<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".02" citation="COMAR 10.34.29.02" title_num="10" subtitle_num="34" chapter_num="29" heading="Content of Protocol.">
  <paragraph num="A.">
    <text>A protocol shall:</text>
    <paragraph num="(1)">
      <text>Be:</text>
      <paragraph num="(a)">
        <text>Written; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Condition or disease-state specific; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Contain the following:</text>
      <paragraph num="(a)">
        <text>The condition that the protocol is designed to manage;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A list of medications that may be used under the auspices of the protocol;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Monitoring parameters including laboratory tests for the:</text>
        <paragraph num="(i)">
          <text>Condition; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Medication employed;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(d)">
        <text>A list of circumstances requiring contact with the authorized prescriber or authorized prescribers who are a party to the prescriber-pharmacist agreement;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>A statement prohibiting substitution of a chemically dissimilar drug product by the pharmacist for the product prescribed by the authorized prescriber unless permitted in the therapy management contract;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>A list of circumstances under which the pharmacist may alter doses, modify the treatment regimen, or switch the agent under the terms of the therapy management contract;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Information to be documented;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>A listing of provisions within the protocol that may be customized within a therapy management contract; and</text>
      </paragraph>
      <paragraph num="(i)">
        <text>An action plan for situations when the pharmacist encounters a situation that is not addressed in the protocol.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>A protocol may authorize:</text>
    <paragraph num="(1)">
      <text>The modification, continuation, and discontinuation of drug therapy;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The ordering of laboratory tests;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Other patient care management measures related to monitoring or improving the outcomes of drug or device therapy; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>For protocols by a licensed physician and licensed pharmacist, the initiation of drug therapy under written, disease-state specific protocols.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>A protocol may not authorize acts that exceed the scope of practice of the parties to the prescriber-pharmacist agreement.</text>
  </paragraph>
  <paragraph num="D.">
    <text>Technical modifications to the protocol shall be registered with the Board of Pharmacy within 30 days of the technical modification.</text>
  </paragraph>
</regulation>