Overview of Physician Assistant Prescriptive Authority

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Physician Assistants usually have the ability to prescribe medications as long as a long list of laws and regulations are complied with.  All states that allow it require a supervising physician that is responsible for oversight. The particular laws and regulations vary by state.  Most states have applications posted with instructions online and you can find them by searching on the state name plus the phrase Physician Assistant prescriptive authority.  Once the application is approved along with the proof of eligibility a certificate to prescribe or a provisional certificate to prescribe is issued.  Proof of eligibility varies by state but always includes proof of educational requirements and a delegated physician as the primary supervising physician.

Prescriptive Authority By State

Below is a map showing the states that allow physician assistants to prescribe medications and the level of authority they are given:

Prescriptive Authority for PA's by State

Source: U.S.Department of Justice, Drug Enforcement Administration

You will notice that in early 2011 there are only 2 states that do not allow PA’s to prescribe medication of any kind. They are Florida and Kentucky. Additionally, many states have classified drugs into 5 categories and have restricted prescription authority given to a certain number of these categories.  Other restrictions which some sates impose on top of these limitations are the amount of medication a physician assistant prescribing to something like a 72 hour supply, or the physician assistnat prescription can have no refills attached to them. These restrictions are shown in the map and are indicated by diagonal lines in addition to the color designation for drug classes allowed.

Prescription Authority Caveat’s

Even though a physician assistant may be granted prescription drug authority by the state he lives and is licensed to do so there are other factors that might limit their ability to do so. Firstly, the hospital, or medical group for which he works can impose there own rules and restrictions on what they can do, Secondly, the supervising physician may not allow or may place additional restrictions on the authority.  He is ultimately responsible for the PA and may wish to avoid the risk or need to build a period of trust in the abilities of a PA before allowing them to prescribe.  Lastly, a few states require a co-signor or supervising physician to be present at the time of writing the prescripton.

Why some states limit the Prescriptive Authority of PA’s

Many patient advocate groups lobby the legislative bodies that grant these powers to prevent or place limitations on Physician assistants and Nurse practitioners to prescribe medications.

The people who oppose granting prescriptive powers to PA’s argue that the additional training and education a physician receives is lacking in a physician assistant education.  They believe the quality of care will suffer because this lower level of education and training means proper diagnosis will not be made in many cases leading to more prescription related incidents.  They also believe that the advanced knowledge of drug interactions is lacking in the education of a PA especially when it comes to controlled substances. Many controlled substances can mask certain symptoms resulting I serious drug interactions and drug addictions.

Why more Prescription Authority for Physician Assistants is likely

The new healthcare legislation makes accessibility of care for more people not only a desire but also the law. The only way that this can effectively be done is to create more doctors or to expand the scope of practice for advanced nurse practitioners and physician assistants. Many legislatures have exploratory groups looking at this now.  They cite better patient outcomes in many cases compared to the outcomes for care provided by a physician.  Some studies showed that those who saw a physician assistant exclusively for 30% or more of their healthcare needs had fewer visits on average per year.  This in addition to the lower cost per visit when seeing a physician assistant leads to a substantial cost savings.  Innovative solutions that lower costs are going to be necessary to expand coverage and find a way to pay for that expansion.

The scope of practice expansion will make it more lucrative for physician assistants and nurse practitioners to participate n primary care. PA’s have generally tended to specialize because of the lower pay in a primary care environment. These new developments will make for a bright future in the physician assistant career field.