In the ever-evolving landscape of healthcare regulation, mid-level practitioners (MLPs)—such as nurse practitioners (NPs), physician assistants (PAs), and other advanced practice providers—play an increasingly vital role in expanding access to care. One of the most misunderstood areas of regulation involves MLPs and their authority to handle controlled substances. Specifically, there’s a critical distinction between a mid-level practitioner’s authority to prescribe controlled substances and their ability to procure them.
This distinction is not merely academic—it has practical implications for how MLPs operate in clinical settings. Moreover, these authorities are governed by a patchwork of state laws and federal DEA regulations, which can lead to confusion and compliance risk if not properly understood.
While the DEA provides a broad federal definition, the scope of practice and level of authority granted to MLPs are determined at the state level, which often leads to discrepancies in what a given practitioner may do.
Prescriptive Authority vs. Procurement Authority: Key Differences
At the federal level, the DEA assigns mid-level practitioners a DEA number only if they are legally authorized under state law to prescribe, administer, or dispense controlled substances. However, having a DEA number and prescriptive authority does not necessarily confer the ability to independently procure controlled substances from wholesalers or manufacturers.
1. Prescriptive Authority
Prescriptive authority refers to an MLP’s legal ability to write prescriptions for controlled substances, subject to:
- Their individual state’s scope-of-practice laws
- Collaborative or supervisory agreements with a licensed physician (in some states)
- DEA registration for the appropriate schedules (II–V)
2. Procurement Authority
Procurement authority refers to the ability to order, purchase, and possess controlled substances directly from a licensed supplier or wholesaler. This right is usually tied to the practitioner’s DEA registration status and business/practice structure, and may include activities such as:
- Stocking medications at a clinic or office
- Obtaining controlled substances for in-office administration
- Compounding preparations involving controlled substances
Here lies the key distinction: many mid-level practitioners may be permitted to prescribe controlled substances but cannot procure or stock them directly without working under a licensed physician or as part of a facility with a separate DEA registration (e.g., a hospital or clinic’s institutional DEA number).
Why the Distinction Matters
This difference creates operational and compliance challenges, particularly in settings where MLPs are autonomous or own their own practices. Even if state law permits a nurse practitioner to write prescriptions for Schedule III substances, they may not be allowed to independently order and store these substances in their practice unless:
- Their state law explicitly allows it;
- Their DEA registration reflects procurement authority;
- They work with a supervising physician who has such authority and procurement rights.
This situation is especially relevant for compounded preparations that involve controlled substances. Compounding facilities often require clarification on whether the ordering provider has legal authority to procure, not just prescribe. DEA registration alone does not override state law. Additionally, A DEA number gives federal authority, but it is only valid when paired with active state licensure and approval.
Implications for Pharmacies and Practice Owners
Compounding pharmacies must verify not only whether a mid-level practitioner is authorized to prescribe, but also whether they are authorized to procure a compounded medication involving controlled substances. Outsourcing facilities filling an order for a controlled medication that is intended for office use (as opposed to a patient-specific prescription) may only be lawful if the ordering provider has procurement authority.
Pharmacy teams should be trained to:
- Verify state-specific prescriptive and procurement privileges;
- Confirm DEA registration and scope of schedules;
- Request proof of collaborative agreements where applicable;
Final Thoughts
The regulatory environment governing mid-level practitioners and controlled substances is complex and nuanced. While prescriptive authority is often the focus of clinical education and practice expansion, procurement authority is a separate—and frequently overlooked—legal hurdle that can have serious compliance implications.
Our wish is to follow the law to the best of our ability while fostering a collaborative relationship with our providers. Determining appropriate eligibility is a time-consuming, and often unclear process that involves many governmental boards on various levels. As MLPs continue to take on greater responsibility in healthcare delivery, it is essential for providers, pharmacy partners, and compliance teams to understand both types of authority and verify them appropriately.
