Nurse Practitioner Prescriptive Authority by State
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Credit: Getty ImagesNurse practitioner (NP) prescriptive authority varies according to state laws. Many states allow NPs to administer, dispense, prescribe, and procure medications. However, some jurisdictions require a collaborative practice agreement between an NP and a physician. Other states limit the duration of the prescription (e.g., five-day or 30-day supplies only) or the types and purposes of the drugs prescribed.
Find out more about which states nurse practitioners can prescribe medication in this guide.
What is Nurse Practitioner Prescriptive Authority?
Nurse practitioner prescriptive authority allows NPs to prescribe medications. The American Association of Nurse Practitioners divides prescriptive authority into three categories:
- Full practice permits NPs to prescribe independently.
- Reduced practice may require a collaborative practice agreement with a physician or limits on the prescribed medications.
- Restricted practice requires physician supervision or delegation when prescribing controlled substances.
Each state’s board of nursing regulates NP prescriptive and practice authority. Federal law classifies controlled substances into schedule categories.
- Schedule II includes substances with high abuse potential, such as amphetamine, codeine, and hydrocodone.
- Schedule III substances have less abuse potential and include compounds that contain limited Schedule II drugs, such as Tylenol with codeine.
- Schedule IV, with lower abuse potential than Schedule III drugs, includes barbital and Xanax.
- Schedule V, with the lowest abuse potential, consists of preparations with limited quantities of narcotics and stimulants, such as analgesics.
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Nurse Practitioner Prescriptive Authority by State Map
The map and table below illustrate the different nurse practitioner prescriptive authority rules in each U.S. state. Because a state’s prescriptive authority designation may change, be sure to check with your state’s nursing board for the latest information.
States’ prescriptive authority laws include full, reduced, and restricted categories. But, variations exist, including limits or restrictions on prescribing particular drugs, where and how certain substances are prescribed, and the duration of the prescription.
Source: U.S. DOJ and DEA Diverson Control Division, December 2, 2022
As of December 2, 2022, NPs who meet state-specific requirements and limitations can prescribe schedule II-V drugs in all states except Georgia and Oklahoma, where NPs can only prescribe schedule III-V controlled substances.
Obtaining Prescriptive Authority as a Nurse Practitioner
Requirements for obtaining nurse practitioner prescriptive authority vary by jurisdiction, with some states granting prescriptive authority as part of the licensing process and others imposing additional requirements. The procedural differences can depend on whether the state allows NPs full practice, reduced, or restricted practice authority.
Generally, prescriptive authority requires an application to the federal Drug Enforcement Agency (DEA) and adherence to all state requirements, including current and active licensing, potential supervisory or collaborative practice agreements, and any applicable continuing education and training. NPs use Form 224 specific to mid-level practitioners.
When nurse practitioners apply to register with the DEA, it is crucial to carefully consider the address they provide on their application. NPs working in restricted practice states must use their practice address as the designated address for both the DEA application and license.
If an NP changes employer or takes a leave of absence, they will not be granted a DEA renewal unless they can provide evidence of a new position and a supervising agreement.
Physician Involvement and Collaborative Practice Agreements
Some reduced practice states require collaborative practice agreements that detail the working relationship between physicians and nurse practitioners. These agreements include the terms of NPs’ prescriptive authority. States in which NP practice is more restrictive may require physician supervision for practice and prescribing medications.
Collaborative relationships between NPs and physicians can foster better communication and positive outcomes. As NPs become more specialized and independent, many states have allowed them to practice and prescribe more autonomously.
Today, NPs have full practice authority in 28 states and Washington D.C. The remaining states are split between reduced and restricted practice/prescribing authority, requiring collaborative practice agreements, physician oversight, or other restrictions.
Information on prescriptive authority was retrieved on August 10, 2023. Check with your state board of nursing for the most current information regarding prescriptive authority.
Page last reviewed August 16, 2023