Greater reliance on nurse practitioners (NPs) has been widely recognized as a critical component to the successful implementation of the Affordable Care Act (ACA). In particular, NPs are viewed integral to the delivery of primary care services, demand for which is expected to increase as more Americans obtain health insurance. However, the services that NPs can provide depend on state scope-of-practice laws. These laws determine whether a physician must be involved in the NP’s care and regulate the NP’s ability to diagnose illness and prescribe medications. Recent research suggests that restrictive scope-of-practice regulations are associated with lower access to care. Thus, scope-of-practice laws are an important workforce policy tool for states because allowing NPs to practice independently from physicians might increase the amount of preventative and primary care services available.
The proposed study examines the effect of scope-of-practice laws on the prescribing of medications by NPs and physicians. Understanding how these laws affect pharmaceutical utilization is important for the implementation of the ACA because they directly limit or facilitate access to care and medications, thereby potentially affecting the quality and cost of health care. The aim of this study is to describe the effect of state NP scope-of-practice laws on pharmaceutical utilization and associated costs of care in the United State for individuals under the age of 65 who are covered by employer-sponsored health insurance. Specifically, we will examine measures of medication adherence, and test whether they are associated with independent scope-of-practice for NPs. We will also assess whether better medication adherence is associated with lower cost and estimate cost savings that may be associated with independent NP practice.