State Overview: Arkansas

State law or statute prohibits or limits the use of prior authorization for buprenorphine containing products by either the state Medicaid plan or private insurance company.

Health care insurers, including Medicaid, shall not require prior authorization for buprenorphine, naltrexone, methadone or naloxone. Medicaid program may not require prior authorization for buprenorphine, naltrexone, methadone or naloxone designated as preferred drugs on the preferred drug list. At least one of each of the drugs must be designated as preferred or without prior authorization.

Prior authorization permitted for injectable formulations. Prior authorization may be required for new FDA-approved formulations/medications if more expensive and less effective than existing formulations. Ark. Stat. Ann. § 23-99-1119

Arkansas credentials three levels of addiction counselors. A licensed alcoholism and drug abuse counselor requires a master's degree, 270 education hours related to drug and alcohol counseling and 6,000 hours of supervised experience. A licensed associate alcoholism and drug abuse counselor requires a bachelor's degree, 270 education hours related to drug and alcohol counseling and 6,000 hours of supervised experience. A certified alcoholism and drug abuse technician requires no post-secondary degree but the individual must have 270 education hours directly related to alcoholism or drug counseling, 6,000 hours of supervised experience. Ark. Stat. Ann. §17-27-401 to 416 and Arkansas State Board of Examiners of Alcoholism and Drug Abuse Counselors

Licensed professional counselors may render to individuals, groups, organizations, or the general public any service involving the application of principles, methods, or procedures of the counseling profession. LPCs may assist individuals or groups to develop understandings of personal problems, to define goals, and to develop an action plan. Diagnostic ability is not directly outlined in statute. Ark. Stat. Ann. §17-27-102(9)

The Arkansas Peer Specialist Program (APSP) is a three-tiered credentialing process that allows an individual the opportunity to progress through the core, advanced and supervision levels of The Arkansas Model. This is a collaborative effort between the state of Arkansas, the NAADAC and the Association for Addiction Professionals. This program credentials Core Peer Recovery Specialists, Advanced Peer Recovery Specialist, and Peer Recovery Peer Supervisors (PRPS).

Full independent practice authority.

CNMs may evaluate patients, diagnose medical conditions, order and interpret diagnostic tests and initiate and manage treatment and care plans, including appropriate co-management or transfer of high-risk patients to other healthcare professionals as needed.

CNMs may also prescribe and administer drugs listed in Schedules III-V without a collaborative practice agreement or supervision by another healthcare professional. Schedule II authority requires a collaborative practice agreement. Ark. Stat. Ann. §17-87-315

Transition to independent practice and prescribing period required.

An NP may practice without a collaborative agreement who applies for and is granted a certificate of full independent practice authority from the Full Independent Practice Credentialing Committee. NPs must practice and prescribe under a collaborative practice agreement with a physician for 6,240 before earning the certificate. The certificate must be renewed every three years. Ark. Stat. Ann. §17-87-314

An NP who has obtained a certificate for full independent practice authority may independently prescribe drugs, medicines, or therapeutic devices in accordance with their scope of practice. Ark. Stat. Ann. §17-87-314

Only physicians are authorized to sign POLST forms. Ark. Stat. Ann. §20-6-304

Nurse practitioners are recognized as a primary care providers. Ark. Stat. Ann. §20-77-140

Physician relationship required for practice and prescriptive authority.

Arkansas opted out of the CRNA federal supervision requirement in 2022.

CRNAs may administer anesthetics “in consultation with, but not necessarily in the presence of, a licensed physician, licensed dentist, or other person lawfully entitled to order anesthesia.” Ark. Code Ann. §17-87-102

CRNAs may select, obtain and administer Schedule II drugs only during the perioperative, peri-obstetrical and medical procedure period. CRNAs with a certificate of prescriptive authority from the Arkansas State Board of Nursing may prescribe and administer drugs listed in Schedules III-V without a collaborative practice agreement or supervision by another health care professional. The authority may extend to hydrocodone combination products reclassified from Schedule III to Schedule II if authorized by the collaborative practice agreement. Ark. Code Ann. §17-87-102 and Ark. Code Ann. §17-87-310

Optometrists may perform all procedures included in their full scope of practice, including surgical procedures and laser privileges specified in statute. Ark. Stat. Ann. §17-90-101

Optometrists may perform injections, excluding intravenous or intraocular injections. Ark. Stat. Ann. §17-90-101

Optometrists may prescribe Schedule III-V controlled substances and also Schedule II hydrocodone or hydrocodone combination medications. Ark. Stat. Ann. §17-90-101(a)(3)

Dental hygienists who work in dental clinics, community health centers, or government sponsored dental facilities and who have at least 1 year of full-time services may operate under general supervision of a dentist, meaning the dentist is not required to be in the treatment facility while procedures are being performed. Arkansas law also provides for a dental hygienist collaborative care program, in which dental hygienists are able to provide services in certain settings to children, senior citizens, and people with developmental disabilities without the presence of or prior examination by a dentist. Ark. Stat. Ann. §17-82-703

Statute does not identify dental therapists as an oral health provider.

Arkansas does not explicitly allow for the practice of teledentistry.

Arkansas has not enacted legislation allowing pharmacists to administer the COVID-19 vaccine. However, the federal PREP Act allowed pharmacists to administer the COVID-19 vaccine through the duration of the public health emergency.

Arkansas does not allow pharmacists to modify prescriptions.

In order to prescribe oral contraceptives, a pharmacist must complete a training program related to oral contraceptives that has been approved by the Arkansas State Board of Pharmacy, make a standardized fact sheet available to the recipient of the drug or device and shall only initiate therapy and administer or dispense, or both, oral contraceptives under a statewide protocol to an individual who is eighteen (18) years of age or older. Ark. Stat. Ann. §17-92-115

A written protocol for tobacco cessation drug therapy must be approved by the Board of Pharmacy. Ark. Stat. Ann. §17-92-101

Supervision by a physician required for practice and prescriptive authority.

The PA is a dependent medical practitioner who provides healthcare services under the supervision of a physician and works under a delegation agreement with a physician. Ark. Stat. Ann. § 17-105-101(1)(A),(B)

Physicians supervising PAs may delegate prescriptive authority to physician assistants to include receiving, prescribing, ordering, and administering Schedules II-V controlled substances as described in the Uniform Controlled Substances Act, all legend drugs, and all nonschedule prescription medications and medical devices. Their prescriptive authority only extends to drugs listed in Schedule II if the prescription is for an opioid (five-day prescription or less) or a stimulant (prescription must have been originally initiated by the physician). Ark. Stat. Ann. § 17-105-108

The state medical board sets a limit on the number of PAs a physician can supervise.

Arkansas statute does not currently have a limit on how many PAs a physician can supervise but the state medical board enforces a policy limiting physicians to supervising no more than three PAs at once.

Chart co-signatures are required (by the state medical board for the first 120 days of practice).

Arkansas does not currently have any provisions related to chart review or co-signatures in statute. However, the state medical board enforces a policy requiring 100% chart co-signature for the first 120 days of practice. After 120 days, the board requires 10% of charts to be co-signed.

Statute allows adaptable proximity.

Supervision of PAs shall be continuous but shall not be construed as necessarily requiring the physical presence of the supervising physician at the time and place that the services are rendered. Ark. Stat. Ann. § 17-105-109

The PA may perform duties in any setting that are delegated by the supervising physician and are also in accordance with all facility policies. Ark. Stat. Ann. §17-105-107