Toward a Pharmacy-Led Value-Based Care Model for Buprenorphine Initiation and Management (PharmValue): Development of...

Opioid use disorder (OUD) treatment needs continue to outpace the capacity of existing treatment systems, with access to buprenorphine particularly constrained in many communities. Pharmacist involvement in medications for OUD (MOUD), including buprenorphine initiation and longitudinal management, has demonstrated feasibility and acceptability in select settings, yet widespread implementation remains limited by regulatory variability and fragmented care models. Pharmacies are highly accessible health care sites, and pharmacists' scope of practice can be expanded through mechanisms such as collaborative pharmacy practice agreements (CPPAs)-a term used interchangeably in the literature with "collaborative practice agreement" and related variants-to support buprenorphine initiation and ongoing management. The CTN-0151 PharmValue project aims to develop a scalable, pharmacist-led CPPA model for MOUD that can be adapted across diverse state regulatory environments and pharmacy settings. Using a community-engaged research approach and a 50-state legal and regulatory review supplemented by a national expert survey, PharmValue will (1) engage community stakeholders to codevelop a model CPPA and care pathway for pharmacist-managed buprenorphine and (2) identify existing legal authorities and advocacy opportunities to expand pharmacist-managed MOUD care nationally. This protocol commentary describes the rationale, guiding frameworks, and key design decisions underlying the PharmValue model and outlines anticipated implementation challenges and future directions for evaluation and scale-up.