Missouri Bill Would Expand Prescribing Authority for Nurse Practitioners

Missouri lawmakers are weighing a proposal to add rules in companion bills that could significantly expand the prescribing authority of advanced practice registered nurses (APRNs), potentially improving access to care across the state.

Currently, Missouri law requires nurse practitioners to maintain a formal collaborative agreement with a physician to prescribe controlled medications. It's one of the most restrictive states for NPs in the country. 

Supporters of the bill say the requirement creates unnecessary barriers to care and drives nurses to practice in neighboring states with fewer restrictions.

Supporters Say Change Could Improve Access to Care

The proposal was recently heard by the Senate’s Emerging Issues and Professional Registration Committee and remains under consideration.

The legislation, introduced by State Sens. Patty Lewis (D–Kansas City) and Nick Schroer (R–St. Charles), would allow qualified nurse practitioners and other APRNs to prescribe controlled substances without a collaborative agreement with a physician once they complete 2,000 documented hours working with a collaborating doctor.

According to Lewis, seven of Missouri’s eight neighboring states have less restrictive rules governing nurse practitioner prescribing authority.

Supporters also point to the cost of maintaining collaborative agreements. Some nurse practitioners report paying tens of thousands of dollars annually to maintain the required physician partnership. Currently, by law, nurse practitioners must pay a physician in order to have a "collaborative physician" agreement that allows NPs to prescribe medications outside of a hospital setting.

The requirement to pay a doctor sparked a 2025 lawsuit by a nurse practitioner who said she had the full support of her supervising physician.

“Yeah, I need permission basically to do my job, and there’s no set number on that. There’s really no oversight on you know who’s monitoring the collaboration, nobody is,” said Marcy Markes, a Nurse Practitioner in Missouri who filed the lawsuit. 

Markes' lawsuit is currently still ongoing. 

Lewis said the arrangement can sometimes function more as a financial obligation than a meaningful collaboration.

She also noted that some nurse practitioners choose to practice in nearby states, such as Kansas, where regulations allow greater autonomy.

Physician Groups Raise Patient Safety Concerns

Physician organizations, including the Missouri State Medical Association, have expressed caution about the need for rigorous physician oversight, pointing to the fact that a physician overseeing an NP remains liable for what the NP prescribe. 

In a statement responding to a 2025 lawsuit challenging the collaboration requirement, which some say was a driving measure behind the new proposals, the association described efforts to remove physician oversight as part of a broader national push to redefine scope-of-practice laws.

"Let’s be clear: this lawsuit isn’t just about one practitioner’s frustration—it’s part of a coordinated national campaign to dismantle physician oversight and redefine scope of practice through the courts," the statement reads. 

Proponents of keeping physician oversight of NP prescribing medications say collaboration agreements allow doctors to provide mentorship, clinical guidance, and oversight for advanced practice nurses.

What Nurses Need to Know 

Efforts to expand nurse practitioner prescribing authority in Missouri are not new. Similar bills have been introduced in previous legislative sessions but have not passed.

As the proposal moves through the legislative process, the debate highlights the ongoing national discussion on advanced nurse practitioner scope-of-practice laws, healthcare workforce shortages, and access to care.

🤔Nurses, what do you think? Should NPs be allow to prescribe medications without physician oversight? Share your thoughts in the discussion forum below!