Groups or providers hoping to ease state-mandated supervision requirements and other restraints on advanced practice registered nurses (APRNs) received a boost from the Federal Trade Commission (FTC or Commission) this week when it recommended a state legislature consider removing regulatory hurdles imposed on independent APRN prescribing. The Commission wrote that a proposed bill raises significant competitive concerns “first because of the many conditions and exclusions it would impose” and second because of apparent conflicts of interest inherent in its oversight provisions.
The West Virginia legislature proposed a bill that would grant the state Board of Medicine and the Board of Osteopathy the authority to license certain APRNs to prescribe medicines without the formal, written collaborative agreement currently required. The bill would separate West Virginia from the at least two dozen states that currently restrict prescription authority to APRNs practicing pursuant to some form of collaborative arrangement with a licensed physician.
However, the West Virginia prescribing license would be limited to an APRN who: (1) has at least five years of clinical prescribing experience in a collaborative arrangement with a physician; (2) is working solely in an area that has been designated as a health professional shortage area; and (3) has a recommendation from his or her collaborative physician for independent prescribing authority. Further, two categories of APRNs – certified nurse midwives and certified registered nurse anesthetists – would not be permitted to prescribe without a written collaborative agreement with a physician.
The FTC praised the proposed legislation’s loosening of regulatory restrictions on APRNs, stating that such action could expand access to primary care and reduce health care costs, particularly for vulnerable populations that lack access to basic primary care. But the Commission cautioned that “excessive restrictions” may undercut these benefits. First, the geographic restriction cuts out many otherwise-qualified APRNs. Second, the physician recommendation requirement and oversight by the Boards of Medicine and Osteopathy may create professional and financial conflicts of interest. The Commission commended the bill as a first step in removing restrictions but pushed the state to consider going further, providing support to APRNs looking for independent access to the prescription pad.
The FTC’s comments can be found here.