Massachusetts Pharmacist Medication Administration Guidance Update

Page 1 of 5 CIRCULAR LETTER: DCP 26-03-124 To: Massachusetts Retail Pharmacies and Licensed Pharmacists Massachusetts Licensed Prescribers From: James G. Lavery, Director, Bureau of Health Professions Licensure Date: March 11, 2026 Re: Pharmacist Administration of Medications Summary of Changes This Circular replaces DCP 23-04-118, dated April 21, 2023, by adding pharmacist authorization to administer the following: testosterone for gender-affirming care, medications for prevention of HIV, and medications for treatment and prevention of sexually transmitted infections. Purpose In accordance with 105 CMR 700.004(B)(9) and this Department guidance, pharmacists and pharmacy interns are authorized to administer certain medications for treating mental illness and substance use disorder, testosterone for gender-affirming care, antiviral therapy for prevention of HIV, and antibiotics for the treatment and prevention of sexually transmitted infections. See M.G.L. c. 94C, § 1. There is no requirement for pharmacists or pharmacy interns to administer these medications. The purpose of this circular letter is to provide guidance to pharmacists and pharmacy interns who choose to administer any of the approved medications. This circular letter also includes guidance to prescribers whose patients are to be administered any of the approved medications in a pharmacy setting. Dispensing by Administration A pharmacist or a pharmacy intern may, without obtaining a Massachusetts Controlled Substance Registration (MCSR), dispense by administration (i.e. administer) FDA-approved drugs included below in the “Medications Eligible for Pharmacist or Pharmacy Intern Administration” to persons 18 years or older, provided that: Eligible prescribers include all practitioners, as defined in 105 CMR 700.001, and pharmacists, in accordance with guidance relative to pharmacist prescribing of contraceptives, medications for the treatment of sexually transmitted infections (STI), and medications for the prevention of human immunodeficiency virus (HIV). The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health 250 Washington Street, Boston, MA 02108-4619 MAURA T. HEALEY Governor KIMBERLEY DRISCOLL Lieutenant Governor KIAME MAHANIAH, MD, MBA Secretary ROBERT GOLDSTEIN, MD, PhD Commissioner Tel: 617-624-6000 www.mass.gov/dph

Page 2 of 5 (a) The pharmacist or pharmacy intern is authorized to dispense controlled substances, in accordance with M.G.L. c. 112; (b) Administration is conducted pursuant to a valid prescription; (c) Administration is not intravenous; (d) the medication is available in single-dose packaging and prescribed in single doses, with or without refills; (e) The prescription is subject to reassessment by the prescriber at appropriate intervals, as determined by the prescriber, if applicable; and (f) The activity is conducted in accordance with Department guidelines. NOTE: A pharmacist may administer medications for addiction treatment, including methadone, pursuant to an order, ONLY in a registered opioid treatment program. Medications Eligible for Pharmacist or Pharmacy Intern Administration The following generic medications, which may have multiple brand names, are the only medications eligible to be administered by a pharmacist or pharmacy intern. Long-Acting Injectable Antipsychotics (LAIs) Aripiprazole Aripiprazole lauroxil Fluphenazine decanoate Haloperidol decanoate Paliperidone palmitate Risperidone Risperidone ER Long-Acting Injectable Medications for Substance Use Disorders Buprenorphine Naltrexone Gender-Affirming Care Medications Testosterone (all salts) HIV Prevention Medications Cabotegravir Lenacapavir (or other medications to prevent HIV) Sexually Transmitted Infection Medications Ceftriaxone (IM injection) Doxycycline (or other medications to treat chlamydia)

Page 3 of 5 Prescriber Assessment Prescribers must regularly re-assess the patient and prescription at appropriate intervals, such as quarterly, to be determined by the prescriber. This assessment does not preclude the issuance of valid prescriptions with available refills. If a pharmacist or pharmacy intern is presented with a prescription and has questions about the interval transpiring between assessments, routine communication with the prescriber is encouraged, but not required, prior to administration. Training To administer, a pharmacist or pharmacy intern must first receive training that is accredited by the Centers for Disease Control and Prevention, the American Council on Pharmaceutical Education or a similar health authority or professional body appropriate for the medications being administered and their respective patient populations. Such training shall include learning modules on techniques for administration by injection. CPR Certification To administer, a pharmacist or pharmacy intern must maintain current certification in cardiopulmonary resuscitation. Continued Competency To administer, a pharmacist or pharmacy intern must maintain continued competency regarding the populations served, medications administered and current guidelines. Continuing education programs are one way to maintain competency. Pre-administration Patient Counseling A pharmacist or pharmacy intern must provide customary patient counseling prior to administering a dose of an approved medication. Such counseling may include information about common side-effects, drug interactions, dietary requirements, injection site reaction and other information routinely provided to patients upon dispensing, as appropriate within the professional judgment of the pharmacist and in accordance with 247 CMR 2.00 et seq. Administration and Dosing – Manufacturers’ Instructions A pharmacist or pharmacy intern may only administer an eligible medication by subcutaneous or intramuscular injection, in accordance with manufacturer approved labeling and any risk evaluation and mitigation (REMS) requirements for the specific medication administered. Administration – Medical Emergencies To administer, a pharmacist or pharmacy intern must maintain competency in management of medical emergencies that may arise as a result of administration of eligible medications. If emergency medical services are required, an adverse event must be immediately reported, as outlined below. Prescribers are urged to issue separate prescriptions for appropriate emergency medications, as needed.

Page 4 of 5 Record Keeping A pharmacy where any of the eligible medications are administered must maintain the following information: • Patient consent; • Patient screening information, including at least date of birth and other relevant vital statistics, known allergies, and other medications taken; • Type of medication administered; • Manufacturer; • Lot number • Expiration date; • Date of administration; • Route and site of administration; • Pharmacist or pharmacy intern (signature or initials and title); and • Adverse outcome, if any; • Adverse event, if any. Reporting Adverse Events Any adverse events or reactions occurring as a result of a pharmacist or pharmacy intern administering a medication listed in this guidance should be appropriately communicated to the prescriber within 24 hours. If the adverse event includes one of the following outcomes, the event must be immediately reported to the prescriber. (i) death; (ii) a life-threatening outcome; (iii) inpatient hospitalization or prolongation of existing hospitalization; (iv) additional treatment, testing, or monitoring in a hospital or emergency department; or (v) a persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions. If the adverse event is the result of a dispensing error or is a serious adverse drug event, the pharmacist or pharmacy intern remains responsible for reporting the event to the Board of Registration in Pharmacy, in accordance with Board regulations. Pharmacist-Prescriber Communication Prescribers issuing prescriptions for eligible medications and pharmacists or pharmacy interns administering these medications are strongly encouraged to engage in regular communication to ensure patient safety, continued patient progress, medication adherence and emergency management. Prescribers should make clear that they intend for eligible medications to be administered by a pharmacist or pharmacy intern by including the following notation on the prescription: “for pharmacist administration”.

Page 5 of 5 A pharmacist or pharmacy intern receiving a prescription for eligible medications without the notation is encouraged to contact the prescriber if, in their professional judgment, it appears the medication is intended to be administered, rather than being dispensed to the patient for administration outside the pharmacy. Pharmacists and pharmacy interns are strongly encouraged to send administration records to prescribers as soon after administration as practical. Prescribers are urged to issue a separate prescription for appropriate emergency medication, as needed, along with any prescription medications to be administered by a pharmacist or pharmacy intern. Prescribers and pharmacists are encouraged to develop an emergency medication protocol to address any emergency medication prescription needs for patients. Privacy A pharmacist or pharmacy intern engaged in this activity must maintain the privacy and confidentiality of any patient to whom medication is administered, in accordance with 247 CMR 2.00 et seq., and 42 CFR Part 2 as applicable, at all times during the course of dispensing and administration. Contact Information Please direct any questions or concerns to the Drug Control Program: dcp.dph@mass.gov