EXECUTIVE SUMMARY

In 2016, a California law took effect, allowing pharmacists to prescribe birth control. Results of a new study indicate that few of the state’s pharmacies currently are offering the service.

  • Results of the study show that only 11% of the state’s more than 5,000 community-based retail pharmacies offer contraception. More than 60% charge a fee for the service.
  • California, Oregon, Colorado, and New Mexico currently are the only states that allow pharmacists to prescribe birth control once they have been trained on how to assess patients’ potential health risks as well as how to counsel them about appropriate birth control.

In 2016, a new California law took effect, allowing pharmacists to prescribe birth control. Fast forward to present: Results of a new study indicate few of the state’s pharmacies actually are offering the service.1

Results of the study show that only 11% of the state’s more than 5,000 community-based retail pharmacies offer contraception. More than 60% charge a fee for the service.

The California legislation, enacted in 2013 and implemented in April 2016, is designed to expand contraceptive access for women. Under the law, women can obtain contraceptive pills, patches, rings, and injections directly from a pharmacist without having to see a doctor or nurse first.

“Our findings strongly suggest that more pharmacies need to offer this service to live up to the promise of widespread, easier access to birth control,” says Anu Manchikanti Gomez, MSc, PhD, the study’s lead author and an assistant professor of social welfare at the University of CaliforniaBerkeley. Gomez also serves as the director of the campus’s Sexual Health and Reproductive Equity Program.

Study Findings

To conduct the study, researchers used telephone surveys of a rep-resentative sample of more than 1,000 California licensed pharmacies.

Most of the pharmacies were in urban areas and part of retail chains. In each call, interviewers asked pharmacy staff if they offered birth control without a prescription from a doctor. If interviewers received a positive response, they continued with questions about the types of contraception available and whether service fees were charged. Findings indicate that one in 11 of the pharmacies contacted had pharmacists who could prescribe birth control, including birth control pills (77%), vaginal rings (40%), patches (38%), and contraceptive injections (9%). Of the drugstores that offered contraception, about 68% charged service fees ranging from $40 to $45.1

Researchers point out that while insurance covers the cost of the contraception itself, pharmacies may charge patients service fees since insurers currently are not required to reimburse for them. Women who receive publicly-funded care may fare somewhat better: California legislation has authorized the state Medicaid program to reimburse pharmacies for contraceptive services. Full implementation is mandated by 2021.

Other States Move Toward Expansion

Anita Nelson, MD, professor and chair of the obstetrics and gynecology department at Western University of Health Sciences in Pomona, CA, says she is not surprised by the current study’s findings, since California’s public healthcare,

Family PACT, is readily available and offers coverage of all methods. Pharmacists are very busy and may not have time to take all the steps needed, she notes. Also, many chains have in-house clinics with nurse practitioners who can prescribe hormonal contraceptives as well as take care of problems that might develop, Nelson says.

California, Oregon, Colorado, and New Mexico currently are the only states that allow pharmacists to prescribe birth control once they have been trained on how to assess patients’ potential health risks as well as how to counsel them about appropriate birth control. Pharmacists in Oregon currently can prescribe only oral and patch contraceptives, although a pending bill seeks to expand access to include the contraceptive vaginal ring and contraceptive injection.2 Bills in Maryland and Hawaii have passed through the legislature; Iowa, Illinois, Massachusetts, Maine, South Carolina, Texas, and Tennessee considered similar legislation.2 The Washington, D.C. District Council voted unanimously in December 2017 to push the Defending Access to Women’s Health Care Services Amendment Act of 2017 into law. It will authorize pharmacists to prescribe contraceptives.

Federal guidance also has been issued. In a January 2017 informational bulletin, the federal Center for Medicaid and CHIP Services encouraged states to expand the scope of pharmacy practice to foster immediate access to such drugs.3

Collaborations with clinicians are key in expanding access through pharmacist prescribing practices. Boards of pharmacies are requiring pharmacists to provide care summaries to be shared with clients’ primary care clinicians to allow all to act as an interprofessional team.

Hurdles remain, data show. A study of Oregon pharmacists prior to implementation of contraceptive prescribing showed that the three main barriers perceived by pharmacists in providing such services include shortage of pharmacy staff to provide services, concerns about liability, and a need for additional training.4

“Pharmacist-prescribed pills are a step in the right direction,” observes Robert Hatcher, MD, MPH, professor emeritus of gynecology and obstetrics at Emory University School of Medicine in Atlanta. “How long will it be before there is complete over-the-counter availability of pills?” 

REFERENCES

  1. Gomez AM. Availability of pharma-cist-prescribed contraception in California, 2017. JAMA 2017;318:2253-2254.
  2. Bonner L. States at work on building pharmacists’ authority to prescribe hormonal contraceptives. Pharmacy Today 2017;23:34-37.
  3. Wachino V. Center for Medicaid and CHIP Services (CMCS). State flexibility to facilitate timely access to drug therapy by expanding the scope of pharmacy practice using collaborative practice agreements, standing orders or other predetermined protocols. Letter. Jan. 17, 2017. Available at: http://bit.ly/2iT32GW. Accessed Jan. 21, 2018.
  4. Rodriguez MI, McConnell KJ, Swartz J, Edelman AB. Pharmacists prescription of hormonal contraception in Oregon: Baseline knowledge and interest in provision. J Am Pharm Assoc 2016;56:521-526.