Can pharmacists in Texas prescribe hormonal contraception?

**No.** Texas requires a Class D exemption and physician involvement for hormonal contraception. Independent pharmacist authority is not available.

What CPT codes can pharmacists bill in Texas?

In Texas, pharmacists have limited billing authority. **CPT 99211** may be billed for Paxlovid dispensing under federal authority.

Can Pharmacists Prescribe in Texas? 2026 Scope of Practice Guide

Status Check: Texas is a Red State. Current Authority Level: Restricted (CDTM Req)

If you are a pharmacist in Texas, the regulatory environment presents significant challenges. Texas has some of the most restrictive pharmacist prescribing laws in the country, with most clinical services requiring physician delegation or federal authority.

Here is the Breakdown of Pharmacist Prescribing Authority for Texas.

At-A-Glance: What Can You Prescribe?

Clinical Service	Authority Status	Protocol / Requirement	Billing Code
Hormonal Contraception	❌ NO	Class D Exemption Req	N/A
Flu/Strep	❌ NO	MD Must Prescribe	N/A
Paxlovid (COVID-19)	✅ YES	Federal Authority Only	CPT 99211
HIV PrEP/PEP	❌ NO	Not Authorized	N/A
Opioid Antagonist	✅ YES	Statewide Protocol	Product Only

1. Hormonal Contraception

The Status: Not Authorized

In Texas, pharmacists cannot independently furnish hormonal contraception. The Class D exemption pathway requires significant physician involvement and is not practical for most pharmacy settings.

What This Means:

Patients must obtain contraception through a traditional prescriber.
Collaborative Drug Therapy Management (CDTM) may offer limited pathways.

⚠️ Critical: Do not attempt to prescribe contraception without explicit legal authority—Texas enforcement is strict.

2. Test & Treat (Flu / Strep)

The Status: Not Authorized

Texas does not authorize pharmacists to prescribe treatment for flu or strep. A physician must prescribe all treatment medications.

What This Means:

Testing services may be available (CLIA-waived).
All treatment requires physician prescription.
Consider telehealth partnerships for referrals.

3. Paxlovid (COVID-19 Treatment)

The Law: Federal Authority Only

Texas pharmacists can prescribe Paxlovid only under federal emergency authorization. This is the primary prescribing authority available to Texas pharmacists.

Requirements:

Perform renal function assessment.
Screen for drug-drug interactions.
Document the clinical encounter thoroughly.

Rx Agent Tip: Paxlovid is your primary clinical service opportunity in Texas. Ensure your workflow is optimized.

4. Collaborative Drug Therapy Management (CDTM)

The Framework: Texas Pharmacy Act

While Texas restricts independent prescribing, CDTM agreements with physicians can expand your scope within specific protocols.

CDTM Requirements:

Written agreement with a licensed physician.
Defined scope of therapeutic categories.
Regular review and documentation.

5. How to Bill for Services in Texas

Billing opportunities are limited in Texas due to restricted authority.

Medicaid Enrollment: To bill Texas Medicaid for available CPT codes, you must enroll as an Ordering/Referring Provider.

Portal Link: Texas Medicaid Provider Enrollment

Commercial Payers: Commercial payer recognition of pharmacist clinical services is very limited in Texas. Focus on cash-pay models where authority exists.

Compliance Checklist for Texas

Before offering any clinical services, ensure you have these documents on file:

NPI Type 1: Do you have an individual NPI? (Type 2 is for the pharmacy).
CDTM Agreement (if applicable): Is your agreement properly executed?
Liability Insurance: Does your policy cover clinical services?
CLIA Waiver: Is your pharmacy registered as a laboratory?
Federal Authority Documentation: Do you have Paxlovid standing order on file?

Advocacy and Future Outlook

Texas pharmacy organizations continue to advocate for expanded scope of practice. Key areas of focus include:

Test & Treat legislation for respiratory infections.
Hormonal contraception access.
Expanded CDTM authority.

Stay engaged with the Texas Pharmacy Association for legislative updates.

Need the Official Protocols?

Stop searching through the Texas State Board of Pharmacy website.

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