During the 2016 legislative session, Florida granted authority to both advanced registered nurse practitioners (ARNPs) and physician assistants (PAs) to prescribe controlled substances, subject to approval by their supervising practitioner. This change brings these professionals’ authority in line with what most other states allow. However, this was not a complete grant of prescribing authority and, as explained below, leaves these professionals with a few restrictions to track.
ARNPs are now allowed to “prescribe, dispense, administer, or order any drug” under a supervisory arrangement with a practitioner. However, in order to dispense a controlled substance, the ARNP must have “graduated from a program leading to a master’s or doctoral degree in a clinical nursing specialty area with training in specialized practitioner skills.” It is not known if this leaves some ARNPs without the authority to prescribe controlled substances.
The Florida Board of Nursing is required to establish a committee to recommend a formulary of controlled substances that ARNPs can and cannot prescribe or only prescribe for specific uses or in limited quantities, or to limit the prescribing of certain drugs to certain types of ARNPs. The formulary must restrict the prescribing of “psychiatric mental health controlled substances” for children younger than 18 years of age to ARNPs who are also psychiatric nurses. With the exception of “controlled substances that are psychiatric medications” prescribed by ARNPs who are psychiatric nurses, ARNPs cannot prescribe more than a 7-day supply of a Florida Schedule II controlled substance. It is not clear whether “psychiatric mental health controlled substances” are the same as “controlled substances that are psychiatric medications”. These requirements are set forth in the ARNP rules (Rule 64B9-4.016, F.A.C.). The formulary applies to prescribed drugs, but not those “dispensed for administration” (presumably drugs administered directly to the patient).
ARNPs practicing in facilities licensed under Chapter 395 and Part II of Chapter 400, FS, (generally hospitals and nursing homes) may, within their protocol arrangements, order any medication for administration to a patient.
PAs were likewise granted Florida controlled substance dispensing authority effective January 1, 2017, subject to the protocols with their supervising physician and subject to certain limitations in the PAs’ formulary:
- Physician Assistants may not prescribe psychiatric mental health controlled substances for children younger than 18 years of age
- Physician Assistants may only prescribe a 7-day supply of Schedule II controlled substances as listed in Section 893.03, FS
PAs may order any medication for administration to the supervising practitioner’s patients allowed by the supervising practitioner in any facility licensed under Chapter 395 and Part II of Chapter 400, FS, (generally hospitals and nursing homes).
Where does this leave pharmacies and pharmacists?
When ARNPs and PAs were first granted prescribing authority, pharmacists had been concerned that when they received prescriptions from PAs or ARNPs that they would not know whether the supervising physician had allowed the prescribing. To address this concern, in 2004, legislation was passed that allowed the pharmacies and pharmacists to presume that ARNP and PA prescriptions were valid (Section 456.0392, FS).
The Legislature excluded controlled substances from this presumption since, at that time, ARNPs and PAs lacked controlled substance prescribing privileges. Unfortunately, this law was not amended during the 2016 legislative session to address any presumption as to controlled substance prescriptions. Existing language addressing PA’s states that if the prescription contains the PA’s prescriber number, it creates a presumption that the prescription is valid. So, while a pharmacy or pharmacist may legally presume that prescriptions written by ARNPs and PAs are valid if the medications are not controlled substances, they may not legally presume that controlled substance prescriptions written by ARNPs are valid. A pharmacy may wish to confirm that an ARNP has a protocol with the prescribing physician and the ARNP has the required educational training before filling controlled substance prescriptions. Pharmacies and pharmacists should also confirm that an ARNP is a psychiatric nurse for those mental health and psychiatric drug prescriptions that only such an ARNP may prescribe. Hopefully, the Legislature will address this gap in the law in a future session.
This same statutory provision required pharmacists to list on the label of prescriptions the name and professional license number of a “practitioner who is authorized under the laws of this state to write prescriptions for drugs that are not listed as controlled substances in chapter 893 but who is not eligible for a federal Drug Enforcement Administration number.” Since this section no longer applies, it should be addressed by the Legislature in a future session as well.
- Subject to protocol, both ARNPs and PAs (PA authority begins January 1, 2017) now have prescribing authority for drugs listed as controlled substances under Florida law and will now need mid-level practitioner DEA registrations
- Neither PAs or ARNPS can prescribe more than a 7-day supply of a Schedule II controlled substance, except an ARNP who is a psychiatric nurse may prescribe more than a 7-day supply of a Schedule II controlled substance that is a mental health drug
- PAs and ARNPs who are not psychiatric nurses may not prescribe psychiatric mental health controlled substances for children younger than 18 years of age
- A pharmacist may wish to confirm that a PA or ARNP has a protocol allowing the prescribing of controlled substances before dispensing Florida controlled substance prescriptions
- A pharmacist may wish to confirm that an ARNP is a psychiatric nurse if the prescription is for a psychiatric mental health controlled substance and it is for a child or the drug is a Schedule II drug for more than a 7-day supply