Page 1166 - Basic _ Clinical Pharmacology ( PDFDrive )

1152 SECTION X Special Topics

Who May Prescribe?

The right to prescribe drugs has traditionally been the respon- referral requirements, limitations to the list of drugs that may be
sibility of the physician, dentist, podiatrist, or veterinarian. prescribed (ie, a formulary), and a method of evaluation by the
Prescribing now includes—in a number of states and in varying supervising physician. The protocol must be in writing and must
degrees—pharmacists, nurse practitioners, nurse midwives, phy- be periodically updated.
sician’s assistants, and optometrists (see below; Table 65–2). In The following rules govern prescribing by nonphysicians in
the future, physical therapists may be licensed to prescribe drugs the various states at the time of this writing.
relevant to their practice. The development of large health main- In almost all states, nurse practitioners (NPs) and physician
tenance organizations has greatly strengthened this expansion assistants (PAs) may prescribe with or without physician supervi-
of prescribing rights because it offers these extremely powerful sion depending on the state. Likewise, optometrists may prescribe
economic bodies a way to reduce their expenses. selected formulary drugs for ophthalmologic indications.
The primary organizations controlling the privilege of Pharmacists can initiate prescriptions in three states: Montana,
prescribing in the USA are the state boards, under the pow- New Mexico, and North Carolina. They may practice with physicians
ers delegated to them by the state legislatures. Many state in collaborative drug therapy management (CDTM) programs in
boards have attempted to reserve some measure of the primary 47 states—all except New York, Maine, Oklahoma, and Alabama.
responsibility for prescribing to physicians by requiring that the Pharmacists may prescribe controlled substances under physician
ancillary professional work with or under a physician according supervision in California, Massachusetts, Montana, New Mexico,
to a specific protocol. In the state of California, this protocol North Carolina, Ohio, and Washington.
must include a statement of the training, supervision, and docu- New Mexico grants prescribing authority to medical
mentation requirements of the arrangement and must specify psychologists with advanced training.

purchase these drugs, but they may be dispensed only on the order Whereas the US FDA controls the drugs and their labeling and
of a legally qualified prescriber. Thus, a prescription is actually distribution, the state legislatures control who may prescribe drugs
three things: the prescriber’s order in the patient’s chart, the through their licensing boards, eg, the Board of Medical Examin-
written order to which the pharmacist refers when dispensing, ers. Prescribers must pass examinations, pay fees, and—in the case
and the patient’s medication container with a label affixed. of some states and some professions—meet other requirements for

TABLE 65–2 Prescribing authority of certain allied health professionals in selected states.

Physician’s
State Pharmacists Nurse Practitioners Assistants Optometrists
1
California Yes, under protocol ; must be trained in clinical Yes 2 Yes, under Yes; limited to certain drug classes
practice protocol 1
Florida Yes, according to state formulary; protocol not Yes 2 Yes 2 Yes; limited to certain drug classes
required
Michigan Yes, under protocol; must be specially qualified by Yes 2 Yes 2 Yes; limited to certain drug classes
education, training, or experience
2
Mississippi Yes, under protocol in an institutional setting Yes, under narrowly No Yes; limited to certain drug classes
specified conditions
Nevada Yes, under protocol, within a licensed medical facility Yes 2 Yes 2 Yes; limited to certain drug classes
New Yes, under protocol, must be “pharmacist clinician” Yes; do not need Yes 2 Yes; limited to certain drug classes
Mexico physician supervision
North Yes, under protocol in an institutional setting Yes; do not need Yes 2 Yes; limited to certain drug classes
Dakota physician supervision
Oregon Yes, under guidelines set by the state board Yes; do not need Yes 2 Yes; limited to certain drug classes
physician supervision
Texas Yes, under protocol set for a particular patient in an Yes; do not need Yes Yes; limited to certain drug classes
institutional setting physician supervision
Washington Yes, under guidelines set by the state board Yes; do not need Yes 2 Yes; limited to certain drug classes
physician supervision
1
Under protocol; see Box: Who May Prescribe?
2
In collaboration with or under the supervision of a physician.