CAPITOL BUILDING – HARRISBURG, PA
PIC QUESTION OF THE WEEK: 10/25/10
Q: What are the prescribing restrictions for physician assistants (PA) and certified registered nurse practitioners (CRNP)? A: Each state can institute practice regulations and guidelines for non-physician prescribing. The chart below details some of the differences between PA and CRNP prescribing allowances and restrictions for the state of Pennsylvania. Please refer to the references below for more specific information on these rules and regulations. Collaborative Agreement
Physician Assistant -The written agreement with a supervising physician allows the PA to prescribe medications for a patient under the specific physician’s care. -The written agreement lists the categories of drugs which the PA is not permitted to prescribe. -Any prescription must be signed with the initials PA-C following the name of the PA; the license number and name of the PA must be printed in the prescription blank heading and the supervising physician must be identified. -May prescribe initial CII therapy for up to a 72-hour dose; the supervising physician must be notified within 24 hours. - May write for up to a 30-day supply of CII medications for continuation therapy with approval of their supervising physician. - Any CII prescription must clearly state whether it is initial or continuing therapy. - No additional limitations when prescribing other controlled substances (CIII and IV). -If authorized to prescribe or dispense controlled substances, the PA must register with the DEA and acquire a personal DEA number. The number will start with the letter M. -Prescriptions for a controlled drug substance must bear the DEA number of the PA.
Certified Registered Nurse Practitioner -The document must be a written agreement between the CRNP and supervising physician. -The CRNP has limited prescribing authority in accordance with the Board of Nursing and their collaborative agreement. The CRNP may not prescribe from the following categories: gold compounds, heavy metal antagonists, radioactive agents, and oxytocics. -The prescription must bear the name, title, CRNP certification number, and NPI (National Provider Identifier) number (if applicable). - May prescribe CII therapy as a 30-day supply if authorized to do so by the collaborative written agreement. - May write for CIII and IV controlled substances for upwards of a 90-day supply if authorized to do so by the collaborative written agreement. - May sign off on and complete initial assessment of a methadone patient’s treatment evaluations (methadone treatment can only be ordered by a physician). - If permitted to prescribe controlled substances as noted in the collaborative agreement, CRNPs must register with the DEA; their personal DEA number will begin with the letter M. - Prescriptions for a controlled drug substance must bear the DEA number of the CRNP.
References: Pennsylvania Pharmacist Association. Pharmacist’s Guide to Non-Physician Prescribing in Pennsylvania (updated March 2010). http://www.papharmacists.com/gov_regulations_PA.htm . Accessed October 20, 2010. Pennsylvania Code, Title 49, Chapter 18 State Board of Medicine and Chapter 21 State Board of Nursing. http://www.pacode.com/secure/data/049 . Accessed October 20, 2010. Photo by: Paul Vasiliades Name: Harrisburg Fireworks used under Creative Commons License; http://www.flickr.com/photos/pvasimages/3708060407/sizes/l/in/photostream/ (Accessed October 21, 2010) Ryan Clement, Kristen L. Dominik Pharm.D. Candidates The PIC Question of the Week is a publication of the Pharmaceutical Information Center, Mylan School of Pharmacy, Duquesne University, Pittsburgh, PA 15282 (412.396.4600).