Bill to let advanced-practice registered nurses prescribe controlled substances on their own after four years passes, at long last

Image from Kentucky Association of Nurse Practitioners and Nurse Midwives shows the bill's House manager, Rep. Russell Webber, a Shepherdsville Republican, speaking on the House floor.

By Melissa Patrick
Kentucky Health News

A bill to create a path for Kentucky's advanced-practice registered nurses to prescribe controlled substances independently has finally passed and is on its way to the governor's desk. 

After seven years of debates and months of negotiations with the powerful Kentucky Medical Association, Sen. Julie Raque Adams, a Republican from Louisville, was able to broker a compromise between the association and the Kentucky Association of Nurse Practitioners and Nurse Midwives. 

To cheers, the House passed Senate Bill 94 by a vote of 92-1, with the only dissenting vote coming from Rep. Kim King, R-Harrodsburg. 

Beth Partin, president of the APRN association, called the passage of this bill "momentous." 

"This means that APRNs will be able to improve access to care. We'll be able to help more people," she said, later adding, "I think it means that more nurse practitioners and nurse midwives will open practices in rural areas."  

Further, she said it means that APRNs won't have to pay "lots of money" to a collaborating physician "to sign the paper" that allows them to have a Drug Enforcement Agency number, which is needed if they want to open a practice. 

"You have to have a DEA number to order certain supplies like flu vaccine and oxygen and things like that. . . . So even if you didn't prescribe scheduled drugs, you still had to have that in order to establish your practice to get get the supplies you need," she said.

Jill York, executive director of the APRN association, said the passage of SB 94 could help about 3,000 veteran APRNs, who are working under a cooperative agreement that allows them to prescribe controlled substances and could begin the process of not working under such a contract, called a Collaborative Agreement for Prescriptive Authority for Controlled Substances, or CAPA-CS.

"They will be able to move toward independence from that agreement if they would like to," she said. "And it opens a lot of opportunity and a lot of doors for APRNs who might want to open their own practice somewhere in Kentucky." 

Partin, who has been involved with legislative work for 30 years and served on the negotiation team for the bill, praised the negotiation efforts between her association and the KMA, calling them respectful, professional and thoughtful. Further, she said there was a spirit of compromise and that everyone left their egos at the door. 

"I'm hopeful that that will carry over into the future because we share a lot of common interests," she said. 

Kentucky APRNs have been able to prescribe controlled substances since 2006 under agreements with with a physician. They are allowed to prescribe a 72-hour supply of a Schedule II drug, the highest class of controlled substance that can be prescribed, and SB 94 would not change that.

With the passage of the bill, an APRN who wants to prescribe controlled substances independently must work under an agreement for four years, have regular meetings with their collaborating physician while working under the agreement, undergo a license review by the Kentucky Board of Nursing, maintain a U.S. Drug Enforcement Administration registration and a master account in the Kentucky All-Schedule Prescription Electronic Reporting system.

The bill would establish the Controlled Substances Prescribing Council in the Office of the Inspector General at the Cabinet for Health and Family Services, which will meet at least quarterly to discuss the safe and appropriate prescribing and dispensing of controlled substances.

Rep. Russell Webber, R-Shepherdsville, who carried the bill in the House, praised the bill for its safeguards that protect Kentuckians from the overprescribing of controlled substances as he asked for passage of the bill. 

"Now is the opportunity to pass good solid policy that will give us assurance that controlled substance prescribing and dispensing is being reviewed with transparency and accountability while also increasing access to quality health care," he said. "I congratulate the physicians and the nurse practitioners for their hard work to make this agreement happen and for bringing us a solid, well-thought-out bill."