On March 6, 2006, Kentucky's Governor signed into law a bill that grants advanced registered nurse practitioners (ARNPs) the authority to prescribe scheduled drugs. The signing of the bill was the culmination of work by the Kentucky Coalition of Nurse Practitioners and Nurse Midwives (KCNPNM) Legislative Task Force that began in 2003.

Kentucky ARNPs have had authority to prescribe nonscheduled drugs since 1996. Authority to prescribe nonscheduled drugs was obtained after a hard-won legislative battle led by KCNPNM. Since 1996, Kentucky ARNPs have successfully demonstrated their ability to safely and responsibly prescribe medications.

A Long Road to Victory

Although an ARNP scheduled drug prescribing bill passed the House in the 2004 and 2005 legislative sessions, both were stalled in the Senate. Opposition from the Kentucky Medical Association (KMA) was the driving force in stopping both bills. However, the 2004 bill was amended in a Senate committee to require the Kentucky Legislative Research Commission (LRC) to do a study on ARNP prescribing of controlled substances. The study was released in January 2005 and is available on the Kentucky LRC Home page at: http://www.lrc.ky.gov/lrcpubs/RR323.pdf. The bill in 2005 was in play until the last days of the session. Movement of the bill through the process both in 2004 and 2005 demonstrated that ARNPs had legislative support. Additionally, letters from physicians who supported ARNPs helped to generate support in the KMA and the General Assembly.

In the summer of 2005, several events occurred that helped to secure success in 2006. Our Senate bill sponsor, who is the chair of the Senate Licensing and Occupations Committee, requested that the KCNPNM Legislative Task Force and representatives from KMA appear before an Interim Joint House and Senate Licensing and Occupations Committee meeting. The Committee heard testimony from both groups and then directed both groups to work together to develop bill language. Further, it was directed that the bill language would be finalized prior to the end of the year and reported back to the Committee.

Language Acceptable to All

The KCNPNM Legislative Task Force, the KMA, and physicians from pain and psychiatric specialties met throughout the summer and fall, and ultimately developed bill language acceptable to all parties. This language granted ARNPs authority to prescribe schedule II-V drugs and did not include any supervisory language or joint oversight with the Board of Medicine. The Board of Nursing has sole regulatory authority. The bill language does require an ARNP to have a collaborative agreement for prescriptive authority of controlled substances with a physician and this agreement can restrict the prescribing authority of the ARNP more than what is included in the statute. The collaborative agreement applies only to prescribing and not to practice.

Companion ARNP scheduled drug prescribing bills were filed in both the House and Senate, but in 2006, it was the Senate bill that moved forward. The bill passed the Senate committee unanimously; passed the Senate by a vote of 32 to 4; passed the House committee unanimously; and passed the House by a vote of 77 to 17. The bill was signed on March 6 and was the first bill of the 2006 Legislative Session passed and signed into law.

Now, the KCNPNM Legislative Task Force is focused on helping to implement the law and educating Kentucky ARNPs about its requirements. The Kentucky Board of Nursing has been supportive of the legislation and is now working to have things in place when the law takes effect (July 15, 2006). Kentucky ARNPs are excited because they are no longer invisible healthcare providers without a Drug Enforcement Administration number, and we are looking forward to providing improved access to care for our patients.