FEBRUARY 2002 STATE BOARD NEWS
(STATE SECTION ONLY)
NURSING BOARD TO BEGIN LICENSING APN PRESCRIBERS
Shortly after you receive this newsletter, the Board of Nursing will begin licensing a large number of additional Advanced Practice Nurses (APNs) to prescribe.
As you know, there have been about 350 APNs prescribing under a trial program for the last few years. As a result of HB 241 from the 123rd General Assembly, which was signed by the Governor on February 15, 2000, the trial program will be phased out over the next year and any APN who meets the proper criteria will be able to be licensed to prescribe by the Board of Nursing. In addition to the number of prescribing APNs greatly increasing, the rules governing their prescribing have also changed from the rules in place for the trial program. This article will attempt to outline the major changes, but it will certainly not be able to cover all of the possible contingencies that may occur during the implementation of the new program.
Please also keep in mind that the collaborating physician may add additional limitations on the APN’s scope of prescribing privileges beyond the limitations placed by the master formulary. It is the responsibility of both the physician and the APN to see that these additional limitations are followed.
Any questions that may come up regarding APN prescribing can be directed to the Board of Nursing office (614-466-3947) or to the Board of Pharmacy office. In addition, the Board of Nursing has assured us that they will maintain both the list of the APNs authorized to prescribe as well as a copy of the master formulary for APN prescribing on their Web page (www.state.oh.us/nur) under the “Advanced Practice” box. This should help you verify the licensure status of any APN prescription that you may receive.
Major Points To Remember With The New APN Law
1. An APN must be licensed to prescribe by the Board of Nursing and have a special prescribing license issued in addition to his/her APN license. Just because a person is licensed as an APN does not necessarily mean that person may prescribe.
2. Any APN who prescribes is to be considered the prescriber of record for purposes of the pharmacy recordkeeping requirements. It is not appropriate or legal to list the collaborating physician as the prescriber.
3. Prescriptions may be issued by an APN in the same manner as those issued by a physician, including oral, fax, board-approved electronic transmission, and handwritten prescriptions.
4. The prescribing APN is subject to the same restrictions that exist for the collaborating physician. If the collaborating physician happens to be a podiatrist, the APN may not prescribe outside of the limits placed on the podiatrist for prescribing. In addition, if the collaborating physician has had limits placed on his/her license by the Medical Board or DEA (e.g., limits on controlled substance prescribing), then those same limits will apply to the APN, regardless of the content of the formulary with the collaborating physician.
5. Any APN who wishes to prescribe controlled substances must be registered with the DEA as a mid-level practitioner. This means that the DEA number assigned will begin with the letter “M”, unlike physicians whose DEA number begins with the letter “A” or "B". This is the DEA number that is required to be maintained to meet the recordkeeping requirements. The physician’s DEA number is not the appropriate number to be maintained in your pharmacy computer system as the prescriber identification.
6. Controlled substances in Schedules III-V that are included in the APN’s formulary may now be prescribed as needed for a legitimate medical purpose. There will no longer be the 72-hour, one time restriction that applied during the trial program.
7. Controlled substances in Schedule II may ONLY be prescribed ONE TIME for NO MORE than a 24-hour period to a TERMINALLY-ILL patient who has previously been prescribed the CII substance by the collaborating physician. (Note - Since a podiatrist should not be prescribing opiates for treatment of terminal cancer pain, this also means that an APN whose collaborating physician is a podiatrist may not write any CII prescriptions.) Other than for this reason, Schedule II substances MAY NOT be prescribed by any APN. In particular, please note that NO APN may write for methylphenidate, Adderall, or any other CII stimulant for any reason.
8. The master formulary that will be listed on the Nursing Board’s Web page will be an exclusionary one rather than the listing of approved drugs that exists for the trial program. In other words, it may specify that the APN may prescribe all antihypertensives except certain drugs; it may specify that the APN may prescribe all oral vitamins, but no intravenous vitamins; etc.
9. The APN may now possess and supply patients with NON-CONTROLLED drug samples of prescription drugs included on his/her formulary as long as the quantity provided to the patient is limited to a 72-hour supply (or smallest available size) and the sample is supplied free of charge.
10. Other than the samples described above, the ONLY prescription drugs that may be personally supplied to patients by an APN are drugs listed as antibiotics, antifungals, scabicides, contraceptives, and prenatal vitamins that are included in his/her formulary AND are furnished ONLY from a licensed location operated by the Board of Health, a federally-funded comprehensive primary care clinic, or a nonprofit health care clinic or program. In other words, unlike the trial program, an APN who is located somewhere other than those sites listed above may NOT personally supply any prescription drugs other than samples of prescription drugs that are included in his/her formulary.
11. The Board of Nursing’s rules require that all prescribing APNs must list their prescribing license number on each prescription written.
Again, please note that these APNs who are licensed by the Board of Nursing are legally entitled to prescribe certain drugs to their patients. Prescriptions issued by these individuals are valid prescriptions and may be filled by pharmacists in the same manner that prescriptions issued by physicians are filled.
If you have any questions about the legitimacy of an APN prescription or the procedures to be followed when presented with such a prescription, please take the steps necessary to enable you to make an informed decision on whether or not to fill the prescription. In these instances - as with all prescriptions - please always act in the best interest of the patient as you make your decisions.
Anyone having a question regarding the license status of a particular practitioner, nurse, pharmacist, pharmacy intern, or dangerous drug distributor in Ohio should contact the appropriate licensing board. The Web sites listed below may include disciplinary actions for their respective licensees.
State Dental Board--614/466-2580, www.state.oh.us/den/
State Medical Board--614/466-3934, www.state.oh.us/med/
State Nursing Board--614/466-3947, www.state.oh.us/nur/
State Optometry Board--614/466-5115, www.state.oh.us/opt/
State Pharmacy Board--614/466-4143, www.state.oh.us/pharmacy/
State Veterinary Medical Board--614/644-5281, www.state.oh.us/ovmlb/
Drug Enforcement Administration--800/230-6844; www.deadiversion.usdoj.gov/
STATE PHARMACY BOARD:
Due to space limitations with this newsletter, recent Pharmacy Board disciplinary actions will not be listed until the next issue. All actions may be seen in the Board's meeting minutes, which are posted on the Internet at the Board's home page (see address above), then click on the Board Minutes box. If you have any questions, please feel free to contact the Board office directly.
STATE MEDICAL BOARD:
A document of legal actions taken by the Medical Board may be accessed on the Internet at the Medical Board's Home page (see address above) then click on Monthly Formal Actions. If you would like a more detailed history of a legal action for an individual practitioner, go Back to the Medical Board's Home page, click on the Licensee Profile & Status tag, then follow the instructions. Please contact the Medical Board if you have questions.