The pharmacy field is growing nationally and in Wisconsin, providing various opportunities and roles for pharmacists to expand their scope of practice.

This article provides a brief overview of the licensure requirements in Wisconsin for pharmacists to help attorneys advise pharmacists regarding their continuing education requirements, duties, and scope of practice. It also discusses how collaborative practice agreements and standing orders can impact pharmacists’ scope of practice.

Pharmacist Licensing and Duties

Pharmacists must meet certain criteria to obtain licensure in Wisconsin:

• graduate from a board-approved pharmacy school or obtain a certification from the Foreign Pharmacy Graduate Examination Committee;

• successfully complete a pharmacy practice internship;

• pass the North American Pharmacist Licensure (NAPLEX) and Multistate Pharmacy Jurisprudence Examination (MPJE); and

• pay the applicable fees.¹

Pharmacists must complete 30 hours of continuing education every two years to maintain licensure compliance.² The continuing education requirement is waived for the first renewal period.

Pharmacist duties include but are not limited to:

• drug utilization reviews;

• patient counseling on new and renewed prescriptions;

• verification of medications;

• compounding;

• transfer of prescriptions; and

• receiving electronic or oral prescriptions.³

Pharmacists must meet a standard of professional conduct to avoid possible disciplinary action. Wisconsin law defines what constitutes “unprofessional conduct,” which includes:

• falsifying medical records;

• dispensing a prescription that the pharmacist should have known would harm the patient;

• violating HIPAA;

• practicing without a current license; and

• engaging in a pharmacy practice that constitutes a danger to public health and safety.⁴

If the pharmacist’s action is deemed “unprofessional conduct,” then a penalty may attach to it. The Pharmacy Examining Board may revoke, suspend, or reprimand the pharmacist’s license.⁵

Standing Orders

Wisconsin law defines “standing order” as “an order transmitted electronically or in writing by a practitioner for a drug or device for multiple patients or for one or more groups of patients.”⁶

The statute expands a pharmacist’s scope of practice and what they can dispense legally, because it allows pharmacists to increase accessibility and dispense certain medications and devices to patients without having patients receive individualized prescriptions from their provider.

For example, in Wisconsin, there is a standing order for naloxone provided by the Department of Health Services that expires in August 2025. It allows pharmacists to dispense naloxone (an opioid antagonist) and expand accessibility to patients who need it without a prescription from a provider.

At the point of sale, a pharmacist must comply with the guidance outlined by the board and counsel the patient on how and when to use the naloxone. For the pharmacist to dispense it, the pharmacist must be practicing and licensed in Wisconsin and complete a one-hour training. The training should include how to:

• identify patients at risk for an opioid overdose;

• administer an intranasal and intramuscular naloxone formulation;

• store the naloxone; and

• educate patients on the use, effects, and instructions after administration.

Pharmacists must maintain dispensing records of naloxone.⁷

Through this standing order, a pharmacist can bill a patient’s insurance for possible coverage. If the patient chooses to purchase the intranasal naloxone over the counter, it would be an out-of-pocket cost.

Attorneys can play a role in aiding a pharmacist and a pharmacy in understanding the scope of practice and its expansion through a standing order, ensuring that all requirements are met.

Collaborative Practice Agreements

Collaborative Practice Agreements (CPAs) form a relationship between a provider and pharmacist that allows pharmacists to carry out certain services delegated by a provider.⁸

Both parties enter into an agreement that allows a pharmacist to, for example, manage a patient’s hypertension or diabetes treatment plan, assess lab values, monitor the patient, or adjust the prescription to a 90-day supply.⁹

CPAs expand a pharmacist’s scope of practice by allowing them to provide additional health care services and broaden their role in managing patient medications, thereby improving patient access.

It is important to discuss with pharmacists the additional duties that may be in place due to a CPA. This is because the duties delegated to pharmacists in a CPA are not usually within the pharmacists’ scope of practice or statutorily defined. Each therapeutic area (i.e., hypertension, diabetes) may have a CPA in place and it could vary from state to state.

If a pharmacist performs health care services outside of their scope of practice or current CPA, then they may be at risk of disciplinary action.

Conclusion

A pharmacist’s scope of practice is constantly expanding and evolving through the addition of standing orders and CPAs. The complexities of these duties can become difficult to navigate to ensure compliance with the law and avoid disciplinary action.

Attorneys play a role in helping pharmacists navigate the statutorily defined scope of practice and duties that are expected within the pharmacy practice.

This article was originally published on the State Bar of Wisconsin’s Health Law Blog. Visit the State Bar sections or the Health Law Section webpages to learn more about the benefits of section membership.

Endnotes

¹ Wis. Stat § 450.03(2).

² Wis. Admin. Code chapter Phar 16.

³ Wis. Admin. Code chapter Phar 7.

⁴ Wis. Admin. Code chapter Phar 10.03.

⁵ Wis. Stat. § 450.10.

⁶ Wis. Stat. § 450.01(21p).

⁷ Wis. Admin. Code chapter Phar 7.11.

⁸ Wis. Stat. § 450.033; 2013 Wisconsin Act 294.

⁹ See, e.g., Pharmacy Society of Wisconsin Collaborative Practice Agreement.