Prescriptive Authority1
- Efforts to expand access to primary care and reduce costs have resulted in increase in prescriptive authority for NPs (nurse practitioners).1
- In the majority of states, NPs can prescribe medications without physician supervision or via a collaborative approach with a physician.2
- Additional Educational Requirements for NP Prescriptive Authority Often Include the Following:2
- Average of 30-45 contact hours in clinical pharmacology
- Completion of course work in pharmacotherapeutic, pathophysiology, physical assessment, etc.
- Completion of continuing graduate education credits in pharmacology
- Completion of board approved educational programs
- Physician supervised experience
- Additional Educational Requirements for NP Prescriptive Authority Often Include the Following:2
- In the majority of states, NPs can prescribe medications without physician supervision or via a collaborative approach with a physician.2
Specific Prescription Restrictions for Nurse Practitioners
- Schedule II Controlled Substances
- Schedule II: Drugs with high potential for abuse and/or high risk of physiological/physical dependence if misused.3
- Medications prescribed to treat severe pain, insomnia, anxiety, and ADHD disorders.3
- Certain states have limitations for NP prescribing authority, regardless of completion of additional educational requirements, regarding Schedule II controlled substances:2
- Arkansas, Florida, Georgia, Missouri, Oklahoma, South Carolina, & West Virginia
- Schedule II: Drugs with high potential for abuse and/or high risk of physiological/physical dependence if misused.3
- Schedule III-V Controlled Substances
- Schedule III: Drugs with moderate to low risk of physical/psychological dependence.3
- Ex: Tylenol with codeine (less than 90 milligrams), ketamine, and anabolic steroids, etc.3
- Schedule IV: Drugs with low potential for risk of abuse and/or dependence.3
- Ex: Xanax, Ativan, Valium, etc.3
- Schedule V: Drugs with lower potential for abuse than Schedule IV, preparations contain limited quantities of narcotics.3
- Ex: Cough medications (less than 200mg of codeine or per 100 milliliters), seizure medications, nerve pain medications, etc..3
- With the completion of state-mandated additional educational requirements, NPs are able to prescribe Schedule III-V medications in states where they may prescribe independently or in collaboration with physicians.
- Schedule III: Drugs with moderate to low risk of physical/psychological dependence.3
ADPIE (Assessment, Diagnosis, Planning, Implementation, & Evaluation) Framework for NPs to Enhance Patient Medication Adherence:4
Assessment of Non-Adherence
- Determine whether a patient is non-adherent by utilizing valid and reliable tools for measuring medication adherence.4
- Note: Current strategies often rely heavily on pharmacy claims data, which may lack accuracy and fail to capture the full scope of adherence behavior.4 Additionally, many providers lack adequate training in accurately assessing medication adherence, underscoring the need for improved education and standardized assessment methods.4
Diagnosis of Non-Adherence
- Accurately identifying the reasons and extent of medication non-adherence is a critical first step in improving treatment outcomes.4
Planning for Enhancing Adherence
- Enhancing medication adherence begins with patient-centered care planning that addresses the individual’s unique barriers, facilitators, and behavioral factors influencing treatment engagement.4
- Providers should develop tailored care plans that promote consistent adherence by:
- Identifying and addressing facilitators and barriers to medication-taking behavior.4
- Incorporating shared decision-making, empowering patients to take an active role in medical decisions that reflect their values, goals, and preferences.4
- Promoting patient awareness and engagement through comprehensive education about the importance of adherence and strategies for successful treatment participation.4
Implementation of Adherence Interventions
- Effective adherence interventions should be tailored to address patient-specific barriers to medication-taking behaviors.4 These interventions aim to reduce obstacles, minimize non-adherence behaviors, and reinforce positive adherence patterns that support long-term treatment success.4
- Interventions shown to be effective in improving adherence often include:
- Behavioral approaches that target and modify patient habits or routines.4
- Community- or home-based programs that extend support beyond traditional healthcare settings.4
- Pharmacist-led interventions, which provide accessible, personalized guidance and ongoing monitoring.4
Repeated Evaluation of Efficacy of Adherence Interventions
- Providers should regularly reassess the effectiveness of medication adherence interventions.4 Ongoing evaluation helps determine whether implemented strategies, such as those targeting forgetfulness, are achieving the desired outcomes.4 It also offers valuable insight into additional barriers that may emerge over time and require further intervention.4 Because medication nonadherence is a multifaceted challenge, it often demands a combination of sustained and comprehensive approaches to effectively address all contributing factors.4
Why Nurse Practitioners (NPs) May be Vital Asset in Enhancing Medication Adherence
Trusted Voices in Patient Care
- For 23 consecutive years, nurses have been rated the most trusted profession in America.5, 6
- Higher trust can translate into a stronger therapeutic alliance via greater patient openness, better communication, and stronger adherence to prescribed treatments.
The Importance of Time and Connection
- NPs consistently spend more time with their patients than other providers when compared to medical doctors, physician assistants, and pharmacists.7
- Over 60% of NPs spend 15+ minutes per patient visit.7
- Patients spend 86% of total appointment time with nurses, compared to just 13% with physicians.6
Personalized, Patient-Centered Care
Nurse practitioners act as the bridge between diagnosis and daily life.5
- They translate complex medical recommendations into actionable, understandable steps, reinforcing why treatment matters and how to stay on track.8
- Patients consistently describe encounters with NPs as personal and compassionate, which helps them feel supported, understood, and accountable.5, 8
AdhereTech: Supporting Nurse Practitioners with Ensuring Medication Adherence
Nurse practitioners (NPs) can play a pivotal role in promoting medication adherence given their trusted, patient-centered approach to care. By spending meaningful time with patients, NPs can translate complex medication instructions into understandable, actionable steps.7, 8 Their ability to connect with patients and provide more personalized support makes them uniquely positioned to address non-adherence.
AdhereTech’s Aidia System supports NPs in promoting medication adherence by reducing administrative burdens and improving workflow efficiency. Its automated, remote monitoring provides NPs with real-time adherence data, automatically flagging patients who deviate from their prescribed regimens. Patients can also report reasons for missed doses, offering valuable insights into barriers they face in taking medications as instructed.
By capturing this information in real time, NPs can identify patients at risk of non-adherence early and intervene proactively, rather than retrospectively. This enables more focused, individualized care, allowing NPs to tailor interventions to each patient’s specific needs and improve overall treatment outcomes.
With smart adherence solutions such as AdhereTechs, offering timely reminders, supporting habit formation, and providing actionable insights tailored to each patient’s needs, NPs can engage with their patients more efficiently and effectively. By integrating digital adherence tools into their practices, NPs can reinforce treatment plans, empower patients, and improve both short-term adherence and long-term health outcomes.
References
1 Duff‑Brown, B. (2023, October 24). Nurse practitioners as safe as physicians in prescribing medication for older patients, study finds. Stanford Medicine. https://med.stanford.edu/news/all-news/2023/10/nurse-practitioner-prescribing.html (med.stanford.edu).
2 American Medical Association. (2017). State law chart: Nurse practitioner prescriptive authority [Chart]. https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/specialty%20group/arc/ama-chart-np-prescriptive-authority.pdf
3 United States Drug Enforcement Administration. (n.d.). Drug Scheduling. https://www.dea.gov/drug-information/drug-scheduling
4 McDermott, J. (2023). Nurse Practitioner Guide to Achieving Medication Adherence Using the ADPIE Framework. The Journal for Nurse Practitioners, 19(10), 104791.
5 Hemp, N. (2025). Patient perception of nurse practitioner care, nurse practitioner scope of practice and how that influences provider choice (Doctoral Project No. 186). San José State University. https://doi.org/10.31979/etd.m7kp‑s2aa (scholarworks.sjsu.edu)
6 Brenan, M., & Jones, J. M. (2024, January 22). Ethics ratings of nearly all professions down in U.S. Gallup. https://news.gallup.com/poll/608903/ethics-ratings-nearly-professions-down.aspx
7 Colturi, J. (2023, January 9). Poll of 4,5000 clinicians: How much time do you spend with your patients?. Doximity: OP-Med. https://opmed.doximity.com/articles/poll-of-4-500-clinicians-how-much-time-do-you-spend-with-your-patients
8 St. Paul’s School of Nursing. (2021, August 1). 3 Reasons nurses are so trusted. https://www.stpaulsschoolofnursing.edu/blog/nursing/3-reasons-nurses-are-so-trusted.html (stpaulsschoolofnursing.edu)