Do physician assistants write prescriptions?

Yes. PAs write prescriptions nationwide under varying supervision or collaboration requirements. Controlled substances require DEA registration and state authorization.

Can PAs prescribe controlled substances?

Sometimes. Controlled-substance authority is governed by a two-layer system: state law determines whether—and under what physician-relationship conditions—a PA may prescribe Schedule II–V drugs, while federal DEA registration determines whether the PA can prescribe controlled substances under federal law. Even in states that authorize controlled substances broadly, the details often include caps, setting-based carve-outs, or drug-specific exclusions.

Does the DEA allow PAs to prescribe via telemedicine?

Yes—if state scope is satisfied and the federal telemedicine pathway is satisfied. Under the Ryan Haight framework, controlled-substance prescribing typically requires an in-person evaluation unless a valid exception applies. The proposed DEA Special Registration model is designed to allow Schedule II–V telemedicine prescribing without an initial in-person visit, but it adds operational requirements like identity verification, PDMP checks, and state-by-state DEA registration where patients are located.

Can physician assistants prescribe Wegovy or Adderall?

OTP allows PAs to practice and prescribe without a mandated physician agreement, letting practices set their own internal collaboration standards.

Physician Assistant Prescriptive Authority by State (2026 Guide): Controlled Substances, Telemedicine, and Key Drug Rules

Disclaimer: This article is for educational purposes only and does not constitute legal or clinical advice. Always verify your state's requirements.

Understanding Physician Assistant Prescriptive Authority

Physician assistant (PA) prescriptive authority defines what medications PAs can prescribe and under what conditions. Every state grants this authority differently, depending on whether PAs work under supervision, collaboration, transition-to-practice, or independent models.

In practice, can physician assistants prescribe medication? — yes, in all 50 states. However, the degree of autonomy and controlled substance authority varies significantly by jurisdiction.

This 2026 guide synthesizes those differences, focusing on:

State-level prescriptive models
Controlled substance schedules (II–V)
DEA and telemedicine prescribing rules
Commonly queried drugs like Wegovy, Adderall, and Norco
The new DEA Special Registration for telehealth providers

The Legal Landscape: Supervision vs. Collaboration

Most states require a defined relationship between PAs and physicians. This can take one of several forms:

Model	Description
Supervised	PA requires direct or indirect oversight from a licensed physician.
Collaborative	PA collaborates with a physician, but operational autonomy is higher.
Transition-to-Practice	PAs gain independence after completing a specific number of supervised hours.
Independent (OTP)	No legal physician tether; scope is defined at the practice level.

The Optimal Team Practice (OTP) model, pioneered in North Dakota, eliminates the requirement for a formal supervisory agreement. States like Utah, Wyoming, and Montana are moving in this direction by allowing scope determination at the practice level after 8,000–10,000 hours of experience.

Can Physician Assistants prescribe medication without a doctor?

Generally, no — but the tide is shifting.

Most states require PAs to have a supervision or collaboration agreement with a physician to prescribe. However:

North Dakota grants full independence under Optimal Team Practice.
Utah and Wyoming determine scope at the practice level, effectively removing state-mandated supervision ratios.

Compared with nurse practitioners (NPs)—many of whom have achieved Full Practice Authority (FPA)—PAs remain more regulated. The PA advocacy community continues to lobby for expanded OTP legislation that allows flexible, team-based scope determination.

For Nurse Practitioner-specific rules and Full Practice Authority states, see our Nurse Practitioner Prescriptive Authority by State guide.

Common Prescribing Questions: Wegovy, Adderall, Norco & More

Patients and providers often ask: What medications can physician assistants prescribe? Here are common examples that illustrate how laws differ:

Can PAs prescribe Wegovy (Semaglutide)?

✅ Yes. Physician assistants can prescribe GLP-1 receptor agonists like Wegovy and Ozempic in all 50 states, provided they have prescriptive authority and, in some states, a collaborating physician agreement.

Can PAs prescribe Adderall?

⚠️ Usually yes, but Adderall is a Schedule II controlled substance, so prescribing rules are stricter. Some states restrict Schedule II prescribing to specific settings (e.g., hospitals or hospice) or impose day-supply limits.

Can PAs prescribe Norco (Hydrocodone/Acetaminophen)?

✅ Yes, though with Schedule II limits. For example:

Arkansas & Missouri: Limited to hydrocodone combination products only.
Florida: May prescribe Schedule II opioids but only for a 7-day supply to opioid-naive patients.

Can PAs prescribe peptides or compounded therapies?

⚠️ Only if the peptide is FDA-approved. Compounded peptides face more scrutiny, and PAs must ensure compliance with both federal FDA and state board rules.

Can a Physician Assistant Prescribe Controlled Substances?

Yes—but only within their state’s statutory limits and with the appropriate DEA registration.

Controlled-substance authority follows a two-tier rule:

State Law: Defines which schedules (II–V) a PA may prescribe and under what conditions.
Federal Law (DEA): Requires the PA to obtain a DEA registration and follow national prescribing standards.

For example:

Georgia prohibits PAs from prescribing any Schedule II drug.
Texas allows it only in hospital or hospice settings.
North Dakota permits full Schedule II–V prescribing authority under OTP.

The DEA Telemedicine Special Registration: 2026 Update

The DEA’s proposed Special Registration program is transforming telehealth prescribing. It enables PAs and other qualified practitioners to prescribe Schedule II–V medications remotely—without an initial in-person visit—if they meet the following:

Hold a Special DEA Registration
Conduct a nationwide PDMP check
Verify patient identity via real-time audio-video
Maintain state-specific DEA registration wherever the patient resides

Why It Matters

Under the Ryan Haight Online Pharmacy Act, prescribing controlled substances via telemedicine previously required an in-person evaluation. This was temporarily waived during COVID-19, but those waivers expire at the end of 2025.

The new rule allows compliant PAs to prescribe drugs like Adderall or Testosterone remotely—provided all DEA and state requirements are satisfied.

PA Prescribing Authority by State Table (2026)

The following table synthesizes data regarding the practice environment for PAs, specifically focusing on their ability to prescribe controlled substances (CS).

Independent: No physician relationship mandated by state law
Transition: Independence allowed after an hours/experience threshold
Collaborative: Collaborative agreement required
Supervised: Supervision required
Sch II: Schedule II Controlled Substances

State	PA Authority	Key Prescribing Notes
AL	Supervised	PA: Sch III-V only. Sch II prohibited [3].
AK	Collaborative	PA: Sch II-V requires MD authorization [3].
AZ	Collaborative	PA: Transition to independent after 8k hours [3].
AR	Supervised	Restriction: Sch II limited to hydrocodone products only [3].
CA	Supervised
CO	Collaborative	PA: Sch II limited to 7-day supply for opioid naive [3].
CT	Supervised	PA: Sch II/III req MD approval [3].
DE	Collaborative	PA: Sch II-V authorized [3].
FL	Supervised	PA: Sch II limited to 7-day supply [3].
GA	Supervised	Restriction: PA prohibited from prescribing Sch II [3].
HI	Supervised	PA: Sch II-V under MD supervision [3].
ID	Collaborative	PA: No written or oral prescriptions allowed [3].
IL	Collaborative
IN	Collaborative	PA: Sch II-V requires agreement. No weight loss Sch IIs [3].
IA	Supervised	PA: Sch II depressants req MD approval [3].
KS	Supervised	PA: Sch III-V only [3].
KY	Supervised
LA	Supervised
ME	Collaborative	PA: Independent after 4k hours [3].
MD	Collaborative
MA	Supervised	PA: Sch II requires 96hr MD review [3].
MI	Collaborative	PA: Practice agreement required [3].
MN	Transition
MS	Supervised
MO	Collaborative	Restriction: Sch II limited to hydrocodone. 5-day limit [3].
MT	Transition	PA: Independent after 8k hours [3].
NE	Supervised
NV	Supervised	PA: Sch II-V authorized [3].
NH	Transition	PA: Independent after 8k hours [3].
NJ	Supervised	PA: Sch II-V authorized [3].
NM	Collaborative	PA: Sch II-V authorized [3].
NY	Supervised
NC	Supervised	PA: Sch II/III limited to 30-day supply [3].
ND	Independent	Standout: PA practices independently [3].
OH	Supervised	PA: Sch II restrictions (e.g., terminal illness, MD initiation) [3].
OK	Supervised	Restriction: PA excluded from independent Sch II [3].
OR	Collaborative	PA: Sch II-V authorized [3].
PA	Supervised	PA: Sch II limited to 72hr (initial) or 30-day (ongoing) [3].
RI	Collaborative	PA: Sch II-V authorized [3].
SC	Supervised	Restriction: PA Sch II limited (5-day narcotic/30-day non) [3], [4].
SD	Collaborative
TN	Collaborative	PA: Sch II/III limited to 30-day supply [3].
TX	Supervised	Restriction: Sch II limited to hospital/hospice settings [3].
UT	Transition	PA: Independent after 10k hours [3].
VT	Collaborative	PA: Sch II-V authorized [3].
VA	Collaborative
WA	Transition	PA: Independent after 4k hours [3].
WV	Collaborative	PA: Sch II limited to 3-day supply [3].
WI	Collaborative
WY	Collaborative	PA: Sch II-V authorized [3].

PA Prescribing Authority by State Map (2026)

PA Prescribing Authority Map

Figure: State-by-state breakdown of Physician Assistant prescribing authority, showing independent, transition, collaborative, and supervised practice environments.

Why Manual Compliance Checks Fail

Healthcare providers working across state lines face a major challenge: the laws change constantly. Manual reference tables, PDFs, and outdated spreadsheets cannot keep up with real-time rule shifts across multiple states and DEA jurisdictions.

Common Provider Risks

Unknowingly prescribing outside scope (state violation)
Missing PDMP documentation requirements
Failing to register with DEA in all states where patients reside
Inadvertently violating telemedicine prescribing laws

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3. https://www.tebra.com/theintake/checklists-and-guides/legal-and-compliance/nurse-practitioner-laws-by-state

4. https://www.scstatehouse.gov/billsearch.php?billnumbers=3580

5. https://nacns.org/wp-content/uploads/2020/08/PractPrescAuthority7.31.2020.pdf

6. https://www.dlapiper.com/insights/publications/2025/01/dea-and-hhs-publish-rules-for-telemedicine-prescriptions

7. https://www.govinfo.gov/content/pkg/FR-2025-01-17/pdf/2025-01099.pdf