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HB232 • 2026

Collaborative agreements; removes registered nurses from list of practitioners, etc.

An Act to amend and reenact § 54.1-3300.1 of the Code of Virginia, relating to collaborative agreements; practitioners; diagnosis.

Healthcare
Enacted

This bill passed the Legislature and reached final enactment based on the latest official action.

Sponsor
Wachsmann
Last action
2026-04-06
Official status
Acts of Assembly Chapter
Effective date
Not listed

Plain English Breakdown

The official source material does not provide specific details on how this change will affect current collaborative agreements involving registered nurses or patient care outcomes.

Removing Registered Nurses from Collaborative Agreements

This act removes registered nurses from a list of health care providers who can make diagnoses that lead to drug therapy decisions in collaborative agreements with pharmacists.

What This Bill Does

  • Removes registered nurses from the list of practitioners whose diagnoses may form the basis of drug therapy conducted pursuant to a collaborative agreement between a pharmacist and another practitioner.

Who It Names or Affects

  • Registered nurses who previously could diagnose patients for drug therapy under collaborative agreements with pharmacists.
  • Pharmacists and other healthcare professionals involved in collaborative agreements.

Terms To Know

Collaborative agreement
An arrangement between a pharmacist and another health care provider to work together on patient care, including drug therapy decisions.
Practitioner
A licensed healthcare professional who provides medical services directly to patients.

Limits and Unknowns

  • The act does not specify the exact impact on current collaborative agreements involving registered nurses.
  • It is unclear how this change will affect patient care and outcomes in practice.

Bill History

  1. 2026-04-06 Governor

    Approved by Governor-Chapter 94 (effective 7/1/2026)

  2. 2026-04-06 Governor

    Approved by Governor-Chapter 94 (effective 7/1/2026)

  3. 2026-04-06 Governor

    Acts of Assembly Chapter text (CHAP0094)

  4. 2026-03-10 House

    Enrolled Bill communicated to Governor on March 10, 2026

  5. 2026-03-10 Governor

    Governor's Action Deadline 11:59 p.m., April 13, 2026

  6. 2026-03-06 House

    Signed by Speaker

  7. 2026-03-06 Senate

    Signed by President

  8. 2026-03-06 House

    Enrolled

  9. 2026-03-06 House

    Bill text as passed House and Senate (HB232ER)

  10. 2026-03-06 House

    Fiscal Impact Statement from Department of Planning and Budget (HB232)

  11. 2026-03-02 Senate

    Read third time

  12. 2026-03-02 Senate

    Passed Senate Block Vote (40-Y 0-N 0-A)

  13. 2026-02-27 Senate

    Rules suspended

  14. 2026-02-27 Senate

    Passed by for the day

  15. 2026-02-27 Senate

    Constitutional reading dispensed Block Vote (on 2nd reading) (37-Y 0-N 0-A)

  16. 2026-02-27 Senate

    Passed by for the day Block Vote (Voice Vote)

  17. 2026-02-26 Education and Health

    Reported from Education and Health (15-Y 0-N)

  18. 2026-02-20 Health Professions

    Assigned Education sub: Health Professions

  19. 2026-02-18 Senate

    Constitutional reading dispensed (on 1st reading)

  20. 2026-02-18 Education and Health

    Referred to Committee on Education and Health

  21. 2026-02-17 House

    Read third time and passed House Block Vote (97-Y 0-N 0-A)

  22. 2026-02-16 House

    Read second time and engrossed

  23. 2026-02-15 House

    Read first time

  24. 2026-02-12 Health and Human Services

    Reported from Health and Human Services (21-Y 0-N)

  25. 2026-02-10 Health Professions

    Subcommittee recommends reporting (10-Y 0-N)

  26. 2026-01-16 Health Professions

    Assigned sub: Health Professions

  27. 2026-01-16 House

    Fiscal Impact Statement from Department of Planning and Budget (HB232)

  28. 2026-01-08 House

    Prefiled and ordered printed; Offered 01-14-2026 26100511D

  29. 2026-01-08 Health and Human Services

    Referred to Committee on Health and Human Services

Official Summary Text

Collaborative agreements; practitioners; diagnosis.
Removes registered nurses from the list of practitioners whose diagnoses may form the basis of drug therapy conducted pursuant to a collaborative agreement between a practitioner and a pharmacist.

Current Bill Text

Read the full stored bill text
An Act to amend and reenact §
54.1-3300.1
of the Code of Virginia, relating to collaborative agreements; practitioners; diagnosis.
Be it enacted by the General Assembly of Virginia:
1. That §
54.1-3300.1
of the Code of Virginia is amended and reenacted as follows:
§
54.1-3300.1
. Participation in collaborative agreements; regulations to be promulgated by the Boards of Medicine and Pharmacy.
A. A pharmacist and his designated alternate pharmacists involved directly in patient care may participate with (i) any person licensed to practice medicine, osteopathy, or podiatry together with any person licensed, registered, or certified by a health regulatory board of the Department of Health Professions who provides health care services to patients of such person licensed to practice medicine, osteopathy, or podiatry; (ii) a physician's office as defined in §
32.1-276.3
, provided that such collaborative agreement is signed by each physician participating in the collaborative agreement; (iii) any licensed physician assistant working in accordance with the provisions of §
54.1-2951.1
; or (iv) any licensed advanced practice registered nurse working in accordance with the provisions of §
54.1-2957
, involved directly in patient care in collaborative agreements which authorize cooperative procedures related to treatment using drug therapy, laboratory tests, or medical devices, under defined conditions or limitations, for the purpose of improving patient outcomes for patients who meet the criteria set forth in the collaborative agreement. However, no person licensed to practice medicine, osteopathy, or podiatry, or licensed as an advanced practice registered nurse or physician assistant, shall be required to participate in a collaborative agreement with a pharmacist and his designated alternate pharmacists, regardless of whether a professional business entity on behalf of which the person is authorized to act enters into a collaborative agreement with a pharmacist and his designated alternate pharmacists.
B. A patient who meets the criteria for inclusion in the category of patients whose care is subject to a collaborative agreement and who chooses to not participate in a collaborative procedure shall notify the prescriber of his refusal to participate in such collaborative procedure. A prescriber may elect to have a patient not participate in a collaborative procedure by contacting the pharmacist or his designated alternative pharmacists or by documenting the same on the patient's prescription.
C. Collaborative agreements may include prescribing, modification, continuation, or discontinuation of drug therapy pursuant to written or electronic protocols, provided implementation of drug therapy occurs following diagnosis by the licensed physician, podiatrist, advanced practice registered nurse,
registered nurse,
or physician assistant; the ordering of laboratory tests; or other patient care management measures related to monitoring or improving the outcomes of drug or device therapy. No such collaborative agreement shall exceed the scope of practice of the respective parties. Any pharmacist who deviates from or practices in a manner inconsistent with the terms of a collaborative agreement shall be in violation of §
54.1-2902
; such violation shall constitute grounds for disciplinary action pursuant to §§
54.1-2400
and
54.1-3316
.
D. Collaborative agreements may only be used for conditions which have protocols that are clinically accepted as the standard of care, or are approved by the Boards of Medicine and Pharmacy. The Boards of Medicine and Pharmacy shall jointly develop and promulgate regulations to implement the provisions of this section and to facilitate the development and implementation of safe and effective collaborative agreements between the appropriate practitioners and pharmacists. The regulations shall include guidelines concerning the use of protocols, and a procedure to allow for the approval or disapproval of specific protocols by the Boards of Medicine and Pharmacy if review is requested by a practitioner or pharmacist.
E. Notwithstanding the provisions of §§
54.1-3303
and
54.1-3408
, a pharmacist may prescribe, modify, continue, or discontinue Schedule II through VI controlled substances in accordance with this section.
F. Prior to a pharmacist prescribing, modifying, continuing, or discontinuing a Schedule II through V controlled substance in accordance with this section, the pharmacist shall submit proof of the signed collaborative practice agreement to the Board and obtain authorization from the Board for such activity.