Prescriptive Authority

Who are considered prescribers?

physicians (MD/DO)

dentists

optometrists

podiatrists

veterinarians

physician assistants

advanced practice registered nurses

nurse anesthetists

other healthcare professionals acting under delegation

What is "scope of practice"?

Defines the legal procedures, actions, and limitations that healthcare professionals may perform under their license, including what medications they may prescribe and what pharmacists may dispense.

What prescriptions may pharmacists dispense from physicians?

Noncontrolled prescriptions from Michigan, out-of-state, and Canadian physicians

Controlled substance prescriptions from Michigan or out-of-state physicians authorized to prescribe controlled substances

What controlled substances may Michigan optometrists prescribe?

Schedule III-V controlled substances

Schedule II hydrocodone combination products

may NOT prescribe oral corticosteroids.

Are prescriptions from out-of-state optometrists valid in Michigan?

No

What limitations exist on podiatric practice?

May not perform amputations of the human foot

May only administer local anesthetics, not general anesthetics

Can Michigan pharmacists dispense prescriptions from out-of-state podiatrists?

No

How did Michigan law change regarding physician assistants (PAs)?

PAs may prescribe medications independently under a physician practice agreement.

What prescriptions may Michigan pharmacists dispense from physician assistants?

Noncontrolled prescriptions from Michigan, out-of-state, and Canadian PAs

Controlled substances from Michigan PAs authorized with both a controlled substance license and DEA registration.

How do physician assistants prescribe controlled substances independently?

Only the PA's name and DEA number are required on the prescription; physician countersignatures are not required.

What is delegation?

Authorization from a licensed healthcare professional allowing another individual to perform tasks outside that individual's normal scope of practice.

What types of tasks cannot be delegated?

Tasks requiring advanced education, skill, or professional judgment.

Who may delegate prescriptive authority in Michigan?

Only licensed MDs or DOs

Which healthcare professionals commonly receive delegated prescriptive authority in Michigan?

pharmacists

registered nurses

registered nurses with specialty certifications

What is a collaborative practice agreement (CPA) in pharmacy?

An agreement between a pharmacist and physician allowing pharmacists to initiate, modify, discontinue, or monitor drug therapy and provide disease state management.

What immunizing authority do Michigan pharmacists have?

Pharmacists may independently order and administer CDC/ACIP qualified immunizing agents to individuals age 3 years and older

What reporting requirement exists after pharmacists administer immunizations?

Immunizations given to individuals age 20 or older must be documented to the Michigan Care Improvement Registry within 72 hours.

What laboratory tests may pharmacists independently order and administer in Michigan?

nasal/throat swabs or finger pricks for COVID-19, influenza, or respiratory infections

When may pharmacists dispense antiviral medications without a prescription?

After already administering a qualified COVID-19 or influenza test

What specialty fields may an RN obtain in Michigan?

Certified Nurse-Midwife (CNM)

Nurse Practitioner (NP)

Clinical Nurse Specialist (CNS)

Certified Registered Nurse Anesthetist (CRNA)

What healthcare professionals are classified as advanced practice registered nurse (APRNs) in Michigan?

Certified Nurse-Midwives (CNMs)

Nurse Practitioners (NPs)

Clinical Nurse Specialists (CNSs)

What medications may RNs and CRNAs prescribe under delegation?

Only noncontrolled prescription drugs delegated by a physician.

Can RNs or CRNAs prescribe controlled substances under delegation?

No

What information is required when pharmacists dispense prescriptions written by RNs or CRNAs?

Both the prescribing RN/CRNA and the delegating physician must appear on the prescription.

What prescribing authority do APRNs have?

They may independently prescribe noncontrolled substances.

May prescribe controlled substances only under physician delegation and the APRN's DEA registration number.

Are APRNs required to hold a controlled substance license in Michigan?

No. They are not currently required to maintain a separate controlled substance license.

What controlled substance limitation applies under delegated authority?

A Schedule II controlled substance prescription may not exceed a 30-day supply on a single prescription.

Who are NOT considered prescribers?

psychologists

physical therapists

chiropractors

Michigan pharmacist may dispense tramadol prescription from?

physician (MD or DO)

dentist (DDS)

veterinarian (DVM)

all of the above

all of the above

Michigan pharmacist may dispense prescription written by (licensed in Canada)?

a) noncontrolled substance by MD, DO or DDS

b) noncontrolled substance by MD or DO

c) noncontrolled substance by MD, DO or DVM

d) noncontrolled or controlled substance by MD or DO

noncontrolled substance by MD or DO

Optometrist may prescribe:

Alphagan P for a patient with open-angle glaucoma.

Polytrim for a patient with acute bacterial conjunctivitis.

Pred Forte for a patient with an inflamed conjunctiva.

Prednisone for a patient presenting with diagnosis for

conjunctivitis.

Oxycodone for a patient undergoing surgery.

Alphagan P for a patient with open-angle glaucoma.

Polytrim for a patient with acute bacterial conjunctivitis.

Pred Forte for a patient with an inflamed conjunctiva.

Patient presents with an empty lisinopril bottle prescribed by Canadian physician with no refills. Pharmacist should:

a) call physician office to obtain verbal refill order from US licensed physician

b) decline and refer to urgent care

c) decline and call another pharmacy for transfer

d) authorize one refill

call physician office to obtain a verbal refill order from a US licensed physician

A pharmacist may dispense a noncontrolled prescription written by a Michigan-licensed ____

MD

DO

DDS

DVM

OD

DPM

PA

RN

CRNA

APRN

All of the above

A pharmacist may dispense a noncontrolled prescription written by an out-of-state-licensed ____

MD

DO

DDS

DVM

OD

DPM

PA

RN

CRNA

APRN

All of the above except OD, DPM, RN, CRNA

A pharmacist may dispense a noncontrolled prescription written by a Canadian-licensed ____

MD

DO

DDS

DVM

OD

DPM

PA

RN

CRNA

APRN

MD, DO, PA, APRN

A pharmacist may dispense a controlled prescription written by a Michigan-licensed ____

MD

DO

DDS

DVM

OD

DPM

PA

RN

CRNA

APRN

All of the above except RN, CRNA

A pharmacist may dispense a controlled prescription written by an out-of-state-licensed ____

MD

DO

DDS

DVM

OD

DPM

PA

RN

CRNA

APRN

MD, DO, DDS, DVM

A pharmacist may dispense a controlled prescription written by a Canadian-licensed ____

MD

DO

DDS

DVM

OD

DPM

PA

RN

CRNA

APRN

None of the above