Protocol · PharmD · Missouri
Practice Protocol for Pharmacists in Missouri
Missouri does not define a named protocol for Pharmacists. Here is what the state does require and what a written protocol usually covers.
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 a Pharmacist protocol must contain in Missouri
Missouri requires a written protocol but gives it no statutory name. Governed by the Missouri Board of Pharmacy. Each numbered item is a requirement the protocol must satisfy.
Missouri does not have a statute establishing a physician-pharmacist "Collaborative Practice Arrangement" analogous to the Collaborative Practice Arrangement required of Nurse Practitioners and Physician Assistants under Chapter 334. The Pharmacist instead practices under the Missouri Pharmacy Practice Act, which permits a pharmacist to administer drugs and biologicals pursuant to a physician's order, standing order, or protocol.
Source: Mo. Rev. Stat. § 338.010
Where the Pharmacist participates in dispensing or administering medications under a Collaborative Practice Arrangement between the Physician and a Nurse Practitioner or Physician Assistant, that participation is governed by § 338.198. This Agreement's terms regarding the Pharmacist accordingly define the working relationship between the Parties and are not themselves required by Missouri law as a condition of the Pharmacist's authority to practice under the Pharmacist's own Board of Pharmacy license.
Source: Mo. Rev. Stat. § 338.198
- The protocol also carries 1 education, 1 registration and 1 authority clauses, authored in the document itself.
Statutes and rules these clauses cite
- Mo. Rev. Stat. § 338.010statute
Definition of the practice of pharmacy, including administration of drugs pursuant to a physician's order, standing order, or protocol.
- Mo. Rev. Stat. § 338.198statute
Pharmacist participation in dispensing/administering medications under a Nurse Practitioner's or Physician Assistant's Collaborative Practice Arrangement.
Terms it has to carry
Ratio, proximity, chart review, meeting and prescribing terms the protocol has to carry, from Missouri's supervision rules.
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)
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.