Collaborative drug therapy management (CDTM) is a form of pharmacy practice in the United States in which a pharmacist initiates, modifies, discontinues or monitors a patient's drug therapy, and orders and interprets related laboratory tests, under the terms of a written agreement with a prescriber, usually a physician. The written instrument that confers the authority is a collaborative practice agreement; CDTM is the practice the agreement authorizes.
CDTM is an expansion of the traditional pharmacist scope of practice rather than a replacement for it. A pharmacist needs no agreement to perform the services already within that scope, among them medication therapy management, immunization, public health screening, patient counseling and recommending a change of therapy to the prescriber. What the agreement adds is the authority to act on a drug-related problem directly instead of referring it back to the prescriber.
Because the pharmacist's authority derives from state law, the scope and even the name of CDTM differ from one jurisdiction to the next. Most states authorize it by statute or board rule; a few leave it unregulated, in which case pharmacists act as agents of the prescriber.
Terminology The term was coined by the pharmacy editor William A. Zellmer in a 1995 editorial in the American Journal of Health-System Pharmacy. Zellmer argued for it in preference to prescribing, on the grounds that it would be more acceptable to legislators and to physician organizations and that it described more accurately what pharmacists were seeking: a way to resolve drug-related problems as part of a care team. According to the healthcare researcher Karen E. Koch, the modern language of collaborative practice was adopted in part to avoid the contested term dependent prescribing authority.
CDTM is also described as clinical pharmacy services, pharmaceutical care, disease state management or comprehensive medication management, though these terms are broader and cover work that needs no agreement. The agreement itself attracts as many names as the practice: consult agreement, collaborative pharmacy practice agreement, physician-pharmacist agreement, standing order, protocol and physician delegation all appear in state law. A 2026 survey of the 50 states, the District of Columbia and Puerto Rico recorded a distinct statutory or regulatory name for the pharmacist instrument in almost every jurisdiction that authorizes one. Among them are the CDTM agreement of Alabama and Maine, the collaborative drug therapy management framework of New York, the consult agreement of Ohio, the drug therapy modification protocol of Georgia, the collaborative drug therapy management order set of Louisiana, the prescriber-pharmacist agreement of Maryland and the written protocol of Texas, Alaska, Mississippi and New Jersey.
Scope Within the traditional scope of practice a pharmacist may detect a drug-related problem and recommend a solution to the prescriber. Under CDTM the pharmacist resolves it directly, within limits the agreement sets. The activities commonly authorized are selecting and initiating a medication for a diagnosed condition, discontinuing a prescription or over-the-counter medication, modifying a regimen by changing its strength, frequency, route or duration, ordering and interpreting laboratory tests to evaluate the patient's response, and continuing therapy by issuing a new prescription. Some agreements also cover administering medications, particularly those given parenterally, such as long-acting injectable antipsychotics.
An agreement is usually written for a defined patient population, a clinical situation or a disease state, and may incorporate an evidence-based protocol for managing the regimen. Its terms are settled between the pharmacist and the prescriber within whatever the state permits.
Legal authority Authority for CDTM is granted state by state. Washington was the first state to provide for it, amending its pharmacy practice requirements in 1979 to allow "collaborative drug therapy agreements". The federal government recognized the arrangement in 1995. By 2016, 48 states and the District of Columbia had authorized it, and Alabama followed in 2022, when the Alabama Pharmacy Collaborative Practice Act took effect alongside a board rule requiring each agreement to be approved by both the pharmacy and the medical board.
The year each of the 50 states first authorized the arrangement, and the year of any later revision, is listed below. Unregulated marks a state that has no specific statutory framework, in which pharmacists may nonetheless perform the same activities as agents of the prescriber; not approved marks one where the arrangement has no legal basis.
State Year authorized Alabama 2022 Alaska 2002 Arizona 2000 Arkansas 1997 California 1981, 2002 Colorado 2007, 2016 Connecticut 2002 Delaware Not approved Florida 1986, 1997 Georgia 2000 Hawaii 1997, 2002 Idaho 1998 Illinois Unregulated Indiana 1996, 2011 Iowa 1996 Kansas 1996, 2014 Kentucky 1996 Louisiana 1999 Maine 2013 Maryland 2002 Massachusetts 2009 Michigan 1991 Minnesota 1998 Mississippi 1987 Missouri 2012 Montana 2001 Nebraska 1998 Nevada 1990 New Hampshire 2006 New Jersey 2004 New Mexico 1993, 2002 New York 2011 North Carolina 1999 North Dakota 1995, 2001 Ohio 1999 Oklahoma Unregulated Oregon 1980 Pennsylvania 2002 Rhode Island 2001 South Carolina 1998 South Dakota 1993 Tennessee 2014 Texas 1995 Utah 2001 Vermont 1992 Virginia 1999, 2013 Washington 1979 West Virginia 2008 Wisconsin 2000 Wyoming 1999 Variation by state States differ in what they call the arrangement, who may be a party to it, what the pharmacist may do under it and how often it must be renewed. Arizona regulates CDTM as a "drug therapy management protocol", Arkansas as "disease state management", Florida as a "prescriber care plan", Idaho as "collaborative pharmacy practice", and Hawaii as a policy, procedure or protocol. Some states confine the prescriber side to a single named physician, while Colorado, Minnesota and Mississippi allow an agreement among several pharmacists and several prescribers; Hawaii and Minnesota count advanced practice nurses among the prescribers who may be a party.
Conditions attached to the agreement vary as widely. North Dakota confines CDTM to institutional settings and never permits the modification of Schedule II controlled substances. Georgia requires the agreement to name the patients, disease states, medication classes and dose ranges it covers, and to be renewed every two years. Mississippi requires a pharmacist to complete sixteen hours of continuing education before practicing under an agreement. Idaho requires annual renewal. Illinois and Michigan have no CDTM statute of their own; pharmacists in those states perform the same activities as agents of the prescriber. In Michigan that agency is documented in a delegation agreement between the pharmacist and the delegating physician, a signed copy of which is kept at the practice site; Illinois instead works through statewide standing orders issued by statute or by the state regulator, which name no collaborating physician.
The name a state uses is a weak guide to what it permits. Jurisdictions whose instrument is not called a collaborative practice agreement often authorize the same activities as those whose instrument is, and written protocol names the pharmacist instrument in some states and the nurse practitioner instrument in others.
A few states have created a designated credential rather than relying on the agreement alone. New Mexico's Pharmacist Prescriptive Authority Act of 1993 recognizes an advanced practitioner designated a "pharmacist clinician", and North Carolina created the "clinical pharmacist practitioner" in 1999.
The 2026 survey recorded, for each jurisdiction, the name of the pharmacist instrument, whether a written agreement is required at all, whether the instrument may reach controlled substances and how often the parties must meet. Three further conditions proved almost uniform across the 52: no jurisdiction caps the number of pharmacists one prescriber may enter agreements with; physical proximity is unaddressed in 48, Louisiana and New York requiring the prescriber to be on site and Indiana and Texas expressly allowing the parties to be remote; and a chart-review obligation is codified in only two, Massachusetts and New Jersey, both of which leave the proportion of charts to the agreement itself.