West Virginia lawmakers are considering a proposal that could significantly expand prescribing authority for advanced practice nurses.
In early 2026, a West Virginia legislative committee reviewed a proposed bill that would alter the rules under which certain advanced practice nurses can prescribe medications. House Bill 5681 was introduced in the West Virginia House of Delegates and referred to the House Health and Human Resources Committee.
This piece of legislation would amend the state’s nursing practice statutes to expand the authority of qualified advanced practice nurses to prescribe, administer, and dispense prescription drugs without requiring a collaborating physician.
Under the introduced bill’s language, advanced practice registered nurses (APRNs), including certified nurse practitioners (NPs) and certified nurse-midwives (CNMs) who meet certain qualifications, could obtain prescriptive authority independent of a formal collaborative agreement with a physician. This marks a potential shift from the existing framework, where nurse prescribers often must operate under written agreements with physicians.
Current prescriptive authority in West Virginia
Before this bill, West Virginia law already permitted APRNs to prescribe medications under certain conditions. According to the West Virginia state code, APRNs must meet certain qualifications, including licensure, pharmacology education, and a collaborative relationship with a physician in order to gain prescriptive authority. After completing years of practice with granted prescriptive authority, an APRN may apply to prescribe without ongoing collaboration.
Additionally, state pharmacy rules specify that prescriptions issued by an APRN must comply with standard legal and professional requirements, including accurate prescriber identification and adherence to federal and state-controlled substances laws.
What advanced practice nurses can currently prescribe
Across the U.S., APRNs prescribe medications in roles that require additional education, graduate-level training, and, in many cases, national certification before nurse prescribing authority is granted. RNs without advanced credentials aren’t permitted to independently prescribe drugs in the U.S. under current practice frameworks.
NPs are the most common prescriber group among nurses and are trained to assess patients, diagnose conditions, initiate treatment plans, and prescribe medications, including certain controlled substances, subject to state law.
The authority for nurses to prescribe medications varies widely by state. Many states use a tiered system of practice authority for NPs that influences how and when nurses can prescribe: full practice authority, reduced practice authority, and restricted practice.
As of the most recent data, just over half of U.S. states and territories have full practice authority for NPs, meaning they can independently manage patient care and prescribe medications under their licensure.
Perspectives on expanding nurse prescribing authority
Supporters of expanding nurse prescribing authority argue that doing so can significantly improve access to care, particularly in rural and underserved communities where physician shortages persist. Allowing qualified advanced practice nurses to prescribe medications independently may help close these gaps, streamline treatment, and reduce delays in initiating care. Greater prescriptive autonomy may also enhance continuity of care.
Professional nursing organizations broadly support full prescriptive authority as a core component of advanced practice. The American Association of Nurse Practitioners (AANP), for example, maintains that prescribing is an integral element of the NP role and should be regulated by state boards of nursing in alignment with education, certification, and national practice standards.
The AANP states, “The authorization of NPs to prescribe legend and controlled medications, devices, healthcare services, durable medical equipment, and other equipment and supplies is essential to providing timely, cost-effective, quality healthcare.”
Despite strong support within the nursing community, opposition remains. Concerns raised by some physician organizations and healthcare associations typically focus on patient safety, variations in clinical training, and the complexity of pharmacologic decision-making, particularly when managing high-risk or controlled substances.
Groups such as the American Medical Association (AMA) state that collaborative or supervisory structures help ensure safe prescribing practices, especially in complex cases or for less experienced providers. These concerns are part of broader national conversations about the scope of practice, healthcare workforce distribution, and professional autonomy, which touch on regulatory, clinical, and liability questions.
How prescriptive authority intersects with controlled substance rules
Even in states where nurses have prescriptive authority, federal and state-controlled substances laws impose separate requirements. In West Virginia, state law prohibits prescribing Schedule I controlled substances and limits initial prescriptions of some Schedule II drugs. APRNs must also register with the Drug Enforcement Administration (DEA).
The interaction between nurse prescribing authority and controlled substance regulations means that nurse prescribers must adhere to multiple layers of legal and professional standards when prescribing medications.
Conclusion
The evolution of nurse prescribing authority reflects a larger shift in how care is delivered in the U.S. Striking the right balance between autonomy and accountability will be critical as policymakers, healthcare leaders, nurses, and other healthcare professionals work together to build a more accessible, efficient, and patient-centered healthcare system.
