EXECUTIVE SUMMARY

Newly published research suggests that pharmacist-prescribed contraception in Oregon is not only successful at deterring unwanted pregnancy but is cost-effective as well.

  • Findings from the study indicate that in the first two years after the Oregon law went into effect in 2016, pharmacist-prescribed contraception prevented more than 50 unintended pregnancies and saved an estimated $1.6 million in associated taxpayer costs.
  • Reproductive health advocates hope to replicate such efforts in other states, as the United States continues to experience high levels of unintended pregnancy. An estimated 2.8 million such pregnancies occurred in 2011 alone, the last year for which data are available.

Newly published research suggests that pharmacist-prescribed contraception in Oregon is not only successful at deterring unwanted pregnancy but is cost-effective as well.1,2 Reproductive health advocates hope to replicate such efforts in other states, as the United States continues to experience high levels of unintended pregnancy — an estimated 2.8 million occurred in 2011 alone, the last year for which data are available.3

Eleven states (California, Colorado, Hawaii, Maryland, New Hampshire, New Mexico, Oregon, Tennessee, Utah, Washington, and West Virginia) and the District of Columbia have passed legislation to allow pharmacists to provide contraceptives without a prescription. This is made possible through standing orders, practice protocols, or an expanded scope of practice. California, Colorado, and New Mexico have established protocols. The Utah state health officer issued a standing order on March 27, 2019. Pharmacists can prescribe and administer types of contraceptives set out by the laws. Some states, including Oregon, also allow pharmacists to prescribe and administer injectable contraceptives.4

Study findings indicate that in the first two years after the Oregon law went into effect in 2016, pharmacist-prescribed contraception prevented more than 50 unintended pregnancies and saved an estimated $1.6 million in associated taxpayer costs.

Researchers examined Oregon Medicaid claims and discovered that of the 3,614 Medicaid patients receiving a new prescription for oral or transdermal contraceptives, 367 received their prescription from a pharmacist. Of those women receiving prescriptions, 252 had been enrolled in Medicaid for at least 180 days prior to receiving their first prescription. In further analysis, researchers found that 74% of the 252 women had no history of a birth control prescription in the preceding 30 days.1,2

This finding suggests that the pharmacist prescription program is indeed reaching new contraceptive users who may be at risk for unintended pregnancy, according to co-author Maria Rodriguez, MD, MPH, associate professor of obstetrics and gynecology at the Oregon Health & Science University (OHSU) School of Medicine.

“Furthermore, claims show that the safety profile seen with pharmacists is equal to what is seen among clinicians prescribing contraception,” Rodriguez said in a press statement. “This suggests that pharmacists are an important strategy to safely reach women with unmet need for contraception.”

Community pharmacies offer an alternative point of access for patients and are highly accessible, remarks study co-author Daniel Hartung, PharmD, MPH, associate professor in the Oregon State University (OSU)/OHSU College of Pharmacy.

About 90% of Americans live within five miles of a pharmacy, notes Hartung. Most pharmacies are open for longer hours than a traditional clinic and do not require an appointment, he states.

Since 2018, Oregon pharmacists also have been able to prescribe the other forms of short-acting hormonal contraception: injection and the vaginal ring.

“As the program matures and contracts with additional insurers are implemented at pharmacies, the number of pharmacist prescriptions will likely increase,” states co-author Lorinda Anderson, PharmD, clinical assistant professor in the OSU/OHSU College of Pharmacy.

According to a 2019 Association of State and Territorial Health Officials overview, most states allow pharmacists to furnish contraceptives after receiving education or training on prescribing and dispensing such methods.4 Pharmacists must assess patients before prescribing and dispensing birth control, usually by a self-screening risk assessment.

Most laws also require that patients be provided with an information sheet about birth control methods, a summary of the consultation, advice about follow-up with a primary care provider, and a referral to a reproductive care provider or clinic if the patient does not visit a provider regularly.

Tennessee, Utah, and Washington state limit pharmacist contraceptive prescriptions to patients 18 years or older, while Oregon allows pharmacists to prescribe to patients younger than 18 if there is evidence of a prior contraceptive prescription. This age limit is set to expire in 2020. Tennessee allows prescribing and dispensing birth control to emancipated patients younger than 18 years.

Some states also limit the amount of time a pharmacist can continue to prescribe and dispense birth control without evidence of a clinical visit by the patient. Colorado laws call for pharmacists to prescribe for three years without evidence of a clinical visit, while Utah legislation calls for two years, and West Virginia limits prescribing to one year.4

REFERENCES

  1. Anderson L, Hartung DM, Middleton L, et al. Pharmacist provision of hormonal contraception in the Oregon Medicaid population. Obstet Gynecol 2019 Jun;133(6):1231-1237.
  2. Rodriguez MI, Hersh A, Anderson LB, et al. Association of pharmacist prescription of hormonal contraception with unintended pregnancies and Medicaid costs. Obstet Gynecol 2019; May 9. doi: 10.1097/AOG.0000000000003265. [Epub ahead of print.]
  3. Finer LB, Zolna MR. Declines in unintended pregnancy in the United States, 2008-2011. N Engl J Med 2016 Mar 3;374(9):843-52.
  4. States authorize pharmacists to prescribe and dispense contraceptives. ASTHO Experts Blog, June 6, 2019. Available at: https://bit.ly/2F5TzH8.