APRNs Prescribing Weight Loss Medications
At its May 18, 2015 meeting, the Committee on Prescriptive Governance (CPG) determined that three medications approved by the FDA for long-term weight management may be prescribed by APRNs with a CTP (CTP holder) if agreed to by the CTP holder and his/her collaborating physician and stated within the CTP holder’s standard care arrangement. These are two schedule- IV medications, phentermine/topiramate (Qsymia), and locaserin (Belviq), as well as non-controlled naltrexone hydrochloride/ buproprion hydrochloride (Contrave). The CPG determination is specific to Qsymin, Belviq and Contrave only. CTP holders continue to be prohibited from prescribing all other anorexiants including, but not limited to phentermine (Adipex). The prescribing designation for anorexiants can be located on page 15 of The Formulary Developed by the Committee on Prescriptive Governance (The Formulary). The Formulary can be accessed on the Board of Nursing website: www.nursing. ohio.gov under the “Practice APRN” link.
Although the Formulary allows CTP holders to prescribe these three drugs under the circumstances documented by their respective standard care arrangement, there are other factors that must be considered by the CTP holder prior to initiating Qsymin, Belviq or Contrave prescriptions for patients. These include, but are not limited to:
Whether the care and treatment of obese patients and weight management is new to the APRN’s existing practice, and whether this aspect of practice is within the APRN’s national certification and patient population specialty, meeting the scope of practice requirements in Section 4723.43, ORC. If not, additional education or an additional certification may be needed. In addition, Section 4723.431(A), ORC, requires the APRN’s collaborating physician to be practicing in Ohio in a specialty that is the same or similar to the nurse’s nursing specialty.
Section 4723.481(B), ORC, prohibits the prescriptive authority of the CTP holder from exceeding the prescriptive authority of the collaborating physician. Should the collaborating physician have restrictions on his/her ability to prescribe controlled substances including controlled substance weight loss medications, the CTP holder would be limited by the same restrictions.
The administrative rules, Advanced Practice Registered Nurse Certification and Practice, contained in Chapter 4723-8, of Ohio Administrative Code (OAC), require all APRNs to utilize and incorporate into the nurse’s practice knowledge of Chapter 4731.,ORC, and rules adopted under that chapter by the State Medical Board that govern the practice of the nurse’s collaborating physician. With respect to the care and treatment of patients with obesity, APRNs are required to incorporate the State Medical Board rules applicable to physicians and prescribing practices. This includes Chapter 4731-11, OAC, Controlled Substances pertaining to the prescribing of schedule II, III, and IV medications for purposes of weight loss. A link to Chapter 4731-11, OAC, is also provided on page 15 of the Formulary.
The nursing law and rules are available for review on the Board’s website www.nursing.ohio.gov under the “Law and Rules” link.
The website for State Medical Board of Ohio is: www.med.ohio.gov.