A bill to allow physician assistants to prescribe highly regulated drugs, a step advocates say is needed to improve health-care access in rural Kentucky, is finally moving through the legislature.

“Kentucky is the last state in the U.S. where PAs don’t have some form of controlled-substance delegation. The other 49 states have it already,” said the bill’s main sponsor, Rep. Steve Sheldon, R-Bowling Green. “And no state has ever reduced or rescinded the authority that has been given.”

House Bill 135 would allow “modified prescriptive authority” of controlled substances in Schedules II, III, IV, and V after the PA has been licensed and has practiced for one year.

It passed the House Health and Family Services Committee Jan. 30 with a committee substitute. This was the fourth time the legislation had been filed, and the first time it had been brought up in committee for a vote.

Leaders of the Kentucky Academy of Physician Assistants urged passage of the bill, explaining that under the current system a supervising physician has to sign off on any controlled substance prescription written by a PA. They said this results in decreased access to care, delays in care, poor prescribing transparency, and ultimately results in Kentucky PAs moving to other states.

“Our graduating PA students are leaving the state of Kentucky to practice in other states where they have less restrictions and more job opportunities,” said Laurie Garner, president of KAPA. “By passing this bill we will keep our best and our brightest in our state rather than seeing them leave for better opportunities elsewhere.”

She also offered an example of how the system results in delayed care, noting that because she is often the only provider at her clinic, her patients who need a controlled substance prescription or a refill must wait until the supervising physician is able to co-sign for it, and often end up canceling appointments when she can’t immediately help them.

Andrew Rutherford, vice-president of KAPA, said the bill would increase transparency, since drugs would be ordered under the PAs’ Drug Enforcement Administration numbers instead of their supervising physicians’ numbers.

“It will also allow PAs to be accountable for the controlled medications that they prescribe, based on their treatment plans,” he said. “Currently a supervising physician signs off on all these prescriptions and this is falsely inflating many physicians’ prescribing numbers.”

The bill includes several restrictions, including only allowing PAs to prescribe a three-day supply of Schedule II drugs, with no refills. Schedule II and III non-narcotic substances would be limited to a 30-day supply with no refill; and Schedule IV and V drugs would be limited to the original prescription, with refills to not exceed a six-month supply.

It also carves out several Schedule IV drugs that can only be written as a 30-day supply without any refills, including: diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax) and carisoprodol (Soma).

Administration of the program would fall under the Kentucky Board of Medical Licensure, and a PA’s license to prescribe such drugs would need to be renewed every two years. The measure also includes new rules around continuing education requirements, including a number of required hours related to controlled substances.

Under the regulation, PAs would still have to work under the supervision of a medical doctor and that physician would be allowed to limit which controlled substances their PAs can prescribe, or if they want to participate in the program.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.