EXECUTIVE SUMMARY

Contraceptive access has expanded for adult women in Utah, as pharmacists have begun to prescribe hormonal contraceptives. As of September 2019, pharmacies in more than 75 Utah cities signed up to participate.

• Pharmacists in the program are required to complete an online training program and register with the state health department. Pharmacists also must submit annual reports on their contraceptive dispensing activities.

• Women may receive birth control from pharmacists after they complete a health history form, undergo a blood pressure test, and discuss which method will work best for them. Women must see a healthcare provider at least once every two years if they wish to continue receiving contraception via the pharmacist.


Contraceptive access has expanded for adult women in Utah, as pharmacists have begun to prescribe hormonal contraceptives. As of September 2019, pharmacies in more than 75 Utah cities signed up to participate in the program.

In 2018, the Utah legislature passed Senate Bill 184 to allow women aged 18 years and above to obtain hormonal contraceptives from a qualified pharmacist without a visit to a healthcare provider. Utah Department of Health Executive Director Joseph Miner, MD, issued a standing order in March 2019 allowing women to obtain birth control pills, contraceptive patches, or vaginal rings from participating pharmacies without needing a provider’s prescription.

Pharmacists enrolled in the program are required to complete an online training program, register with the state health department, and submit annual reports on their contraceptive dispensing activities. Women may receive birth control from pharmacists after they complete a health history form, undergo a blood pressure test, and discuss which contraceptive method will work best for them.

“This standing order will remove some of the barriers many women encounter when trying to access family planning services,” Miner said in a statement. “My hope is that pharmacists throughout the state will take the time to educate themselves about the new program and participate in dispensing contraceptives to women who wish to receive them.”

Utah’s program requires patients to see a healthcare provider at least once every two years if they wish to continue receiving contraception through a pharmacist.

“While it’s important to remove barriers to care, it’s also important for all patients to have a relationship with a primary healthcare provider,” Miner said. (Miner’s remarks can be found online at: https://bit.ly/2TArhZz.)

Few States Offer Pharmacist Option

According to the Association of State and Territorial Health Officials, 11 states and the District of Columbia allow pharmacists to issue contraception without a prescription. Almost all states require pharmacists to assess patients before prescribing and dispensing contraceptives, most often by using a self-screening risk assessment. Most states also require pharmacists to provide patients with a standardized information sheet about contraceptives, a written summary of the consultation, advice about follow-up with a primary care provider, and a referral to a reproductive care provider or clinic if there is no established contact.

Sixty-five percent of pharmacists say they are interested in prescribing birth control, according to a 2019 study designed to assess U.S. community pharmacists’ perspectives on prescribing contraception.1 Individual patient contact was seen as the top motivation for prescribing contraception, according to study results.

Pharmacist participation in providing contraception may take time. In 2016, California implemented legislation allowing pharmacists to prescribe birth control, but results of a 2018 study indicate few of the state’s pharmacies were actually offering the service.2 Just 11% of the state’s more than 5,000 community-based retail pharmacies offered birth control through the pharmacist. More than 60% charged a fee for the service.

Pharmacist prescribing privileges can be effective in expanding access. Findings from a study of the Oregon prescribing program indicate that in the first two years, pharmacist-prescribed contraception prevented more than 50 unintended pregnancies and saved $1.6 million in associated taxpayer costs.3,4

An examination of Oregon Medicaid claims suggests that of the 3,614 Medicaid patients who received a new prescription for oral or transdermal contraceptives, 367 received their prescription from a pharmacist. Of those women, 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.3,4

Will Women Use Option?

Before access to pharmacist prescription in Washington, DC, researchers conducted focus groups among teen girls ages 14-17 years and young women ages 18-24 years to determine their views on such services.5 While the young women said they viewed pharmacies as convenient locations to access contraceptives, they expressed concerns about privacy, affordability, and pharmacist approachability. Such concerns were seen as significant barriers by younger participants.

To protect privacy and confidentiality, participants suggested that pharmacies offer private consultation spaces and clear information about what insurance plans can disclose to parents. Participants also recommended that pharmacies create a youth-friendly, nonjudgmental environment and offer pharmacists training on contraceptive counseling for young women.5

REFERENCES

  • Rafie S, Cieri-Hutcherson NE, Frame TR, et al. Pharmacists’ perspectives on prescribing and expanding access to hormonal contraception in pharmacies in the United States. J Pharm Pract 2019; doi:10.1177/0897190019867601.
  • Gomez AM. Availability of pharmacist-prescribed contraception in California, 2017. JAMA 2017;318:2253-2254.
  • Anderson L, Hartung DM, Middleton L, et al. Pharmacist provision of hormonal contraception in the Oregon Medicaid population. Obstet Gynecol 2019;133:1231-1237.
  • Rodriguez MI, Hersh A, Anderson LB, et al. Association of pharmacist prescription of hormonal contraception with unintended pregnancies and Medicaid costs. Obstet Gynecol 2019;133:1238-1246.
  • Zuniga C, Wollum A, Katcher T, et al. Youth perspectives on pharmacists’ provision of birth control: Findings from a focus group study. J Adolesc Health 2019; doi:10.1016/j.jadohealth.2019.05.013.