Can Pharmacists Prescribe in California? 2026 Scope of Practice Guide

Status Check: California is a Green State. Current Authority Level: Advanced Practice Pharmacist (APh)

If you are a pharmacist in California, you are likely leaving revenue on the table—or practicing efficiently but dangerously.

The laws in California have changed significantly in recent years. Whether you are looking to launch a "Test and Treat" clinic or just want to legally dispense Paxlovid, you need to know exactly which protocol protects your license.

Here is the Breakdown of Pharmacist Prescribing Authority for California.

At-A-Glance: What Can You Prescribe?

Clinical Service	Authority Status	Protocol / Requirement	Billing Code
Hormonal Contraception	✅ YES (SB 493)	Self-Screening Form Req	CPT 99202
Flu/Strep (Test & Treat)	✅ YES (CLIA Waived)	CDPH Lab License Req	CPT 87880 + 99211
HIV PrEP/PEP	✅ YES (SB 159)	Training Required	CPT 99203
Paxlovid (COVID-19)	✅ YES	Renal Assessment Req	CPT 99212
Opioid Antagonist	✅ YES	Statewide Protocol	Product Only

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1. Hormonal Contraception Authority

The Law: SB 493

In California, pharmacists can independently furnish hormonal contraception to patients of any age. This includes oral contraceptives, patches, and vaginal rings.

The Protocol: To legally prescribe, you must:

1. Complete a Board-approved training program (1 hour CE).
2. Use the standard California Self-Screening Questionnaire.
3. Measure and document the patient's Blood Pressure (required).

⚠️ Audit Trap: Failing to retain the patient's screening questionnaire for 3 years is the #1 reason for audit failures in California.

Revenue Potential:

• Consult Fee: $35-50 (Cash) or CPT 99202 (Medicaid).
• Product: Standard dispensing margin.

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2. Test & Treat (Flu / Strep / COVID)

The Law: CLIA Waiver + CDPH Lab License

California allows pharmacists to test and treat influenza, strep throat, and COVID-19 under CLIA-waived testing protocols.

The Workflow:

1. Test: Perform a CLIA-waived rapid test.
2. Evaluate: Assess for high-risk criteria (e.g., Centor Score).
3. Treat: If positive, prescribe Tamiflu, Amoxicillin, or Paxlovid per the statewide protocol.

Rx Agent Tip: You cannot treat negative test results symptomatically in California without a Collaborative Practice Agreement (CPA).

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3. HIV PrEP/PEP Authority

The Law: SB 159

California pharmacists can initiate HIV PrEP and PEP therapy independently, making California one of the most progressive states for HIV prevention.

Requirements:

1. Complete required training on PrEP/PEP protocols.
2. Perform baseline assessments including HIV testing.
3. Provide 60-90 day supply with referral for ongoing care.

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4. How to Bill for Services in California

It is not enough to do the work; you must get paid.

Medicaid Enrollment: To bill Medi-Cal for CPT codes (like 99202, 99203, 99211), you must enroll as an Ordering/Referring Provider.

• Portal Link: Medi-Cal Provider Enrollment

Commercial Payers: Most commercial plans in California are beginning to recognize pharmacists as providers. We recommend billing the patient a cash "Consult Fee" and providing a Superbill using the codes above.

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Compliance Checklist for California

Before you write your first prescription, ensure you have these documents on file:

• NPI Type 1: Do you have an individual NPI? (Type 2 is for the pharmacy).
• Liability Insurance: Does your policy cover "Prescribing" or just "Dispensing"?
• Protocols: Do you have a printed copy of the California Standing Order signed by the State Medical Director?
• CLIA Waiver: Is your pharmacy registered as a laboratory?
• APh License: Have you applied for Advanced Practice Pharmacist recognition?

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Need the Official Protocols?

Stop searching through the California Board of Pharmacy website.

Rx Agent has the official, up-to-date Protocols and Standing Orders for California built right into the chat.

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