Can Nurse Practitioners Prescribe Medicines? What to Know
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“If we put the focus on what is best for the patients, then ultimately NPs will have unrestricted prescriptive authority in all 50 states and US territories. The evidence points to that being a reality. Now we need to harness the political will to make it happen.”
Elizabeth Kuzma, DNP, is a Clinical Assistant Professor at the University of Michigan’s School of Nursing (UMSN)
Nurse practitioners (NPs) are an essential component of the American healthcare system. They provide high-quality, cost-effective care and significantly increase healthcare access, particularly in rural and underserved areas. But in many states, NPs face obtuse and outdated regulations that inhibit their ability to prescribe certain medicines, devices, and services to their patients. Even some states with full practice authority for NPs still have onerous restrictions around prescriptive authority and it’s a burden on both NPs and their patients.
Prescribing is inherent to NP practice. According to the American Association of Nurse Practitioners (AANP), the authorization of NPs to prescribe legend and controlled medications, devices, healthcare services, durable medical equipment, and other equipment and supplies, is essential to providing timely, quality healthcare. Conversely, restrictions on prescriptive authority for NPs create unnecessary friction between patients and the treatments they need.
October is Talk About Your Medicines Month. Its goal is to empower patients to maximize the benefits and minimize the risks associated with their prescriptions. For NPs, it’s also an opportunity to bring greater awareness to the importance of unrestricted prescriptive authority, which empowers NPs to practice to the full extent of their training and education when it comes to the prescription of medicines, devices, and services.
To learn more about prescriptive authority, and why it’s a benefit to patients and practitioners everywhere, read on.
Meet the Experts: Dr. Elizabeth Kuzma & Dr. Beth Ammerman
Elizabeth Kuzma, DNP, FNP-BC, is a clinical assistant professor at the University of Michigan’s School of Nursing (UMSN) in the health behavior and biological sciences department, where she is also a family nurse practitioner program lead. She earned her MSN from Michigan State University and her DNP from Wayne State University.
Dr. Kuzma sees public policy advocacy at all levels as the broadest form of patient advocacy for health promotion and disease prevention. She is a former American Association for Nurse Practitioners (AANP) State Representative for Michigan and a former member of the AANP National Research Committee. She also is a member of the AANP Nominations Council and the UMSN’s Faculty Practice Advisory Committee. She was awarded the AANP State Award for Excellence in 2012.
Beth Ammerman, DNP, FNP-BC, is a clinical assistant professor at the University of Michigan’s School of Nursing (UMSN) in the health behavior and biological sciences department. She earned both her MSN and her DNP from Michigan State University. Her scholarship focuses on translating clinical research and addressing policy issues that pertain to the health and well-being of primary care patients.
Dr. Ammerman’s teaching role includes teaching graduate nursing students both in the classroom and in the clinical setting. As a classroom instructor, she leads the role transition course, guiding RNs to APRN roles. In addition, she has the opportunity to evaluate graduate students in their precepted clinical sites as well as directly precept students in her family practice office.
The Importance of Unrestricted Prescriptive Authority
“Patients who have full unrestricted access to prescriptions from NPs can receive the care they need, when they need it, from the provider directly involved in and responsible for their care,” Dr. Kuzma says. “When NPs have unrestricted prescriptive authority, they can make clinical decisions for the evaluation and management of their patients’ needs based on their knowledge, skills, expertise, and experience, rather than be held back by the comfort and expertise of their collaborating or supervising physician.”
Most restrictions around prescriptive authority for NPs center around the need for a supervising physician to approve certain prescriptions. In the best-case scenario, this can mean extra paperwork and wasted time. But in many instances, it can lead to a breach in the continuity of care, a major delay in treatment, or even adverse health outcomes. Patients who need medications for asthma, HIV prevention, or opioid dependence, for example, cannot afford wasted time.
“I received training and additional education on prescribing pre-exposure prophylaxis (PrEP) for adolescents to prevent HIV infections,” Dr. Kuzma says. “However, due to the level of comfort and experience of my supervising physician, I was unable to prescribe it. After working diligently for nine months to create a policy and educate my colleagues and supervising physicians on how to do so safely, I was then able to prescribe PrEP. That delayed my patients—many of whom were engaged in high-risk behaviors—from getting access to a highly effective medication to reduce HIV infection. Had I had unrestricted prescriptive authority, I could have started prescribing PrEP nine months sooner, and increased patient access to a potentially life-saving medication.”
“We know that opioid abuse is widespread, and has worsened with the stress of Covid-19 pandemic,” Dr. Ammerman says. “And we have a medication, buprenorphine, that can help patients with opioid dependence. In Michigan, a physician has the ability to take a class to obtain a waiver to prescribe buprenorphine. A nurse practitioner can also prescribe buprenorphine after taking the same course, but only if his or her supervising physician chooses to obtain the waiver. In other words, the physician cannot delegate a privilege that they do not possess. Full unrestricted prescriptive authority will help nurse practitioners help patients get the care, medications, and equipment they need.“
Prescriptive authority isn’t just about medications, either. NPs must also be able to freely prescribe medical devices and services that are essential for optimal health. These can include nebulizer machines for asthma or chronic obstructive pulmonary disease (COPD), diabetic shoes to ensure patients with diabetes to prevent foot ulcers, or glucometers and test strips for a patient with diabetes to be able to check and measure their blood sugar regularly.
Advocating for unrestricted prescriptive authority for NPs isn’t just advocating for NPs, it’s advocating for their patients and their right to healthcare access. For NPs who want to get involved, the first step is often connecting to their state NP organization, as well as becoming a member of AANP. Through these organizations, at both the state and federal levels, NPs are speaking with a collective voice on behalf of their profession and their patients.
“Doing nothing is not a valid option,” Dr. Kuzma says. “It is important that all NPs and future NPs engage in advocating for unrestricted prescriptive authority for NPs.”
“For years, I felt I was too inexperienced in health policy to make a difference,” Dr. Ammerman says. “I was a nurse and not a politician. But when I had to sit in a Michigan health policy committee meeting, I was shocked to learn how very little the legislators knew about basic healthcare, and I realized how important it is for nurses to become resources for their legislators. There is a definite need for a nurse, oftentimes, just to explain or clarify healthcare terms and medical equipment.”
The pace of regulatory change can often seem glacial, but NPs are advocacy veterans. Through grassroots efforts, NPs have successfully lobbied for more progressive rules and regulations around full practice authority in several states. Unrestricted prescriptive authority is the logical next step, and NPs will continue to advocate for it so that their patients can get the care they need.
“We remain very hopeful that one day, NPs will have unrestricted prescriptive authority as long as we, as a profession, continue to advocate for our patients,” Dr. Kuzma says. “There are a number of states where this is already possible and there is no evidence to suggest it is harmful. Rather, the evidence suggests the opposite: that NPs provide high-quality, cost-effective patient care with good outcomes. If we put the focus on what is best for the patients, then ultimately NPs will have unrestricted prescriptive authority in all 50 states and US territories. The evidence points to that being a reality. Now we need to harness the political will to make it happen.”
State-by-State Regulations for the Prescriptive Authority of NPs
Below you will find a detailed table of state-by-state regulations for the prescriptive authority of NPs. These data were derived from a combination of sources, including the American Medical Association (AMA), the American Association of Nurse Practitioners (AANP), the Centers for Disease Control and Prevention (CDC), and state agencies for NPs.
Please note that each state’s regulations are nuanced and they can change quickly. NPs should always check with their state board of nursing and professional society for the latest updates.
| State | Physician Involvement | Controlled Substances | Additional Requirements | Notes |
|---|---|---|---|---|
| Alabama | Yes | NPs may prescribe Schedule III, IV, and V medications, but not Schedule II. | NPs must complete approved courses in advanced pharmacology and prescribing trends in order to receive certification for prescribing controlled substances. NPs must demonstrate 12 months of safe practice to be approved for a controlled substance certificate. | Collaborative agreements may permit NPs to prescribe certain hydrocodone combinations reclassified from Schedule III to Schedule II. |
| Alaska | No | NPs may prescribe Schedule II, III, IV, and V medications. | NPs must complete 15 hours of advanced pharmacology and clinical management of drug therapy coursework. | NPs must submit an application to the state board of nursing in order to prescribe medications, and renew their authority every two years. |
| Arizona | No | NPs may prescribe Schedule II, III, IV, and V medications, but may not include refills for Schedule II medications. | NPs must complete 45 hours of pharmacology and/or clinical management of drug therapy coursework. | NPs must apply to both their state board of nursing and the Drug Enforcement Agency (DEA) for full prescriptive authority. |
| Arkansas | Some | NPs may prescribe Schedule III, IV, and V medications, but only certain Schedule II medications. | NPs must obtain a certificate for full independent practice authority, which requires an NP to complete 6,240 hours of supervised practice under a physician. | A bill passed in March of 2021 states that NPs who have obtained a certificate for full independent practice authority may prescribe drugs, medicines, or therapeutic devices in accordance with their scope of practice. |
| California | Some | NPs currently need physician involvement when prescribing Schedule II and III medications. | NPs currently need a furnishing number assigned from the Board of Nursing, as well as six months of physician-supervised experience, in order to prescribe medications within their scope of practice. | A September 2020 bill granted full practice authority to NPs, and will go into effect in 2023. |
| Colorado | Some | With provisional prescriptive authority, NPs may prescribe Schedule II, III, IV, and V medications. | NPs must complete coursework in pathophysiology, pharmacology, and physical assessment. NPs must complete 750 hours of supervised mentorship in order to earn provisional prescriptive authority. | All NPs with prescriptive authority are assigned an identifier by the state board of nursing. |
| Connecticut | Some | NPs may prescribe Schedule IV and V medications, but will need written physician collaboration for the first three years after licensure when prescribing Schedule II and III medications. | NPs need a minimum of 30 hours of pharmacology coursework. | After three years of physician collaboration, NPs may prescribe independently. |
| Delaware | No | NPs may prescribe Schedule II, III, IV, and V medications. | NPs must complete coursework in advanced health assessment, advanced pathophysiology, and advanced pharmacology as part of their licensure requirements. | A June 2021 bill removed physician collaboration requirements, and granted NPs full prescriptive authority upon licensure. |
| Florida | Some | NPs practicing autonomously may prescribe Schedule II, III, IV, and V medications. | After completing 3,000 hours under physician supervision, NPs may apply for autonomous practice. | None |
| Georgia | Yes | If authorized, NPs may prescribe Schedule III, IV, and V medications with written collaboration from a physician. | NPs must complete advanced pharmacology coursework. | None |
| Hawaii | No | NPs may prescribe Schedule II, III, IV, and V medications. | NPs must complete 30 hours of advanced pharmacology coursework. | None |
| Idaho | No | NPs may prescribe Schedule II, III, IV, and V medications. | NPs must complete 30 hours of advanced pharmacology coursework. | None |
| Illinois | Yes | If outlined in a collaborative agreement with a physician, NPs may prescribe Schedule III, IV, and V medications. Schedule II medications may be prescribed if delegated through the collaborating physician, and if additional requirements are met. | NPs must complete at least 45 hours of pharmacology coursework as part of their graduate level education in order to prescribe Schedule II medications. | None |
| Indiana | Yes | If outlined in a written collaborative agreement with a physician, NPs may prescribe Schedule II, III, IV, and V medications. | NPs must apply for Controlled Substances Registration (CSR). | None |
| Iowa | No | NPs may prescribe Schedule II, III, IV, and V medications. | NPs must register with the DEA and the state board of pharmacy. | None |
| Kansas | Yes | Under a collaborative agreement with a supervising physician, NPs may prescribe Schedule II, III, IV, and V medications. | Before prescribing controlled substances, NPs must register with the DEA and notify the state board of nursing | None |
| Kentucky | Yes | Under a collaborative agreement with a supervising physician, NPs may prescribe Schedule II, III, IV, and V medications. | None | After four years under a collaborative agreement with a physician, an NP may prescribe legend drugs independently. |
| Louisiana | Yes | Under a collaborative agreement with a supervising physician, NPs may prescribe Schedule III, IV, and V medications. NPs will need authority from the board of nursing to prescribe Schedule II medications. | NPs must complete 500 hours of clinical practice as an NP or in a preceptorship. They must also complete 45 contact hours of education in advanced pharmacotherapeutics and 45 contact hours of education in physiology. | NPs must apply separately for prescriptive authority. |
| Maine | Some | NPs may prescribe Schedule II, III, IV, and V medications. | NPs prescribing controlled substances must first register with the DEA. As part of the requirements for licensure, NPs must complete 45 contact hours in pharmacology. | After practicing for at least 24 months under a supervising physician, NPs may be granted independent practice authority. |
| Maryland | Some | NPs may prescribe Schedule II, III, IV, and V medications. | As part of the requirements for licensure, NPs must complete coursework in advanced pharmacology, advanced pathophysiology, and advanced physical assessment. | After 18 months in collaborative practice with a physician or an NP with full practice authority, NPs may be granted full practice authority. |
| Massachusetts | Yes | NPs may prescribe Schedule II, III, IV, and V medications. | NPs must complete 24 contact hours in pharmacotherapeutics that goes beyond what is acquired in a general nursing program. | NPs must obtain a controlled substances registration (CSR) in order to prescribe medications. |
| Michigan | Yes | If delegated by a physician, NPs may prescribe Schedule II, III, IV, and V medications. | None | NPs have their own DEA numbers, but they do not have a Controlled Substance License, which is needed to prescribe controlled substances independently. NPs are covered under their supervisory physician’s Controlled Substance License. |
| Minnesota | No | NPs may prescribe Schedule II, III, IV, and V medications. | None | None |
| Mississippi | Yes | After completing an educational program approved by the state board of nursing, NPs may prescribe Schedule II, III, IV, and V medications. | NPs must complete 40 contact hours related to advanced clinical practice, two hours of which must be directly related to the prescription of controlled substances. | None |
| Missouri | Yes | If outlined in a collaborative agreement with a physician, NPs may prescribe Schedule II, III, IV, and V medications. | NPs must complete three hours of graduate-level pharmacology education. | None |
| Montana | No | NPs may prescribe Schedule III, IV, and V medications. They may also prescribe Schedule II medications in emergency situations by phoning a pharmacist. | NPs must complete 45 contact hours in pharmacology, pharmacotherapeutics, and clinical management of drug therapy in their area of specialty. | NPs must apply separately for prescriptive authority through the state board of nursing. |
| Nebraska | Some | NPs may prescribe all medications that fall under their scope of practice. This may include Schedule II, III, IV, and V medications. | NPs must complete at least 30 hours of education in pharmacotherapeutics. | After 2,000 hours of collaborative practice with a physician, NPs may prescribe without a collaborating physician. |
| Nevada | Some | NPs may prescribe Schedule III, IV, and V medications independently. NPs require a collaborating physician for prescribing Schedule II medications. | For prescriptive authority, NPs must pass an exam administered by the state board of nursing, and receive certification from the state board of pharmacy. | After 2,000 hours or two years in a regulated relationship with a physician for prescribing schedule II substances, an NP may be granted full independent practice authority. |
| New Hampshire | No | NPs may prescribe Schedule II, III, IV, and V medications. | NPs generally must complete 480 hours of clinical nursing practice, including pharmacological interventions. | None |
| New Jersey | Yes | If they have a written collaborative agreement with a physician, NPs may prescribe Schedule II, III, IV, and V medications after consulting with the physician. | NPs must complete coursework in pharmacology related to controlled substances. | None |
| New Mexico | No | NPs may prescribe Schedule II, III, IV, and V medications. | NPs must apply for a state controlled substance license with the state board of pharmacy. | None |
| New York | Yes | Through a collaborative agreement with a supervising physician, NPs may prescribe Schedule II, III, IV, and V medications. | As part of licensure, NPs must complete coursework in pharmacotherapeutics. | None |
| North Carolina | Yes | If outlined in a collaborative agreement with a supervising physician, NPs may prescribe Schedule II, III, IV, and V medications. | As part of licensure, NPs must complete coursework in pharmacology. | None |
| North Dakota | No | NPs may prescribe Schedule II, III, IV, and V medications. | NPs must complete 30 contact hours in pharmacotherapy related to their scope of practice. | None |
| Ohio | Yes | In collaboration with a physician, NPs may prescribe Schedule III, IV, and V medications. NPs may also prescribe Schedule II medications in collaboration with a physician, but only under certain conditions. | NPs must complete 45 contact hours in advanced pharmacology, and a 1,500-hour externship | None |
| Oklahoma | Yes | In collaboration with a physician, NPs may prescribe Schedule III, IV, and V medications, but not Schedule II medications. | NPs must complete 45 contact hours of continuing education or three academic credits of education in pharmacotherapeutics. | None |
| Oregon | No | NPs may prescribe Schedule II, III, IV, and V medications. | NPs must complete 45 hours of pharmacology education, and complete a pharmacotherapeutic practicum under a physician, NP, or clinical nurse specialist with prescriptive authority. | None |
| Pennsylvania | Yes | If outlined in a written collaboration agreement with a physician, NPs may prescribe Schedule II, III, IV, and V medications. | NPs must complete 45 hours of coursework in pharmacology, beyond what is required in traditional nursing programs. | None |
| Rhode Island | No | NPs may prescribe Schedule II, III, IV, and V medications. | None | None |
| South Carolina | Yes | If listed within one’s specialty, and if outlined in a written collaborative agreement with a physician, NPs may prescribe Schedule II, III, IV, and V medications. | NPs must complete 45 contact hours in pharmacotherapeutics, and, for controlled substances, 15 hours of education in controlled substances. | None |
| South Dakota | Some | NPs may prescribe Schedule II, III, IV, and V medications. | None | After completing 1,040 practice hours under physician supervision, NPs may be granted full independent practice authority. |
| Tennessee | Yes | After consultation with a collaborating physician, NPs may prescribe Schedule II, III, IV, and V medications. | NPs must complete three quarter-hours (or the equivalent) in pharmacology. | To prescribe controlled substances, NPs must also receive a certificate of fitness from the state board of nursing. |
| Texas | Yes | If outlined in a written agreement with a collaborating physician, NPs may prescribe Schedule II, III, IV, and V medications. | NPs must complete coursework in pharmacotherapeutics, pathophysiology, advanced assessment, and diagnosis and management of problems within their clinical specialty. | To prescribe controlled substances, NPs must file an application with the state’s Department of Public Safety for controlled substances registration (CSR). |
| Utah | No | NPs may prescribe Schedule II, III, IV, and V medications. | NPs must complete advanced coursework in patient assessment, diagnosis and treatment, and pharmacotherapeutics. | None |
| Vermont | Some | NPs may prescribe Schedule II, III, IV, and V medications. | As part of licensure, NPs must complete coursework in advanced pathophysiology, advanced assessment, and pharmacotherapeutics. | After 2,400 hours (or two years) spent in collaborative practice with a physician, NPs may be granted full independent practice authority. |
| Virginia | Some | If certain conditions are met, NPs may prescribe Schedule II, III, IV, and V medications without a collaborative agreement with a physician. | NPs must complete 30 contact hours in pharmacology or pharmacotherapeutics. | After five years of clinical experience under a collaborating physician, NPs may be granted full independent practice authority. |
| Washington | No | NPs may prescribe Schedule II, III, IV, and V medications. | NPs must complete 30 hours of pharmacotherapeutics education. | None |
| Washington DC | No | NPs may prescribe Schedule II, III, IV, and V medications. | NPs must complete a Controlled Substances Registration in order to prescribe controlled substances. | None |
| West Virginia | Yes | NPs may prescribe Schedule III, IV, and V medications, but not Schedule II medications. | NPs must complete one undergraduate pharmacology course and 45 contact hours of graduate-level advanced pharmacology. | NPs must complete a three-year transition to practice period before being authorized to independently prescribe Schedule III, IV, and V medications. |
| Wisconsin | Yes | If delegated under a collaborative agreement with a physician, NPs may prescribe Schedule II, III, IV, and V medications. | NPs must complete 45 contact hours in clinical pharmacology and must pass a jurisprudence examination. | None |
| Wyoming | No | NPs may prescribe Schedule II, III, IV, and V medications. | None | None |
Matt Zbrog
WriterMatt Zbrog is a writer and researcher from Southern California, and he believes nurse practitioners (NP) are an indispensable component of America’s current and future healthcare workforce. Since 2018, he’s written extensively about the work and advocacy of NPs, with a particular focus on the rapid growth of specialization programs, residencies, fellowships, and professional organizations. As part of an ongoing series on state practice authority, he’s worked with NP leaders, educators, and advocates from across the country to elevate policy discussions that empower NPs. His articles have featured interviews with the leadership of the American Association of Nurse Practitioners (AANP), the National Association of Pediatric Nurse Practitioners (NAPNAP), and many other professional nursing associations.