Thursday, March 4, 2010

Will Washington State Lead the Way for Improved Access to Midwifery Care?

by Heather Bradford, CNM, ARNP, Chair, ACNM Government Affairs Committee

In Washington State, we are working on legislation related to an access to care issue. The legislation would authorize pharmacists to fill prescriptions written by advanced registered nurse practitioners (ARNPs) in other states or in certain provinces of Canada. What does this have to do with midwifery? In Washington, certified nurse-midwives (CNMs) are licensed as ARNPs. The legislation would help CNMs in border states too, as the language considers those midwives to be ARNPs.

Current law authorizes pharmacists to accept prescriptions from physicians, osteopaths, dentists, podiatrists, and veterinarians licensed in any state or in a province of Canada that shares a common border with the state of Washington; however, ARNPs are not included. This can be problematic for women choosing an ARNP or CNM as her primary care provider. Most people need prescriptions filled locally so they have easy access to refills and consultation with their pharmacists. In our argument to legislators, we have shared that CNMs and ARNPs in our bordering states, Idaho and Oregon, have the same independent scope of practice and full authority to write prescriptions. The good news is the bill has passed unanimously in our state Senate and is moving forward through the House of Representatives.

Unfortunately, the language of the bill does not extend to prescriptions written by ARNPs across the country. Currently, only two other states (Kentucky and Texas) have limits on accepting prescriptions from ARNPs licensed in other states. In these states, pharmacists will not accept schedule II prescriptions for which their state’s ARNPs are not authorized to write. It is less clear which states have limits on accepting prescriptions written by CNMs licensed in other states. I received varying responses in an informal poll on the ACNM eMidwife clinical practice discussion group. There are some limitations with pharmacy laws in Texas and Kansas, both requiring a physician name on all prescriptions. However, with the use of a DEA or NPI number (which are essentially national license numbers), many states accept out-of-state prescriptions written by a CNM. Of the 15 or so responses I received, these states include Massachusetts, New Hampshire, New York, New Jersey, Virginia, Georgia, Mississippi, Arkansas, Missouri, and Alabama. Obviously, this is not a conclusive list, but it seems that the law needs to change in Washington State with hopes of others following suit.

Is anyone else advocating for or working on midwifery legislation in their state similar to this?


pinky said...

that is excellent news! I am thinking of doing my clinical rotations in WA State. I have some family there and figure I could visit them while doing my clinical rotation.

Heather Bradford, CNM, ARNP said...

WA State is a great place to practice. Full prescriptive authority and no physician supervisory language. Read more about our scope of practice at