Guidelines for prescribing out of state may be different for physicians, physician assistants, and nurse practitioners. Scope of practice regulations governing each profession places unique restrictions on prescribing. According to a literature review, for nurse practitioners, state scope of practice law may take one of three approaches to handling prescriptions written by NPs licensed in another state:
- Prescriptions written by out of state NPs are subject to the same rules as those written by NPs licensed in the state.
- Prescriptions written by out of state NPs are subject to the rules within the state which the NP is licensed.
- The filling of prescriptions written by nurse practitioners licensed out of state is prohibited.
Kentucky for example, takes the first approach. Prescriptions for controlled substances written by out of state advanced practice nurses may only be dispensed up to the authority the NP would have if licensed in Kentucky.
While State and Federal law dictates the scope of practice for physician, physician assistants and Nurse Practitioners, State and federal laws also govern the filling of prescriptions by pharmacies which affect the nurse practitioner's ability to prescribe. These laws specify when and how prescribing across state lines can occur. For example, the prescribing of controlled substances must occur within the boundaries of an established patient-provider relationship. The same holds true when it comes to prescribing across state lines. To fill a prescription written by a provider in another state, in states where it is allowable, the pharmacist may only do so 'in good faith' that a provider-patient relationship exists.
State law may also place additional stipulations on the filling of prescriptions written by providers licensed out of state. Such requirements can include specifications as to the method by which the medication is prescribed.
It would appear that overall, for nurse practitioners in most states, prescribing across state lines is allowable within the home states prescribing guidelines. Prescribing should always occur within the scope of practice for the state within which the NP is licensed, and often within the scope of practice in the state where the prescription is filled. Before prescribing out of state, the nurse practitioners should have a thorough understanding of the prescribing law in their home state, and the state(s) where they plan to prescribe.
A web link to a Medscape article that summarizes State to State APRN prescribing law has been provided below for review.
https://www.medscape.com/viewarticle/440315