Electronic Prescribing Requirements for Mid-level Practitioners in the United States

Abstract

Objectives: To identify which types of mid-level practitioners have prescribing authority in each state in the United States (US), compare the types of prescriptive authority for scheduled medications for mid-level practitioners, and delineate differences between state and federal requirements for electronic prescribing (e-prescribing) for mid-level practitioners in each state. Methods: A data extraction tool was developed and utilized to collect e-prescribing requirements and mid-level practitioner prescriptive authority from publically accessible state and federal websites. Dependent variables were analyzed using frequencies and percentages. A comparison of regional mid-level practitioner prescriptive authority patterns was conducted. Results: Mid-level practitioner prescriptive authority and e-prescribing requirements were collected from 50 states, the District of Columbia, and the Drug Enforcement Administration (DEA). For e-prescribing requirements, 19 (37%) states listed federal law requirements, 28 (55%) states listed requirements in addition to federal law, and 4 states (8%) did not specify requirements. Overall, over half of the US had more stringent e-prescribing requirements than federal law. States varied in which mid-level practitioners had authority to prescribe controlled substances: 98% of states allow nurse practitioners to prescribe; 96% allow physician assistants; 84% allow optometrists; 14% allow naturopathic doctors; 12% allow registered pharmacists; 8% allow certified nurse midwives, 4% allow homeopathic physicians, medical psychologists, and nursing homes; and 2% allow doctors of oriental medicine, certified chiropractors, clinical nurse specialists and/or advanced practice registered nurses. Conclusions: There are differences in e-prescribing requirements and varying levels of prescriptive authority for mid-level practitioners between US states.