State Overview: Washington

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 companies.

Health plans and state and school employee plans must cover at least one FDA-approved opioid agonist, antagonist and partial agonist without prior authorization. Wash. Rev. Code Ann. §48.43.760; Wash. Rev. Code Ann. §41.05.525

Upon initiation or renewal of Medicaid managed care plan, a managed health care system may not impose prior authorization on at least one FDA-approved opioid antagonist, agonist and partial agonist. Wash. Rev. Code Ann. §74.09.645

Diagnostic ability is outlined in statute. 

Mental health counselors may apply the principles of human development, learning theory, psychotherapy, group dynamics, and etiology of mental illness and dysfunctional behavior to individuals, couples, families, groups and organizations for treatment of mental disorders and promoting optimal mental health and functionality. Mental health counseling also includes, but is not limited to, the assessment, diagnosis and treatment of mental and emotional disorders, as well as the application of a wellness model of mental health. Wash. Rev. Code §18.225.010

Full independent practice and prescriptive authority and the NM must practice with their scope of practice.

The ARNP is prepared and qualified to assume primary responsibility and accountability for the care of patients within their roles of ARNP licensure. Wash. Admin. Code §246-840-300

A NM may prescribe prescription drugs and Schedules II-V controlled substances. Wash. Rev. Code §18.79.050

Full independent practice and prescriptive authority and the NP must practice with their scope of practice.

The ARNP is prepared and qualified to assume primary responsibility and accountability for the care of patients within their roles of ARNP licensure. Wash. Admin. Code §246-840-300

An NP may prescribe prescription drugs and Schedules II-V controlled substances. Wash. Rev. Code §18.79.050

NPs are authorized to sign portable orders for life-sustaining treatment forms as a qualified emergency services personnel. Rev. Code Wa. Ann. §43.70.480

NPs are recognized in state policy as primary care providers. Primary care provider means a general practice physician, family practitioner, internist, pediatrician, osteopath, naturopath, physician assistant, osteopathic physician assistant and advanced registered nurse practitioner. Wash. Rev. Code §74.09.010(18)

Full independent practice and prescriptive authority.

Washington opted out of the CRNA federal supervision requirement in 2003. 

An ARNP, including a CRNA, is prepared and qualified to assume primary responsibility and accountability for the care of patients within their roles of ARNP licensure. Wash. Admin. Code §246-840-300.

A CRNA may prescribe prescription drugs and Schedules II-V controlled substances. Wash. Rev. Code §18.79.050.

Washington allows the removal of lumps and bumps by an optometrist.

(1) The practice of optometry is defined as the examination of the human eye, the examination and ascertaining any defects of the human vision system, and the analysis of the process of vision. The practice of optometry may include, but not necessarily be limited to, the following:

• (i) Removal of nonpenetrating foreign bodies, debridement of tissue, epilation of misaligned eyelashes, placement of punctual or lacrimal plugs, including devices containing pharmaceutical agents
  implanted in the lacrimal system, dilation and irrigation of the lacrimal system, nonlaser light therapy, and placement of biologic
  membranes.

Wash. Rev. Code §18.53.010

The practice of optometry may include the following advanced procedures:

1. (i) Common complication of the lids, lashes, and lacrimal systems;
2. (ii) Chalazion management, including injection and excision;
3. (iii) Injections, including intramuscular injections of epinephrine and subconjunctival and subcutaneous injections of medications;
4. (iv) Management of lid lesions, including intralesional injection of medications;
5. (v) Preoperative and postoperative care related to these procedures;
6. (vi) Use of topical and injectable anesthetics; and
7. (vii) Eyelid surgery, excluding any cosmetic surgery or surgery requiring the use of general anesthesia. Wash. Rev. Code §18.53.010

Optometrists may prescribe Schedule III-V controlled substances and Schedule II controlled substances containing hydrocodone combinations. Wash. Rev. Code §18.53.010

Dental hygienists who work for a health care facility or senior center can provide their services without the supervision of a dentist if they meet certain experience requirements, enter into a written agreement with a licensed dentist who will provide off-site supervision, and they refer the treated patients to a dentist for dental planning and treatment. Wash. Rev. Code §18.29.056

Dental health aide therapists may provide preventive services in practice settings on tribal reservations and operated by an Indian health program. A dental health aide therapist must practice under the supervision of a dentist. Wash. Rev. Code §70.350

Washington 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.

Washington does not allow pharmacists to modify prescriptions.

Washington allows pharmacists to prescribe hormonal contraceptives if they enter into a collaborative practice agreement with a practitioner who has the appropriate prescriptive authority. Wash. Rev. Code §18.64.008

Washington does not allow pharmacists to prescribe tobacco cessation aids.

Collaboration allowed with a physician for practice and prescriptive authority.

A physician assistant who has completed fewer than 4,000 hours of postgraduate clinical practice must work under the supervision of a participating physician, as described in the collaboration agreement and determined at the practice site. A physician assistant with 4,000 or more hours of postgraduate clinical practice may work in collaboration with a participating physician, if the physician assistant has completed 2,000 or more supervised hours in the physician assistant's chosen specialty. Wash. Rev. Code §18.71A.030 

A PA may prescribe, order, administer and dispense legend drugs and Schedule II, III, IV, or V controlled substances consistent with the scope of practice in an approved practice agreement filed with the commission provided: (a) The PA has an active DEA registration; and (b) All prescriptions comply with state and federal prescription regulations. Wash. Admin. Code §246-918-035

Statute does not limit the number of PAs a physician may supervise. 

Washington does not have any provisions related to the number of PAs a physician can supervise or collaborate with. Wash. Rev. Code §18.71A.120(6)-(7) 

Chart co-signatures may be determined at the practice level.

A physician is not required to countersign orders written in a patient's clinical record or an official form by a PA with whom the physician has a collaboration agreement. Wash. Rev. Code §18.71A.090(2)

Statute allows adaptable proximity.