Nurse Practitioner Prescriptive Authority in Missouri
Yes, nurse practitioners can prescribe medications in Missouri, but they must do so under a collaborative practice agreement with a physician—Missouri does not grant full independent prescriptive authority to NPs.
Legal Framework in Missouri
Missouri operates under a restricted scope of practice model for nurse practitioners regarding prescriptive authority 1. This means:
- NPs cannot prescribe independently without physician oversight 1
- A collaborative practice agreement with a physician is mandatory for prescribing activities 2, 3
- Both practice authority and prescriptive authority require physician supervision in Missouri 2, 1
Prescribing Categories
Controlled Substances
- NPs can prescribe controlled substances when authorized under their collaborative practice agreement 4
- The collaborative agreement must specifically delineate which controlled substances the NP may prescribe 4
- This authority enhances flexibility and timeliness in primary care delivery 4
Non-Controlled Medications
- Standard prescription medications can be prescribed within the scope defined by the collaborative practice agreement 2, 3
- The supervising physician must be available for consultation 2
Key Requirements
Collaborative Practice Agreement Must Include:
- Specific medications the NP is authorized to prescribe 4
- Protocols for physician consultation 2
- Scope of prescriptive authority boundaries 1
Common Pitfalls to Avoid
- Do not prescribe outside your collaborative agreement scope - this violates Missouri law and puts your license at risk 1
- Ensure your supervising physician is properly credentialed and the collaborative agreement is current 2
- Document all prescribing decisions and consultations with your collaborating physician 4
- Verify DEA registration requirements for controlled substance prescribing under your collaborative agreement 4
Clinical Implications
Research demonstrates that NP prescriptive authority does not compromise quality or safety when properly implemented 2. Studies show that scope of practice expansions for NPs with prescriptive authority:
- Do not increase potential for abuse or misuse of prescriptive authority 2
- Improve access to care, particularly in physician-underserved areas 3
- Decrease healthcare costs while maintaining quality 4
However, in Missouri's restricted model, these benefits are achieved within the physician supervision framework 1.