Missouri's Medication Therapy Services

What are medication therapy services?

Missouri’s Rule 20 CSR 2220-6.060(1)(F)1 defines “medication therapy services” as “the designing, initiating, implementing, or monitoring of a plan to monitor the medication therapy or device usage of a specific patient, or to enhance medication therapeutic outcomes of a specific patient, by a pharmacist who has authority to initiate or implement a modification of the patient’s medication therapy or device usage pursuant to a medication therapy protocol.”

Missouri’s Medication Therapy (MT) services rule was a joint effort of the Missouri Pharmacy Association (MPA) and Missouri Medical Association (MMA), signed into law by Governor Matt Blunt in 2007.  The rules and regulations were effective August 31, 2012.

What is required to perform 
MT services?

Pharmacists must hold a certificate of medication therapeutic authority (MT certificate) issued by the Board of Pharmacy (Board). To receive an MT certificate, pharmacists must have a current and active Missouri pharmacist license and must hold, or have completed, one of the following:

  • A PharmD degree from an ACPE accredited school; OR
  • A post-graduate medication therapy certificate course or program accredited or granted by ACPE, ASHP, ASCP, or APhA; OR
  • A current certification from the Board of Pharmaceutical Specialties, the Commission for Certification in Geriatric Pharmacy, or the National Certification Board for Diabetes Educators; OR
  • A qualifying post-graduate medication therapy certificate course.

When will the Board issue certificates?

  • The rules became effective on August 30, 2012, and the Board is currently issuing certificates.
  • Applications and complete MT services information is available online at http://pr.mo.gov/pharmacists-forms.asp.
  • There is a $50 application fee with 1-2 weeks processing time.
  • Once approved, the Board will reissue your current pharmacist license with “Medication Therapy Services” designated on the license. This designation officially authorizes a pharmacist to perform MT services as defined by the rule.
  • MT certificates will be renewed biennially at the same time as your Missouri pharmacist license. Six hours of your CE must concern medication therapy management.

Additional Facts:

  • An MT certificate from the Board is required to initiate, alter or modify medication therapy.
  • Pharmacists with an MT certificate can only perform MT services under a protocol with a Missouri licensed physician. This is NOT prescriptive authority!
  • Pharmacists cannot initiate, alter or modify any controlled substance prescription.
  • Pharmacists cannot diagnose or perform any activity that might be deemed the practice of medicine.  This is reserved for duly licensed physicians.
  • MT services may not be delegated to someone who does not hold an MT certificate.

Is Medication Therapy Protocol required?

Prior to performing MT services, pharmacists must have a written protocol with a Missouri licensed physician who is actively practicing medicine in the state of Missouri and whose practice location is no more than fifty (50) miles by road from the pharmacist.

The Board does not have a format or any recommended protocols. However, protocols should clearly delineate the pharmacist’s scope of authority.  Refer to the Board Compliance Guide.

The STLCOP and UMKC certification programs provide sample templates. When you attend the onsite program, the Board requirements and sample templates will be discussed.

Examples of MT services protocol scenarios include, but are not limited to:

  • Adjusting medication doses, ordering laboratory tests, and educating patients in an anticoagulation clinic.
  • Administering vaccines beyond those covered by routine vaccine protocol rules and regulations.
  • Managing intravenous infusions in a home health care agency.
  • Providing direct patient care for chronic diseases in a community pharmacy.

Next Steps

  1. Review information and guidance provided by the Board.
  2. Obtain MT certificate, issued by the Board.
  3. Refer to the Board Compliance Guide.
  4. Watch the “2012 Regulatory and Legislative Update” Board video.
  5. Decide what protocol would be best to start with and approach a physician/physician group with whom you have a strong relationship.
  6. Write a protocol, or modify a template protocol, addressing the therapeutic area you want to address. (Certification programs such as STLCOP’s or UMKC’s provide a template.)
  7. Start with something easy and gain experience, then expand.
  8. Collect results to justify expansion/continuation of MT services.
  9. Visit the Missouri Board of Pharmacy for complete information.
  10. Consult with your attorney and insurance agent regarding liability insurance coverage.