State Overview: Pennsylvania

Gov. Tom Wolf announced in October of 2018 that he reached an agreement with seven major insurers to end prior authorization for medication-assisted treatment (MAT) for substance-use disorders (SUDs). Insurers also agreed to including a comprehensive range of medications to treat SUDS on the lowest cost-sharing tier of a health plan's pharmacy benefit. This action was not legislative.

Diagnostic ability is outlined in statute. 

Physician relationship required for practice and prescriptive authority.

A nurse midwife may not engage in midwifery practice without having entered into a collaborative agreement and having filed the collaborative agreement with the board. A nurse midwife shall only engage in midwifery practice in accordance with the midwife practice guidelines and collaborative agreements. Pa. Cons. Stat. tit. 49 §18.5

A nurse midwife may, in accordance with a collaborative agreement with a physician, and consistent with the nurse midwife's academic educational preparation and National certification by the AMCB or its successor organizations, prescribe, dispense, order and administer medical devices, immunizing agents, laboratory tests and therapeutic, diagnostic and preventative measures. This includes Schedules II-V. Schedule II must be limited to a 72-hour supply and Schedules III-IV are limited to a 30-day supply. Pa. Cons. Stat. tit. 49 §18.6

Physician relationship required for practice and prescriptive authority.

Written collaboration agreement required and the agreement must be signed by both the NP and the physician and agree to the details of their collaboration. Pa. Cons. Stat. tit. 49 §21.251

Drugs and therapeutic measures available for prescribing must be outlined in the written collaboration agreement and relevant to the NP's specialty. The NP may prescribe Schedule II-V controlled substances. Pa. Cons. Stat. tit. 49 §21.284

NPs are authorized to sign POLST forms. Pa. Con. Stat. tit. 20 §5422

NPs are recognized in state policy as primary care providers. There are six patient populations the State Board of Nursing designates for NPs to focus including neonatal, pediatrics, family/across the life span, adult/gerontology, women's health/gender-related and psychiatric/mental health. Pa. Cons. Stat. tit. 28 §9.678

Physician relationship required for practice authority; no prescriptive authority.

The CRNA is authorized to administer anesthesia in cooperation with a surgeon or dentist. The CRNA’s performance shall be under the overall direction of the chief or director of anesthesia services. In situations or health care delivery facilities where these services are not mandatory, the CRNA’s performance shall be under the overall direction of the surgeon or dentist responsible for the patient’s care. Pa. Code §49.21.17

Pennsylvania does not explicitly allow for CRNA prescriptive authority.

Optometrists may only perform procedures related to foreign body removal and the examination, evaluation, diagnosis and treatment of the human eye. Pa. Cons. Stat. tit. 49 §23.3

Optometrists may use epinephrine auto-injectors for anaphylaxis. Optometry Practice Act, Act 130, Section 2

Optometrists may prescribe Schedule III-V controlled substances and Schedule II controlled substances containing hydrocodone combinations. The prescription for hydrocodone combinations cannot exceed a 72-hour supply. Optometry Practice Act, Act 130, Section 2

A certified public health dental hygiene practitioner may provide care in a variety of public health settings without the supervision or prior authorization of a dentist. The dental hygienist must have 3,600 hours of practice experience and liability insurance. Pa. Cons. Stat. tit. 49 §33.205b

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

Pennsylvania 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.

Pennsylvania does not allow pharmacists to modify prescriptions.

Pennsylvania does not allow pharmacists to prescribe hormonal contraceptives.

Pennsylvania does not allow pharmacists to prescribe tobacco cessation aids.

Supervision by a physician required for practice and prescriptive authority.

The PA practices medicine with physician supervision. A PA may perform those duties and responsibilities, including the ordering, prescribing, dispensing and administration of drugs and medical devices, as well as the ordering, prescribing and executing of diagnostic and therapeutic medical regimens, as directed by the supervising physician. (b) The PA may provide any medical service as directed by the supervising physician when the service is within the physician assistant's skills, training and experience, forms a component of the physician's scope of practice, is included in the written agreement and is provided with the amount of supervision in keeping with the accepted standards of medical practice. Pa. Cons. Stat. tit. 49 §18.151

Statue limits the number of PAs a physician may supervise.

A PA shall not assist a physician in a manner not described in the agreement or without the nature and degree of supervision described in the agreement. There shall be no more than six PAs for whom a physician has responsibility or supervises pursuant to a written agreement at any time. Pa. Cons. Stat. tit. 63 §422.13(e)

Chart co-signatures are required by statute to practice or prescribe as a PA.

The primary supervising physician shall determine countersignature requirements of patient records completed by the PA in a written agreement, except as provided for in paragraph (4).

(4) The primary supervising physician shall countersign 100% of patient records completed by the PA within a reasonable time, which shall not exceed 10 days, during each of the following time periods: (i) The first 12 months of the PA's practice post-graduation and after the PA has fulfilled the criteria for licensure. (ii) The first 12 months of the PA's practice in a new specialty in which the PA is practicing. Pa. Cons. Stat. tit. 63 §422.13(d.1)

Statute allows adaptable proximity.

The supervising physician shall be responsible for the medical services that a PA renders. Supervision shall not require the onsite presence or personal direction of the supervising physician. Pa. Cons. Stat. tit. 63 §422.13(d)

State regulations outline services a PA may provide to patients. The medical services must be delegated by the supervising physician if the services are within the PA's skills, training and experience, and outlined in the written agreement. Pa. Cons. Stat. tit. 49 §18-151