Missouri House introduces bill to expand advanced practice registered nurse prescribing authority

On March 27, 2025, the Missouri State Legislature introduced House Bill 327, aimed at revising the prescriptive authority of advanced practice registered nurses (APRNs) in the state. This bill, sponsored by Representative Casteel, seeks to repeal existing sections 195.070 and 334.104 of the Revised Statutes of Missouri and replace them with updated provisions that expand the scope of practice for APRNs.

The primary purpose of House Bill 327 is to enhance the ability of APRNs to prescribe controlled substances, specifically allowing them to prescribe medications classified under Schedules III, IV, and V. Additionally, the bill proposes limited authority for APRNs to prescribe certain Schedule II medications, including those containing hydrocodone, as well as benzodiazepines and stimulants for hospice patients. This change is intended to address the growing demand for healthcare services and improve access to care, particularly in underserved areas.

During the legislative discussions surrounding the bill, there has been notable debate regarding the implications of expanding prescriptive authority for APRNs. Proponents argue that this measure will alleviate the burden on physicians and enhance patient care by allowing APRNs to manage more aspects of treatment independently. They emphasize that APRNs are highly trained professionals capable of making informed decisions regarding patient prescriptions.

Conversely, some opposition has emerged from various medical associations concerned about patient safety and the potential for over-prescription. Critics argue that the existing collaborative practice arrangements may not sufficiently ensure oversight and that the expansion of prescriptive authority could lead to increased risks associated with controlled substances.

The economic implications of House Bill 327 are significant, as it could potentially reduce healthcare costs by streamlining the prescription process and increasing the efficiency of care delivery. Socially, the bill aims to improve healthcare access for patients, particularly in rural areas where medical professionals are scarce.

As the bill progresses through the legislative process, its future remains uncertain. Stakeholders are closely monitoring discussions and potential amendments that may arise as lawmakers weigh the benefits of increased APRN authority against concerns for patient safety. The outcome of House Bill 327 could set a precedent for similar legislative efforts in other states, reflecting a broader trend toward expanding the roles of non-physician healthcare providers in the evolving landscape of healthcare delivery.