Writing Prescriptions as a Nurse Practitioner: The FAQ’s

It seems that working in the emergency department some days all I do is write prescriptions. Muscle relaxers for back pain, nausea medications for vomiting, and migraine meds for headaches. Prescribing is at the core of many nurse practitioner’s practice. Unfortunately, the guidelines surrounding this privilege can be difficult to sort through and understand.

When it comes to prescribing as a nurse practitioner the list of rules and regulations is a long one. Not only must NPs prescribe in accordance with federal law, they must prescribe within state guidelines as well. The legal implications surrounding nurse practitioners and prescribing are many, but let’s look at a few of the most common questions and concerns NPs ask about prescribing.

Do nurse practitioners need a DEA number in order to write prescriptions?

The short answer to this question in “No”. Nurse practitioners must be licensed by their state in order to prescribe but do not need a DEA number. A DEA number is required only to write prescriptions for controlled substances, not for medications like antibiotics.

Although a DEA number may not technically be required to write prescriptions, insurance companies and pharmacies often use the DEA number as a way to identify medical providers. Practicing without a DEA number be a hassle as these entities won’t have a systematic way to track things like insurance claims for your patients or prescriptions you write.

Are nurse practitioners allowed to prescribe controlled substances?

In every state except Alabama and Florida, nurse practitioners are allowed to prescribe at least some controlled substances. Controlled medications are categorized into groups called ‘schedules’ based on their potential for abuse. Schedule I medications have the highest potential for abuse and are not recognized by the DEA as having an accepted medical use. Schedule V medications are those like Lyrica or codeine containing cough syrups that have a much lower abuse potential. State nurse practice acts outline which schedules of medications nurse practitioners are permitted to prescribe. For example, in Georgia NPs are not allowed to prescribe schedule II medications but may prescribe schedules III-V.

If nurse practitioners practicing in a particular state are permitted to prescribe all schedules of controlled medications, the state nurse practice act will usually refer to these medications as a group rather than outlining privileges based on each schedule. State laws regarding the prescribing of controlled substances vary significantly. Some states allow NPs to prescribe these drugs with few guidelines. Other states require, for example, that nurse practitioners work under a collaborative agreement with a physician in order to prescribe controlled substances. 

Can nurse practitioners write prescriptions for friends and family?

The laws regarding writing prescriptions for friends and family vary by state. Many states allow nurse practitioners to prescribe for family members in ’emergency situations’. When writing a prescription, regardless of it it is for a friend or family member, federal law requires that medical treatment and prescribing be accompanied by written documentation, even if it occurs outside the clinic or hospital setting. Federal law also requires that the prescribing of controlled substances occurs only under a bona fide provider-patient relationship.

Although prescribing for friends and family members is technically legal under certain circumstances in most states, approach this practice with caution. Once a patient-provider connection has been established through prescribing, as a nurse practitioner you are legally responsible for that interaction and its consequences.

What legal pitfalls should nurse practitioners avoid related to prescribing?

With some states having strict guidelines regarding nurse practitioner’s prescribing practices, it can be tempting to skirt these rules for the sake of convenience. These guidelines, however, must be followed exactly. In Georgia, for example, one primary care physician was prosecuted for pre-signing blank prescription sheets so that the nurse practitioner he worked with could write patients prescriptions for controlled medications on his day off. State and federal agents raided the clinic where he worked. He served seven months in federal prison as federal law prohibits the pre-signing of prescriptions.

Keep up with federal and state laws writing when it comes to writing prescriptions. Cutting corners to avoid the practice inconveniences that come with following these guidelines can have serious consequences.

Can nurse practitioners write prescriptions to be filled out-of-state?

In most cases, laws allow prescriptions written by nurse practitioners to be filled out of state. When prescribing a medication to be filled in a different state, NPs must abide by the prescribing guidelines for the state where the prescription is to be filled. For example, if you practice in Tennessee and write a patient a prescription for a schedule II medication, the patient could not fill the prescription in Texas. This is because NPs practicing in Texas are not allowed to write prescriptions for schedule II controlled substances. The prescription could, however, be filled in New Mexico where nurse practitioners are permitted to prescribe controlled substances.

In Washington State, pharmacies are not allowed to accept prescriptions for controlled substances written by nurse practitioners out-of-state.

What state laws might I encounter in prescribing as a nurse practitioner?

There are many restrictions states may impose when it comes to NP’s prescribing ability. Some states prohibit nurse practitioners from prescribing controlled substances completely while others may allow NPs to do so only under a collaborative agreement with a physician. Other states may limit the types of controlled substances or the quantity NPs may prescribe. Nurse practitioners must know and follow state laws closely to remain within their scope of practice when prescribing medications, especially controlled substances.

What questions do you have about prescribing as a nurse practitioner?

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