Michigan’s Rules and Regulations for Prescriptive Authority
Since 1978 the Occupational Regulation Sections of the Michigan Public Health Code provided physicians (M.D. & D.O.) with the authority to delegate the prescription of drugs. Because the law was specific to PAs, in 1980 the Michigan Nurses Association (MNA) asked Attorney General Frank Kelley to issue an opinion concerning the authority of a physician to delegate prescribing to a registered professional nurse. The opinion concluded that other than controlled substances, physicians MAY delegate to a licensed professional nurse. The law does not differentiate between an RN and APN. The physician may not delegate unlimited authority to prescribe. A summary of the limitations from the opinion is as follows:
· The physician delegates the prescribing of only those medications which fall within the physician’s scope of practice. What this means for NPs is that delegation of full prescriptive authority from a physician without a similar specialty is prohibited, e.g. -an FNP cannot prescribe cardiac medications, etc. if the ‘delegating’ physician is a Pediatrician, Psychiatrist, etc.
· Delegation is the “authorization granted by a licensee (physician) to an unlicensed and licensed individuals (RNs and PAs) to perform selected tasks (prescribing) or functions that fall outside the scope of practice of the delegate (R.N. & PA) and which, in the absence of the authorization, would constitute illegal practice of the licensed profession.”
· The physician MAY NOT delegate prescribing which requires the physician’s level of education, skill and judgment.
· Prescription of controlled substances cannot be delegated (this changed in November 1999, and may now be done in accordance with specific rules – see below).
On November 17, 1999, new rules authorizing but not requiring physicians (both M.D.s and D.O.s) to delegate the prescribing controlled substances to nurse practitioners. The new rules were based on the 1978 statute contained in the Public Health Code but required a change in Administrative Rules to implement. Administrative Rules 338.2304/338.2305 (Medicine) and Rules 338.108a/338.108b (Osteopathic) have identical requirements for physicians who elect to delegate the prescribing of controlled substances (3-5) to PAs, NPs, and CNMs. When delegating Schedule 3-5 controlled substances, the rules require a delegating physician to:
· Establish a written authorization (which should be kept at each place of practice) containing the signatures and license numbers of both parties
· Record limitations or exceptions to the delegation, if any
· Document the effective date of the delegation
· Review and update the authorization annually and record amendments, if any
The pharmacy section of the Public Health Code (PHC) specifically states the delegating physician’s name must be “used, recorded, or otherwise indicated” (PHC section 333.17708#2) when prescriptions are being written by other licensed health professionals. Some pharmacies interpret this to mean that the ‘delegating’ physician’s name MUST appear on the pharmacy label; however, the Public Health Code does not indicate that. It says “the prescribers name…” must be on the label. Under the ‘definition’ of prescriber, NPs and CNMs are classified as ‘…. other health care professionals.’ Under PHC Section 333.17745b, “A dispensing prescriber (physician)…shall not delegate the dispensing of more than a 72 h-hour supply (of medications).”
The Administrative Rules provide that Schedule 2 controlled substances can only be delegated if both the delegating physician and the NP are practicing within a hospital, freestanding surgical outpatient facility, or hospice. In this instance, a prescription cannot be issued for more than a 7-day period to a patient who is being discharged. The Michigan Official Prescription Program rules (333.7334) apply. No differentiation between narcotic/stimulant and non stimulant medications are made re: Schedule 2’s.
The rules also prohibit a physician from delegating the prescription of a drug or device individually, in combination, or in succession for a woman known to be pregnant with the intention of causing miscarriage or fetal death.
The Drug Enforcement Agency (DEA) requires NPs and CNM to obtain federal DEA numbers for prescribing controlled substances. As NPs and CNM are ‘delegated’ prescribers in Michigan, the state does not require a state DEA license.
This document was partially developed from the Michigan Nurses Association “FAQ on Advanced Practice Nursing” document. Information regarding rules, regulations and reimbursement changes frequently. The reader is advised to ensure that all the information pertaining to practice is current.