With the exception of Clinical Nurse Specialists (CNS), Advanced Practice Registered Nurses (APRN) who have current Board authorization may register with the Department of Public Health Drug Control Program (DCP) for prescriptive authority.
PLEASE NOTE: It is not legal to prescribe or write orders for any prescription drug or controlled substance until the appropriate state and federal registration numbers are issued.
How do I apply for prescriptive authority?
Prescriptive authority is granted by the Department of Public Health - Drug Control Program (DCP) and the Drug Enforcement Administration (DEA) after you receive the Board's authorization to practice as an APRN. You can obtain the DCP application for a Massachusetts Controlled Substances Registration (MCSR) online: Massachusetts Controlled Substances Registration (MCSR) or by calling (617) 983-6700. Please Note: The DCP definition of “controlled substances” includes all drugs, substances, or immediate precursors in any schedule.
What are Prescriptive Guidelines; where do I get them?
Guidelines are written instructions and procedures describing the methods that an APRN with prescriptive practice is to follow when managing medications for a health care situation which specifies those instances in which referral to or consultation with a physician is required for appropriate medication management. When appropriate, as determined by the APRN and supervising physician, guidelines shall also address procedures for the ordering of tests and therapeutics.
CNP, CRNA, and PCNS are required to have guidelines for prescriptive practice. CNM prescriptive practice does not require guidelines. CNS are not authorized by statute to register for prescriptive practice.
Guideline development is an opportunity for an APRN to collaborate with a physician regarding the parameters of their prescriptive practice. Guideline development and maintenance are a joint responsibility of the APRN and physician with whom the guidelines are established. The Board regulations at 244 CMR 4.07 address specific requirements that must be included in the prescriptive guideline document. The Board offers an audit tool to assist with guideline content compliance. There is no requirement for third party review, however, the Board may request a copy of the document at any time to assess compliance. Guidelines are public documents, and an APRN that is mandated to have prescriptive guidelines must make a copy of the guidelines available to any person upon request.
I am employed in more than one practice setting. Do I need to develop prescriptive guidelines for each setting?
When a CNP, CRNA, and a PCNS registers with the Department of Public Health - Drug Control Program (DCP) for prescriptive practice they are required to provide the name and credentials of the physician with whom they have established and signed prescriptive guidelines. If you are employed in additional settings in which the physician with whom the established and signed prescriptive guidelines is not, you may be required to amend your Massachusetts Controlled Substances Registration (MCSR) to reflect the establishment of additional guidelines with an additional physician. Please refer to the DCP requirements at 105 CMR 700.000 and 105 CRM 721.000. Contact the DCP for additional information regarding MCSR requirements.
The physician with whom I developed and signed prescriptive guidelines is changing. Am I required to inform the Board?
No. Guidelines remain current for the two (2) year period from which they were originally signed and dated. When the physician with whom you developed and signed prescriptive guidelines changes prior to the end of the two (2) year period, the new physician with whom guidelines are established must review sign, and date the existing guidelines. Alternatively, the APRN and physician can agree to create a new document.
However, changes in physician supervision must be reported to the Massachusetts Department of Public Health – Drug Control Program (DCP) by submitting a request to amend your Massachusetts Controlled Substances Registration (MCSR). The amendment form can be found on the DCP web site.
My practice site is changing. Am I required to notify the Board?
No. When your practice site changes, contact the Drug Enforcement Administration (DEA), New England Field Division online or at: 1-888-272-5174 to amend the Federal registration for changes that include name, address, Schedule, and/or drug code changes. If your MCSR (MA Controlled Registration) is associated with your address, you will be required to amend the MCSR through the Drug Control Program.
Educational requirement as of 1-1-11
As of January 1, 2011, pursuant to MGL 94C, Section 18(e), all prescribers, upon initial application for MA Controlled Substance Registration (MCSR) and subsequently during each APRN license renewal period, must complete education relative to:
- effective pain management,
- identification of patients at high risk for substance abuse, and
- counseling patients about the side effects, addictive nature and proper storage and disposal of prescription medications.
Please note that MGL 94C, Section 18(e) does not specify a minimum number of contact hours to comply with this education requirement. All continuing education offerings must be consistent with the Board of Registration in Nursing (Board) requirements at 244 CMR 5.00: Continuing Education. Advisory Ruling 0901: Management of Pain includes the education requirement for APRNs with prescriptive authority.
By signing the MCSR form and by your signature on your license renewal form, you attest under penalties of perjury that you have complied with state tax and child support laws, mandatory reporting laws, and all Board laws and regulations, including continuing education requirements.
Prescription Monitoring Program (PMP)
Established in 1992, pursuant to joint regulations of Massachusetts Department of Public Health – Drug Control Program (DCP) (see 105 CMR 700.012) and the Board of Registration in Pharmacy (see 247 CMR 5.04), the PMP uses a computer-based, Electronic Data Transfer (EDT) system to collect prescription data from Massachusetts community, hospital outpatient and clinic pharmacies as well as from out-of-state mail order pharmacies that deliver to patients in Massachusetts. PMP is a tool that supports safe prescribing and dispensing and assists in addressing prescription drug misuse and abuse.
All MA prescribers will automatically be enrolled in the PMP upon renewal of the Massachusetts Controlled Substances Registration (MCSR). DCP is currently staggering this process. For additional information and to voluntarily enroll go to: www.mass.gov/dph/dcp/onlinepmp
This information is provided by the Division of Health Professions Licensure within the Department of Public Health.