UPDATE ON COMPREHENSIVE ADDICTION AND RECOVERY ACT (CARA)
Federal legislation entitled “Comprehensive Addiction and Recovery Act (CARA)” was signed into law on July 22, 2016 by President Obama. Included in the new law is a provision that would allow APRNs to prescribe Suboxone® (buprenorphine) for medically assisted treatment; however, prior to prescribing buprenorphine for the treatment of addiction, specific criteria (yet to be fully established) must be met. For example, completion of educational training addressing various topics will be required of the prescriber.
Until such time (up to eighteen months) that the Secretary of Health and Human Services (HHS) convenes a task force to develop best practices and establishes the guidelines for prescribing, (which will likely be communicated through the Federal Register), the state of Kentucky and the Kentucky Board of Nursing have no information to guide interested APRN licensees. Information will be made available to KY APRNs when guidance is received from the federal government. For additional information, please contact the Drug Enforcement Agency (DEA) at 1-800-882-9539 (8:30 am-5:50 pm ET) or DEA.Registration.Help@usdoj.gov
From HHS: https://www.hhs.gov/about/news/2016/11/16/additional-steps-expand-opioid-treatment.html
KRS 314.011(8) defines "advanced practice nursing practice"
KRS 314.195 states the advanced practice registered nurse shall be considered a practitioner for prescriptive authority purposes for non-scheduled legend drugs and controlled substances.
For practice issues not addressed in KRS 314.011(8), please utliize the APRN Scope of Practice Decision-Making Model or contact the APRN Education & Practice Consultant.
APRN Scope of Practice Decision Making Model [PDF Format - 232KB]
Inquiries have been received in the KBN office regarding a variety of issues surrounding advanced practice registered nurse (APRN) practice. These questions have been addressed in the information and links provided.
APRN FORMS FOR PRESCRIPTIVE AUTHORITY
KRS 314.196(2) states that if the Kentucky Board of Nursing and the Kentucky Board of Medical Licensure agree on a common CAPA-NS form, KBN shall require its use. Both Boards agreed on the form in 2015. The common CAPA-NS form is available below and shall be used by all APRNs who wish to enter into a CAPA-NS. The law does not mandate a common CAPA-CS form. An APRN and the collaborating physician may use any form as long as it meets the requirements of KRS 314.042(10). A sample of a form that meets these requirements can be found on the website of the Kentucky Coalition of Nurse Practitioners and Nurse Midwives (www.kcnpnm.org)
Prescribing Non-Scheduled Legend Drugs (CAPA-NS)
KRS 314.042(8)(a-g) provides information about requirements to prescribe nonscheduled legend drugs.
KRS 314.042 (9)(a-e) states that the APRN who has maintained a CAPA-NS for four (4) years or more will no longer be required to maintain a CAPA-NS and shall not be compelled to maintain a CAPA-NS as a condition to prescribe after the four (4) years have expired, but an advanced practice registered nurse may choose to maintain a CAPA-NS indefinitely after the four (4) years. The KBN must be notified that an APRN is discontinuing a CAPA-NS.
Prescribing Controlled Substances (CAPA-CS)
KRS 314.042(10)(a) provides detail about prescribing controlled substances.
Collaborative Agreement CAPA-CS Form
The law does not mandate a common CAPA-CS form. An APRN and the collaborating physician may use any form as long as it meets the requirements of KRS 314.042(10). A sample of a form that meets these requirements can be found on the website of the Kentucky Coalition of Nurse Practitioners and Nurse Midwives
NOTE: When submitting the Notification of CAPA-CS form to KBN you must provide a copy of your DEA registration.
KASPER Registration KRS 218A.202, 201 KAR 20:057
ALL BUTALBITAL CONTAINING PRODUCTS (Fioricet, Bupap, Esgic, etc.) are SCHEDULE III CONTROLLED SUBSTANCES in the Commonwealth of Kentucky and are NOT exempt from the licensing, distribution, and recordkeeping provisions of KRS 218A.150-218A.172, 218A.180, and 218A.200. Prescriptions for butalbital containing products must be reported to KASPER.
Effective September 17, 2014, a prescriber without a DEA license cannot write or issue a prescription for a butalbital containing product (Fioricet, Bupap, Esgic, etc.) . In addition, any remaining refills on a butalbital containing product prescription issued by a prescriber without a valid DEA license may NOT be dispensed. If a DEA licensed prescriber issued a prescription for a butalbital containing product with refills AND it has not been more than 6 months from the date written, it MAY be refilled. Exception: APRNs who have a valid DEA Number are not permitted to write refills for butalbital containing products as APRNs are not permitted to write refills on Schedule III medications.
For questions regarding the changes made to 902 KAR 55:045 and 902 KAR 55:090, please call the Drug Enforcement and Professional Practices Branch at 502-564-7985.
House Bill 1 Materials
In 2012, HB1 established new procedures for the Board of Medical Licensure, established new requirements for physicians, required specific sanctions for certain conduct, required the Board to set out prescribing/dispensing standards in regulations, and established ownership and other requirements for pain management facilities.
Please view this page for a free training opportunity regarding House Bill 1 provided by CECentral.
APRNs & Medication Samples
The 2000 Regular Session of the General Assembly amended KRS Chapter 314 to allow advanced practice registered nurses to receive and dispense sample drugs. The applicable statutes are as follows:
KRS 314.011(8) states, in part: "‘Advanced practice registered nursing’ means the performance of additional acts . . . Advanced practice registered nurses who engage in these additional acts shall be authorized to issue prescriptions for and dispense nonscheduled legend drugs as defined in KRS 217.905, ...under the conditions set forth in KRS 314.042."
KRS 314.011(17) states: " ‘Dispense’ means to receive and distribute noncontrolled legend drug samples from pharmaceutical manufacturers to patients at no charge to the patient or any other party."
KRS 314.042(8) states: "Before an advanced practice registered nurse engages in the prescribing or dispensing of nonscheduled legend drugs as authorized by KRS 314.011(8), the advanced practice registered nurse shall enter into a written collaborative agreement for the APRN's prescriptive authority for nonscheduled legend drugs (CAPA-NS) with a physician that defines the scope of the prescriptive authority for nonscheduled legend drugs."
The 2006 Regular Session of the General Assembly amended KRS Chapter 314 to give APRNs limited authority to write prescriptions for controlled substances, but did not permit an APRN to receive and distribute, nor dispense, controlled substance samples.
Dispensing by Nurses.pdf