Pharmacist Cheat Sheet for Missouri
Requirements for Supervising Physician agreements in Missouri, plus a free agreement builder tailored to Missouri law.
Provider supervision requirements in Missouri
Updated 2026-09-03
Provided for educational and research purposes only — this is not legal advice. Laws and regulations change frequently, and this content may contain errors or omissions. Always confirm current requirements with a licensed attorney before relying on this for compliance decisions.
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 A pre-2024 numeric 75-mile proximity rule was reportedly rescinded by both boards — current text uses an undefined 'geographic proximity' standard; verify with counsel before relying on any specific mileage figure.
Pharmacist
Represents Missouri's Medication Therapy Services (MTS) tier, not ordinary dispensing licensure. Authority is protocol-based (a physician-authored written protocol under § 338.010.5), not a bilaterally-negotiated collaborative-practice agreement, and NPs/PAs cannot delegate protocol authority to a pharmacist — only a physician can.
Proximity
Not codified — left to the practice agreement
Chart review
Not codified — left to the practice 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).Practice ownership (CPOM)
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
Supervision ratio
Not codified — left to the practice agreement
Meeting cadence
Not codified — left to the practice agreement
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)).$500–$700/mo
Estimated Pharmacist supervision cost in Missouri
Available Supervising Physicians in Missouri
Browse supervising physicians open to new collaborations near you.