify first?