Nurse Prescription Bill Makes A Comeback

Dec 1, 2015

The House Health Quality Subcommittee approved a bill Tuesday that would allow registered nurse practitioners and physicians assistants to prescribe controlled substances.

Rep. Cary Pigman (R-Avon Park) proposed the bill. He said Florida is the only state that does not allow these two professions to prescribe under a physician’s guidance.

"Now if you're a physician's assistant or nurse practitioner in another state contemplating moving to Florida, that's a big disincentive to move to Florida and yet we have a huge need in primary care,” Pigman said.

He said HB 423 could help lower health care costs. Instead of a patient seeing a nurse practitioner, then being referred to a doctor, they can skip a step.

Pigman gave the example of a patient twisting their ankle, and needing a painkiller for temporary relief.

“At the end of the day, you go home with your narcotic prescription, but in Florida, you have to have a step where you see a doctor,” Pigman said. “No benefit was given to you. You didn’t derive any additional care but you incurred an additional cost.”

“Now whether you paid it or your insurance company paid it, someone paid for that additional cost and that kind of waste we cannot afford in health care.”

Pigman, an emergency physician, also said it would help patients in rural areas have better access to medically necessary drugs where there may not be a physician nearby to prescribe them.

Physician groups like the Florida Medical Association have lobbied in the past against such proposals, though they did not speak about Pigman's bill during the meeting Tuesday.

Rep. Julio Gonzalez, a Venice Republican who is an orthopedic surgeon, said he would support the bill because it included the condition of physician supervision before nurse practitioners and physician assistants could prescribe controlled substances.

"The access to care of a patient, particularly, in a rural community, may be non-existent," Gonzalez said.

Rep. Matt Gaetz, a Fort Walton Beach Republican who opposed the bill, agreed that rural areas have health-care access problems. But he expressed concern that the proposal could be "thinning the soup" in quality of care in other areas.

An identical bill passed through the House earlier this year during both the regular and special session. It died in the Senate.

Pigman said opponents of the bill fear that expanding prescribing power could lead to over-prescribing, but he said there's no evidence to support that.

"The pill mill crisis that existed eight years ago was because of physicians,” Pigman said. “It was not because of nurse practitioners, it was not because of PA's. It was a physician problem, not a nurse practitioner problem.”