The Missouri Senate is considering a measure supporters say would increase the availability of medical care in the state by allowing some nurses to prescribe medications without physician oversight.
The new rules, included in companion bills from Sens. Patty Lewis, D-Kansas City, and Nick Schroer, R-St. Charles, would apply to advanced practice registered nurses. Such nurses usually have an advanced degree and more specialized education and training and frequently work as nurse practitioners, clinical nurse specialists or certified nurse-midwives.
In Missouri, such providers need an agreement with a physician to prescribe controlled substances. The bill would remove that requirement for qualified nurses who have logged 2,000 documented hours with a collaborating doctor.
The Senate's Emerging Issues and Professional Registration Committee is considering the measure after a hearing earlier this month.
"Missouri has some of the most restrictive laws when it comes to nurse practitioners; seven of our eight surrounding states have less restrictive measures," Lewis said.
Controlled substances include medications such as Adderall, opioids and depressants such as Xanax and Valium. Not all medicines are controlled substances.
Similar legislation introduced in previous sessions of the state legislature has been unsuccessful.
Many physician groups, including the Missouri State Medical Association, have historically opposed dropping the collaboration requirements.
After a Columbia-based nurse practitioner filed a lawsuit in 2025 challenging the agreement, the organization decried "a coordinated national campaign to dismantle physician oversight and redefine scope of practice through the courts."
Such agreements "exist to protect patients, ensure continuity of care, and uphold clinical standards through physician-led, team-based care," representatives said in a statement. "They are not bureaucratic relics — they are safeguards rooted in decades of medical expertise and interdisciplinary teamwork."
Nurse practitioners have argued the collaboration requirement pushes needed providers into other states with less restrictive work rules.
"Where I live, I've talked to several nurse practitioners who chose to work in Kansas instead of Missouri because of the restrictions," Lewis said. "Some of our nurse practitioners have to pay up to $50,000 a year to collaborate with a provider. But they're not really collaborating, they're just giving them money. I've heard some folks say it's a great retirement fund."
Missouri doctors argue the cost is not a "transactional checkbox" but rather a shared responsibility that allows doctors to provide needed mentorship, guidance and oversight.
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