NPs in Puerto Rico Can Prescribe Meds, But Pharmacies Won’t Fill Them

Puerto Rico faces a unique problem: while nurse practitioners (NPs) on the island are legally allowed to prescribe medications, another law does not permit pharmacists in Puerto Rico to fill those prescriptions.

If it sounds confusing, that’s because it is. Patients who live in Puerto Rico, or may have a prescription from an NP in another state, have faced problems getting their medications from pharmacies for years. That’s why a new bill moving through the island’s legislature is trying to fix the disconnect.

Senate Bill 757 (PS 757) aims to fix that mismatch. The Senate passed it in April 2026, and it is now in front of the House.

Want to see more Nurse.org articles in your Google results? Add us as a preferred source.

PS 757 was filed on Oct. 1, 2025, sponsored by Senate President Thomas Rivera Schatz, Sen. José Luis Dalmau and Sen. Joanne Rodríguez Veve.

The bill would amend Articles 1.03, 5.02 and 6.06 of the Puerto Rico Pharmacy Law (Law 247-2004) to add the nurse practitioner as an authorized prescriber.

The fact that under Puerto Rico Pharmacy Law, NPs are not considered “authorized” prescribers is what’s caused the disconnect for patients trying to fill medications prescribed by an NP. It’s legal for NPs to prescribe the medication, but there is a separate pharmacy law that does not recognize NPs as “authorized prescribers.”

A similar bill, Senate Bill 1390, was filed in November 2023 and stalled in 2024, so this is not the first time Puerto Rico has tried to fix the problem.

Under Law 254-2015, an NP is a nurse with a master’s or doctorate in an NP specialty who acts as a primary provider under agreements with a physician. The law lets NPs order medications for diagnosed conditions as set out in those collaborative protocols, but it excludes Schedule I and II controlled substances.

The problem is the Pharmacy Law. Its definition of a “prescriber” lists only physicians, dentists, podiatrists, and veterinarians, not nurse practitioners.

As a result, pharmacies and insurers have rejected NP prescriptions unless a physician or another authorized professional countersigns them.

“It is public knowledge that the NPs are recognized under Puerto Rico Law 254, our prescriptions are not dispensed by pharmacies because NPs are not recognized as authorized prescribers under Puerto Rico’s Pharmacy Act,” William M. Rojas Cotto, MSN, APRN, FNP-C, CORLN, a Puerto Rico-based family NP, tells Nurse.org.

Cotto adds: “This legal inconsistency prevents qualified NPs from fully exercising their professional competencies and creates unnecessary barriers to patient access when it comes to receiving care. We believe this issue deserves greater attention, particularly since NP prescriptive authority is already recognized throughout the 50 states in the US.”

Advocates for the bill say that gap keeps qualified clinicians from fully using their training and adds delays for patients.

The American Association of Nurse Practitioners (AANP) even weighed in on the situation, writing a support letter to the state legislators weighing the bill, stating that the bill would “harmonize” pharmacy law to be consistent with current NP prescribing laws.

“Existing Puerto Rico law authorizes NPs to prescribe medications for their patients, and S. 757 would make needed conforming changes to authorize pharmacists to fill those prescriptions,” they continued, adding:

“Puerto Rico, like other U.S. jurisdictions, faces complex challenges to ensuring that residents have timely access to high-quality health care. Compounding that challenge is this disconnect between prescribing laws. Our members share how this is delaying treatments and creating unnecessary complications for patients. S. 757 offers a no-added-cost, no-delay solution to improving health, and more efficiently and effectively using Puerto Rico’s health care workforce to meet the territory’s growing health care needs.”

Cotto explains that NPs in Puerto Rico can currently and legally:

• Provide care via collaborative agreements with physicians
• Focus on promoting healthcare and its maintenance
• Participate in patient evaluation
• Perform collaborative care with a multidisciplinary healthcare group
• Order blood work and diagnostic tests with the intention of consultation and collaboration with a physician
• Prescribe medications with the exception of narcotics and other functions designated by Nurse Law 254

NPs can prescribe medication in all 50 states, though how much independence they have varies widely. As of 2026, 27 states and Washington, D.C. grant nurse practitioners full practice authority, according to the American Association of Nurse Practitioners.

 Under full practice authority, NPs can evaluate, diagnose, order tests, and prescribe without a supervising physician. Puerto Rico’s model is closer to a collaborative or supervised one, which is the approach PS 757 would keep in place.

>>Listen to The Latest Nurse News Podcast

Where PS 757 Stands Now

The Senate passed the bill with broad support on April 23, 2026. It reached the House for a first reading on April 30 and was sent to the House Health Committee.

At the committee’s first public hearing on Sept. 2, 2026, Health Secretary Víctor Ramos Otero said he would not recommend approval unless his department’s amendments are included. His requests include:

• Defining “nurse practitioner” by direct reference to the nursing law
• Limiting prescribing to advanced practice specialties expressly authorized by law, within the nurse’s specialty and under protocols or collaborative agreements
• Guaranteeing patients the right to ask for a direct evaluation by a physician
• Reviewing possible conflicts with federal rules, including Medicare Advantage
• Estimating the cost to the Nursing Examining Board and the Health Department of overseeing collaborative agreements

House Health Committee Chair Gabriel Rodríguez Aguiló said the panel will keep holding hearings and has questions about how consistent collaborative agreements would be, and whether an NP could run a separate office and see referred patients without direct physician supervision.

He also said the committee will call the Nursing Examining Board to testify on licensing exams, pass rates, and malpractice data. “Esta es la primera vista y vamos a estar trabajando de forma extensa este proyecto,” he said, which translates to: “This is the first hearing, and we will be working on this bill extensively.”

• Puerto Rico Hospital Association: Eduardo Fantauzzi told lawmakers the bill would fix a regulatory mismatch between nursing law and prescribing and dispensing laws, and said NPs are especially important in emergency rooms.
• Colegio de Profesionales de la Enfermería de Puerto Rico: President Marisel Delgado said the bill would expand access to care, especially in areas with provider shortages.
• American Association of Nurse Practitioners: Carmen López, DNP, FAANP, who directs the DNP program at the San Juan Bautista School of Medicine, endorsed the bill at an earlier Senate hearing as an AANP representative, with recommendations, saying it could increase patient access.

Supporters argue that NPs could handle routine follow-ups and medication refills, which could reduce long waits for physicians and cut unnecessary emergency room visits. They also say NPs could help in rural areas, where access to physicians is limited. Puerto Rico has faced physician shortages, and the “éxodo de médicos” (physician exodus) is a frequent theme in local coverage.

Whether the House takes up the bill as passed by the Senate, or rewrites it along the Health Department’s lines, will determine how much practical change NPs see in daily practice.

🤔 NPs in Puerto Rico can legally write prescriptions. Pharmacies can’t legally fill them. A new bill would fix the gap. Would you back it? Tell us in the comments below.