When people seek out treatment for health issues, there’s a greater chance the person prescribing their medications will be a nurse practitioner or physician assistant. The shift, amplified during the pandemic when patients increasingly turned to telehealth appointments, has helped expand access to care. It also signals a need for new go-to-market strategies for drug developers.
Nurse practitioners (NPs) and physician assistants (PAs) now write a third of all prescriptions in the United States, up significantly from 25 percent in 2020, according to pharmacy claims data recently analyzed by IQVIA.
The expanded prescribing role of these mid-level providers addresses a critical healthcare challenge: provider shortages. Nearly half of all physicians report insufficient time for patient care, with one-third describing their patient loads as unmanageable, according to a national survey by Morning Consult commissioned by the American Academy of Physician Associates (AAPA). These shortages mean 14 percent of physicians report they cannot accept new patients.
“Outdated practice laws are actively limiting access to care,” said Jason Prevelige, DMSc, president and chair of the board at AAPA, in a news release. “It’s time to modernize these laws so healthcare teams can focus on what matters most—patient care.”
Physicians largely agree. The AAPA survey shows 86 percent of physicians acknowledge that PAs significantly enhance patient access to healthcare, and 90 percent recognize their importance in delivering care.
More than half of physicians say removing regulatory barriers to PA practice could reduce patient wait times, and 68 percent believe it would alleviate provider shortages.
In practice, physician oversight of mid-level providers often differs from the perceived requirement of constant supervision. More than 80 percent of physicians report spending less than a quarter of their time supervising PAs, and nearly two-thirds are rarely or never present during PA-patient interactions.
Legislation, Telehealth Grow NP and PA prescribing
Legislation is beginning to reflect this reality. For instance, New York recently expanded prescribing abilities for PAs, allowing them more autonomy in prescribing durable medical equipment.
Concerns about potential overprescribing or misuse are challenged by evidence, such as a JAMA Health Forum study published in December, which found no rise in high-risk opioid prescribing in states where nurse practitioners have full practice independence.
Telehealth has significantly fueled the growth of NP and PA prescribing, stabilizing at about 5 percent of all medical visits — down from a pandemic peak of 7 percent, but still 10 times pre-pandemic levels, according to IQVIA.
Mid-level providers are more likely to be listed as providers for telehealth visits compared to in-person appointments, particularly in mental health, obesity treatment and chronic disease management.
“The convenience of remote telehealth visits, along with reduced exposure to illness, continues to make telehealth appealing even post-pandemic,” according to the IQVIA report.
The impact of this trend is particularly notable in mental health, where mid-level prescribers now account for 56 percent of prescriptions. Weight-loss medications have also become a significant therapeutic area, with NPs and PAs prescribing over 40 percent of these treatments.
As telehealth becomes further embedded in care models, the global telehealth market is projected to reach over $175 billion by 2026, reflecting broader industry growth fueled by advances in artificial intelligence, hybrid care models and remote patient monitoring technologies, according to Healthcare Transformers.
Digital Health Brings Marketing Opportunities
Traditional strategies targeting only physician specialists may now miss critical segments of the prescribing community. Digital innovations, including subscription-based telehealth platforms and virtual provider integration, present significant opportunities for capturing market share.
Digital health platforms connecting patients directly with prescribers exemplify this evolution. Hims & Hers has grown its subscriber base substantially in recent years, adding millions of new customers with a focus on expanding access to patients who aren’t receiving treatment, said Yemi Okupe, CFO of Hims & Hers during a March 4 investor presentation at a Morgan Stanley conference.
“I think that the fundamental principle for the company is less around, how do you pull a consumer from competitor, or how do you convert a consumer from brick and mortar or online,” Okupe said, “but it's going after the things that are fundamentally preventing the consumer from getting treated today for their given condition, and how do you remove that barrier?”