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Prescriptive Authority Agreement · PA

Texas Prescriptive Authority Agreement for Physician Assistants

Required. The Prescriptive Authority Agreement is the written instrument Texas law names for a Physician Assistant working with a physician. Below: the board that governs it, what it must contain, and the terms it has to carry.

Practice authoritySupervision required
Written agreementAgreement required
What Texas calls itPrescriptive Authority Agreement
Governing boardTexas Medical Board and the Texas State Board of Pharmacy
Agreement familySupervising Physician + Prescriptive Authority
Research date2026-08-13 · clauses 2026-09-03

No experience- or hours-based pathway to independent practice exists for PAs in Texas at any tenure — no PA-specific full-practice-authority bill was found in the 88th (2023) or 89th (2025) Legislature (S.B. 1700 that session addressed NP/APRN practice only, not PAs — see the `np` entry). PAs practice under a Prescriptive Authority Agreement (Tex. Occ. Code § 157.0512) for the life of their practice.

What a Texas Prescriptive Authority Agreement must contain

Governed by the Texas Medical Board and the Texas State Board of Pharmacy. Each numbered item is a statutory requirement the agreement must satisfy.

  1. The Physician Assistant ("PA") shall practice under the supervision of the Physician, as required by Tex. Occ. Code § 204.204, and, to the extent the Physician Assistant prescribes, under a Prescriptive Authority Agreement meeting the requirements of Tex. Occ. Code §§ 157.0511–157.0514. Supervision must be continuous but does not require the Physician's physical presence, provided the Physician remains reliably available by telecommunication.

  2. The number of Physician Assistants and advanced practice registered nurses combined whom the Physician may supervise or for whom the Physician may serve as the physician under a Prescriptive Authority Agreement may not exceed seven (7) full-time-equivalent providers, except as Texas law otherwise permits for practices in a medically underserved area or a hospital or facility-based practice. Where the Physician Assistant has prescriptive authority, the Prescriptive Authority Agreement shall provide for face-to-face meetings between the Physician and the Physician Assistant at least monthly until the third anniversary of the date the agreement is executed, and at least quarterly thereafter.

  3. The Prescriptive Authority Agreement on file also carries 1 scope, 1 education, 1 registration clauses, generated in the document itself.

Statutes and rules cited

  1. Tex. Occ. Code §§ 157.0511–157.0514statute

    Required contents of a Prescriptive Authority Agreement between a physician and an APRN or PA, the seven-provider ratio and its exceptions, chart review and periodic-meeting requirements, and annual review/retention requirements.

  2. 22 Tex. Admin. Code § 295.13regulation

    Texas Medical Board / Texas State Board of Pharmacy rule governing drug therapy management by a pharmacist under a physician's written protocol, including required protocol contents and physician oversight duties.

Terms it has to carry

Ratio, proximity, chart review, meeting and prescribing terms the agreement has to carry, from the state's supervision rules.

Proximity

No proximity requirement

No mileage/radius or continuous-availability standard is codified. TMB's own guidance (tmb.texas.gov/apply-renew/physician/prescribing-and-supervision) treats distance between practice sites as one factor it may weigh in judging whether supervision is 'adequate,' not a fixed rule.

Supervision ratio

Up to 7 at a time (combined across provider types)

One physician's total roster of APRNs and PAs together may not exceed 7 FTE under a Prescriptive Authority Agreement (§ 157.0512(c)) — a combined cap, not 7 per provider type. No cap applies at a facility-based hospital practice or a site serving a medically underserved population (§ 157.0512(d)). A separate 7-per-medical-director cap applies to long-term-care facility-based delegation specifically (§ 157.054(b)(4)).

Chart review

Not codified — left to the agreement

Meeting cadence

Monthly, in person or via telehealth

At least monthly (§ 157.0512(e)(9)(B), (f)), method left to the physician and PA — a 2019 amendment (H.B. 278) removed a prior in-person requirement, so phone/video meetings satisfy this. The same subsection requires a documented chart-review process, with the number of charts reviewed 'determined by the physician and physician assistant' — no fixed percentage is codified in current law.

Prescriptive authority

Separate prescribing terms required · controlled substances permitted

PAs need only individual DEA registration to prescribe controlled substances — Texas eliminated the separate DPS Controlled Substances Registration requirement for mid-level practitioners effective Sept. 1, 2016 (S.B. 195, 2015); the delegating physician separately registers the delegation with TMB, not DPS.

Written agreement

Required

Practice ownership (corporate practice of medicine)

Licensee-only ownership required — Professional association, PLLC, corporation, or partnership jointly owned by a physician and PA (Tex. Bus. Orgs. Code § 301.012; 22 Tex. Admin. Code § 174.5, 'Joint Ownership' — TMB reorganized its rules effective Jan. 9, 2025, repealing former §§ 177.16/.17 and moving this content into new Chapter 174) — PAs are the ONLY non-physician profession in Texas with an express statutory joint-ownership pathway. The PA's interest (alone or combined with other PA-owners) must stay a minority, may not equal or exceed any individual physician-owner's interest, and the PA may not be an officer, may not employ or contract the supervising physician, and may not direct the physician's practice of medicine. An organizer must be a physician ensuring physician control.

This is the only entry in this dataset where a non-physician provider has a direct statutory ownership pathway — every APRN entry below (np, pmhnp, crna, cnm, cns) has none at all under current Texas law.

Legal sources for these rules (7)
How the relationship works day to day
Who has to be where, how often you meet, and what the physician costs: Physician Assistant in Texas on collaborativeagreement.com.

About Texas's rules

Texas has no independent-practice pathway for any APRN type (NP/PMHNP/CRNA/CNM/CNS) at any experience level — a 2025 rural 10-year/20,000-hour bill (S.B. 3055) died in committee, as did 2023's full-practice-authority S.B. 1700. No chart-review percentage is codified (the physician and provider set the number themselves) — the commonly-cited 10%/20% figures reflect a pre-2013 rule since repealed. PA is the only non-physician profession with a statutory joint-ownership pathway into a medical entity.

Other clinicians in Texas: see the state overview.