Committee approves bill letting APRNs substitute equivalent stimulant medications with physician notification

The Arkansas Public Health Committee voted to pass House Bill 1963 as amended, allowing an advanced practice registered nurse (APRN) to substitute a therapeutically equivalent stimulant medication in specified situations, with a requirement that the APRN notify the physician who originally wrote the prescription.

Sponsor State Senator Justin Boyd of Fort Smith told the committee the amendment was “an agreed to amendment between the bill sponsor and the medical society to clarify that if a substitute is made under the bill as drafted, that, notice would go back to the original physician.”

The bill, as explained in committee, would permit an APRN to substitute a therapeutically equivalent stimulant medication — examples cited at the hearing included Vyvanse, Focalin XR and Adderall XR — when issues such as prior authorization or formulary restrictions prevent dispensing the originally prescribed product. Under current practice described in committee, APRNs may write ongoing prescriptions for these medicines but a physician must write the initial prescription and patients must be seen by a physician at least every six months.

Senator Peyton asked whether the APRNs referenced operate independently; the sponsor clarified APRNs can work in either independent clinics or physician clinics.

Committee members adopted the agreed amendment requiring notification to the original physician. The committee then moved and voted “do pass as amended.” The transcript records the chair saying, “Ayes have it,” and the chair announced that House Bill 1963 passed as amended.

The committee record did not include a roll-call tally or the names of the motion mover and seconder in the transcript.