PharmD · Missouri
Collaborative Drug Therapy Management for Pharmacists in Missouri
Yes, a written agreement with a physician is required before you manage drug therapy. Missouri does not name a specific instrument.
Represents Missouri's Medication Therapy Services (MTS) tier, not ordinary dispensing licensure. Authority is protocol-based (a physician-authored written protocol under § 338.198), not a bilaterally-negotiated collaborative-practice agreement, and NPs/PAs cannot delegate protocol authority to a pharmacist — only a physician can.
What the collaboration must look like
The rules the physician relationship has to follow. Each fact comes from the statute or board rule listed under sources.
Proximity
Not codified — left to the agreement
Supervision ratio
Not codified — no cap on file
Chart review
Not codified — left to the agreement
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Separate prescribing terms required · no controlled-substance authority
Independent (no-protocol) carve-outs: nicotine-replacement products, and FDA-approved vaccine ordering/administration (§ 338.010.1(4), eff. 8/28/2023).
Written agreement
Required
Required for the MTS/protocol tier. Two independent carve-outs need no physician protocol: pharmacists may independently prescribe authorized nicotine-replacement products, and (eff. 8/28/2023) independently order/administer FDA-approved vaccines (§ 338.010.1(4)).
Practice ownership (corporate practice of medicine)
Non-licensee ownership permitted — No pharmacist-ownership requirement identified for pharmacy permits; the pharmacist-in-charge control mechanism sits in the 20 CSR 2220 series
Sources for the supervision rules (2)
What a collaborating physician costs here
Typical monthly cost in Missouri
$500 – $600
Estimate for one Pharmacist. Standard-tier state.
About Missouri's rules
PA/APRN collaboration is governed by nearly-identical §§ 334.104/334.735: a 6-FTE combined ratio cap, 10%/20% chart-review every 14 days, biweekly physician presence, and a 120-hour controlled-substance Rx cap. A pre-2024 numeric 75-mile proximity rule was reportedly rescinded by both boards — current text uses an undefined 'geographic proximity' standard; verify with counsel before relying on any specific mileage figure.
Other clinicians in Missouri: see the state overview.