Missouri nurse practitioner challenges law forcing her to pay doctors for permission to work

Jefferson City, Missouri; August 21, 2025: A licensed family nurse practitioner filed a lawsuit today challenging Missouri’s law that forces nurse practitioners to pay physicians for permission to do the very work they’re already licensed to perform. Marcy Markes alleges the state’s collaborative practice agreement requirement violates her constitutional rights while blocking patients’ access to affordable healthcare.

“Nurse practitioners are exceptionally trained, licensed healthcare providers who shouldn’t need to pay a doctor tens of thousands of dollars just for permission to treat patients,” said Donna Matias, an attorney with Pacific Legal Foundation, which represents Markes free of charge. “This protectionist scheme strips away Marcy’s constitutional rights while worsening Missouri’s healthcare crisis.”

Markes has spent more than 30 years caring for patients across Missouri. She owns Columbia Allergy and Asthma Specialists, providing patients specialized care for asthma, allergies, and immunotherapy. Despite her extensive training and experience, Missouri law forces her to maintain a “collaborative practice agreement” with a physician to practice outside hospital settings—costing her over $50,000 per year.

Missouri is one of just 11 states with such restrictive rules. Unsurprisingly then, approximately 80 percent of the state is considered a “medical desert” with little primary care access. The law allows physicians to control nurse practitioners’ entire careers while charging unlimited fees for minimal oversight.

A victory for Markes would free Missouri’s nurse practitioners to provide care without unnecessary and burdensome payments to physicians. It would expand healthcare access across a state whose majority of counties lack the much-needed primary care.

The case is Marcy Markes v. Andrew Bailey.