Practice Protocol
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Protocol · PharmD · North Dakota

Practice Protocol for Pharmacists in North Dakota

Recognized but not required in every case. North Dakota law names the instrument a Collaborative Practice Agreement, and the clinical protocol is the content that instrument carries. Below: the board that governs it, what it contains when one is used, and the supervision rules that apply either way.

Practice authorityConditional independence
Written agreementNo agreement required
What North Dakota calls itCollaborative Practice Agreement
Governing boardNorth Dakota State Board of Pharmacy
Agreement familyCollaborative Practice
Research date2026-09-03 · clauses 2026-09-03

Uniquely tiered: § 43-15-31.6 grants pharmacists real independent prescribing for an enumerated list of conditions/devices with no physician agreement, while broader drug-therapy initiation/modification outside that list requires the written collaborative agreement under § 43-15-31.4 — see agreementRequiredNote.

Independent practice requires: prescribing only from the specific statutory list of conditions/devices under N.D. Cent. Code § 43-15-31.6 (lice, cold sores, motion sickness, hypoglycemia, influenza/strep/COVID-19 after a positive point-of-care test, PEP, travel medicine after CE, emergency epinephrine/diphenhydramine, Lyme prophylaxis, certain devices) — this tier needs no physician agreement at all.

What a North Dakota Collaborative Practice Agreement contains when one is required

Not every Pharmacist in North Dakota needs one; the conditions are under "Written agreement" below. When one is required, these are its clauses. The North Dakota State Board of Pharmacy governs pharmacists here.

  1. North Dakota permits the Pharmacist ("Pharmacist") to practice under a collaborative practice agreement with the Physician, on a form approved by the North Dakota State Board of Pharmacy and the North Dakota Board of Medicine, which authorizes the Pharmacist to initiate or modify the patient's drug therapy within the scope described in the agreement. Absent such an agreement, the Pharmacist may practice under the Pharmacist's own pharmacist license but may not initiate or modify a patient's drug therapy on the Physician's behalf.

    Source: N.D.C.C. § 43-15-31.4

  2. A copy of the collaborative practice agreement, and any subsequent amendment approved by the boards, shall remain on file with the North Dakota State Board of Pharmacy and the North Dakota Board of Medicine.

  3. The Collaborative Practice Agreement also carries 1 scope, 1 education, 1 registration and 1 authority clauses, authored in the document itself.

Statutes and rules these clauses cite

  1. N.D.C.C. § 43-15-31.4statute

    Authorizes a pharmacist to initiate or modify a patient's drug therapy under a collaborative practice agreement with a practitioner.

North Dakota's supervision rules

Ratio, proximity, chart review, meeting and prescribing rules for pharmacists, and the conditions under which a written protocol becomes required.

Proximity

Not codified

Supervision ratio

Not codified — no cap on file

Chart review

Not codified

Meeting cadence

Not codified

Prescriptive authority

collaborative-agreement tier (drug therapy initiation/modification beyond the independent list): Separate prescribing terms required · no controlled-substance authority

Requires shared access to the patient's medical record and immediate notification of the collaborating physician/APRN whenever the pharmacist initiates or modifies drug therapy (§ 43-15-31.4(5)). No controlled-substance authority found under this tier.

independent statutory list (§ 43-15-31.6): No agreement needed to prescribe · no controlled-substance authority

Limited to the enumerated conditions/devices in § 43-15-31.6; requires a bona fide patient-pharmacist relationship, a maintained assessment protocol, and notifying the patient's PCP within 3 business days. Therapeutic substitution (§ 43-15-31.7) is separately authorized but expressly EXCLUDES Schedule II controlled substances, antidepressants, antipsychotics, chemotherapy agents, biologics, and narrow-therapeutic-index drugs.

Written agreement

Not required

False reflects the § 43-15-31.6 independent-list tier, which needs no agreement. Broader prescriptive practice — initiating/modifying drug therapy outside that enumerated list — requires a written collaborative agreement with a physician or APRN under § 43-15-31.4, executed either individually or via a medical-director/pharmacist-in-charge umbrella agreement covering multiple providers.

Practice ownership (corporate practice of medicine)

Non-licensee ownership permitted

Sources for the supervision rules (4)
  • N.D. Cent. Code § 43-15-31.4 — Limited prescriptive practices under collaborative agreement
  • N.D. Cent. Code § 43-15-31.5 — Drug administration authority
  • N.D. Cent. Code § 43-15-31.6 — Independent statutory prescriptive authority
  • N.D. Cent. Code § 43-15-31.7 — Therapeutic substitution
How the relationship works day to day
Who has to be where, how often you meet, and what the physician costs: Pharmacist in North Dakota on collaborativeagreement.com.

About North Dakota's rules

H.B. 1175 (2019, eff. 2020) and a 2022 rule amendment repealed ND's old PA supervision-contract/ratio/countersignature model — PAs are now CONDITIONAL only below 4,000 practice hours or outside a qualifying facility. All four APRN roles (NP, CRNA, CNM, CNS) are FULL independent practice with no collaboration agreement of any kind.

Other clinicians in North Dakota: see the state overview.