RxP: In the beginning…

May 27, 2016, then Governor Terry Brandstad signed Senate File 2188, an Act relating to prescription authority for certain psychologists (RxP) and making penalties applicable making it law. Iowa became the fourth state in the United States to enact such legislation. In 2014, Illinois became the third state after a long draught! New Mexico was the first state in 2002 with Louisiana following closely in 2004. Since Iowa passed their law, 3 other states have joined this group: Idaho in 2017, Colorado in 2023, and Utah in 2024.

At the time of this writing, Vermont and Hawaii both have very good chansce of passing RxP legislation as well. Numerous other states have introduced legislation including Washington, Arizona, Tennessee, Pennsylvania, Oregon and others I am probably forgetting.

The legislative process for Iowa was started with a task force when I came back from SLC (now PSLC) as Iowa’s President-elect. While there, NM passed their legislation based on limited rural access which I thought applied to Iowa as well. The task force became a standing committee in 2006 and adopted a 3-year strategic plan with increasing levels of involvement with RxP culminating in legislation. The first year was education and information and IPA stayed in this phase for several years.  During this time, we formed a relationship with Fairleigh Dickinson University’s post-doctoral Master of Science in clinical psychopharmacology (MSCP) program, meaning IPA members could receive a discount for attending FDU’s program. At the time, FDU was one of the few programs available for this training. Now, there are 7 programs including one right here in Iowa at Drake University. 

The Legislative Journey

After we’d been at level 1 for several years, I asked the Executive Council to support introducing legislation which IPA did for the first time in 2013. Iowa’s legislative session runs in 2-year cycles and 2013 was the first year of a two-year cycle. We had a sponsor for each chamber as well as one from each party. This is something our lobbyist, Amy Campbell, suggested and was one of the best things we did in the process. The opposition to these pieces of legislation is typically the medical community and specifically the psychiatric profession. It was no different here. We worked diligently to have conversations with them without success. The first two years gained some movement and let folks know what we were hoping to accomplish which led not only to opposition but also to support from unexpected entities like some religious communities and churches. We did not pass the law during the first two-year session, so it died.

We re-introduced in 2015 during the next two-year cycle and the first year, the bill did not move. This was very disappointing as we’d gotten some good traction the first cycle. We went back for the second year and had informally decided if it didn’t pass that year, we would take a break before introducing legislation again. However, one of our sponsors was very firm with those opposing this, stating they needed to get on board and what would it take. This resulted in the final amendment of agreeing to creating the administrative rules jointly with the Board of Medicine. We passed in both chambers and the Governor signed!!!

Next came the administrative rules portion of enactment. There is no policy or guidance for how to resolve differences in the rules process, so we had to reach consensus with the representatives from the Board of Medicine. This was a long process taking 3 years to complete. The administrative rules were adopted in February 2019. These rules are currently in the process of being reviewed due to the consolidation of Boards that occurred in 2025, so look for emails in the future requesting comments.

We Built It and They Came!

With the adoption of the rules, Iowa was ready for RxP psychologists and folks began the training process!!  Then in March 2020, the pandemic hit which effectively halted all movement as there were limited numbers of people being allowed in physicians rooms during this time and our rules indicated the practicum had to be live, face to face.  We weathered that storm and folks begin to complete the training process and apply for prescribing certificates!

Iowa now as 4 prescribing psychologists which is not as many as I would like.  There are between 7-10 other folks in some phase of training so hopefully we will have more in the very near future. Part of the struggle is finding placement sites for the supervision required by law and the rules. We have contacted many entities in hopes of working with us including Federally Qualified Health Centers and the Primary Care Association. We have also reached out to Indian Health Services and community mental health centers. We continue to work on this issue and recently partnered with Iowa’s Health and Human Services department.  

As with most scope of practice legislation, we did not get everything we wanted and have gone back to the legislature once (2023) for some revisions. We have other pieces of the law we would like to modify so most likely will go back again when the time is right.

Celebrating Progress 

I have been working in the RxP space since 2002. Twenty-four years and there has been a lot of change!

• We have designated programs which lend credibility to our training.
• We are expecting states #8 and #9 to pass legislation later this year.
• Reimbursement concerns are being addressed with third party payors.
• There is an increasing greater understanding of what RxP psychologists do.  

I highly encourage folks to consider the training even if you do not plan to prescribe as it increases understanding of medication and that knowledge can be passed on to the people you work with. With a program in the state now, there really isn’t a reason not to check it out!

Five years ago, I wrote a post about the day I got the call from our lobbyist about the Governor’s signature. I was debating whether or not to buy a pricey pair of tennis shoes. I bought the shoes; I still have them and wear them. This year, in honor of the 10-year anniversary, I think I’ll buy something too!