EXECUTIVE SUMMARY

Access to contraception has been broadened in seven Western states as Kroger Health pharmacists now offer contraceptive patches and self-administered hormonal contraceptive products.

Pharmacists at stores under the Kroger Health banner, including participating Fred Meyers, King Soopers, QFC, Ralphs, and Smith’s locations in the seven states, as well as Kroger Health clinic facilities, will administer screenings prior to dispensing the contraceptive products.

Pharmacists who hold licenses in states that have approved contraceptive provision can access appropriate training online. The Comprehensive Contraceptive Education and Certification course, developed by faculty at the Oregon State University College of Pharmacy with guidance from the Oregon Board of Pharmacy, the Oregon Health Authority, and others, offers online certification.


Access to contraception has been broadened in seven Western states as Kroger Health pharmacists now offer contraceptive patches and self-administered hormonal contraceptive products. Pharmacists at stores under the Kroger Health banner, including participating Fred Meyers, King Soopers, QFC, Ralphs, and Smith’s locations in California, Colorado, Idaho, New Mexico, Oregon, Utah and Washington, as well as Kroger Health clinic facilities, will administer screenings prior to dispensing the contraceptive products.

“Prescribing hormonal contraceptives is another way our pharmacists are practicing at the top of their licenses,” Jim Kirby, PharmD, senior director of pharmacy services at Kroger Health in Cincinnati, said in a statement. “We are excited to help more women access hormonal contraceptives through our pharmacies offering this service.”1

Training Sessions Expand

Pharmacists licensed in states that have approved contraceptive provision can access appropriate training online. The Comprehensive Contraceptive Education and Certification course, developed by faculty at the Oregon State University College of Pharmacy with guidance from the Oregon Board of Pharmacy, the Oregon Health Authority, and others, offers online certification for pharmacists practicing in participating states.

Registration is available for pharmacists in California, Colorado, Hawaii, Idaho, Maryland, Montana, Oregon, Tennessee, Utah, and Washington. The online course covers information on hormonal contraceptives, including mechanism of action, doses, types, use, benefits, and risks.

The University of Tennessee partnered with the Oregon State University College of Pharmacy to offer its comprehensive contraceptive education and certification course for Tennessee pharmacists.

“While pharmacists are knowledgeable in being able to counsel women on the side effects and what to expect, before now they have never been in the role of starting or continuing a woman on any form of hormonal contraception,” said James Wheeler, PharmD, BCPS, assistant professor of clinical pharmacy and translational science at the University of Tennessee Health Science Center in Knoxville. “It is good to have a foundational knowledge on hormonal contraception, but prescribing it requires a deeper understanding of how to practice seeing patients and in making clinical decisions.”2

Study Details Pharmacist Provision

California Senate Bill 493 was passed in 2013, allowing pharmacists to provide a wider range of healthcare services, including direct provision of hormonal contraceptives. Oregon passed a similar law in 2015. Both states use a statewide protocol that went into effect in 2016.

Researchers of a 2019 study analyzed use of contraceptive services by women accessing pharmacies at Albertsons, a supermarket-based chain, in California and Oregon. They examined data of 2,117 patients, ages 13 to 55 years, who used the service between August 2016 and February 2017. Initial pharmacist screenings revealed health issues in about 7% of women that required a follow-up visit to primary care physicians. The most common health issue was high blood pressure, researchers reported.3

Seventy-four percent of women accessing the pharmacy had health insurance, 89% visited a primary care provider in the past year, and 91% previously used hormonal contraception. The contraceptive pill was the most commonly dispensed method, with almost 96% of women receiving pill prescriptions. Other methods included the contraceptive patch (1.6%), vaginal ring (2.6%), and the contraceptive injection (0.1%).3

Contraceptive services are just the start for the expanded scope of practice for pharmacists, noted Lisa Kroon, PharmD, chair of the Department of Clinical Pharmacy at the University of California, San Francisco School of Pharmacy. Albertsons is exploring the provision of even more services, said Rebecca Strauss, PharmD, manager of specialty care, quality assurance, and patient outcomes at Albertsons Companies.4

“Where states allow, we have begun prescribing [medications] for chronic conditions, such as statins for patients with diabetes, emergency medications such as epinephrine and naloxone, and medications for self-limiting conditions such as influenza, strep throat, urinary tract infections, and cold sores,” Strauss said in a statement. “We also are working on implementing more smoking cessation services where pharmacists can prescribe tobacco cessation medications and also HIV pre-exposure prophylaxis.”

The American College of Obstetricians and Gynecologists (ACOG) updated its guidance in 2019 regarding over-the-counter access to hormonal contraception, expanding its support for access to vaginal rings, the contraceptive patch, and contraceptive injections with no age restrictions.5

Women still should visit a gynecologist each year for a well-woman health assessment for such services as discussing reproductive health plans, a pelvic or breast exam, cervical cancer screening, or sexually transmitted infection testing, the organization said. However, obtaining contraception does not require an exam or office visit, the ACOG guidance stated.5

REFERENCES

  1. Kroger Health. Kroger Health pharmacists now prescribing hormonal contraceptives in several markets. Oct. 28, 2019. Available at: https://prn.to/2qQUwP6.
  2. Oregon State University College of Pharmacy. Comprehensive Contraceptive Education and Certification. Available at: https://bit.ly/2qMAhlM.
  3. Lu S, Rafie S, Hamper J, et al. Characterizing pharmacist-prescribed hormonal contraception services and users in California and Oregon pharmacies. Contraception 2019;99:239-243.
  4. Burningham G; University of California San Francisco. Study shows promise for hormonal contraception services in the community pharmacy setting. April 30, 2019. Available at: https://bit.ly/33LUPcC.
  5. Over-the-counter access to hormonal contraception: ACOG committee opinion, number 788. Obstet Gynecol 2019;134:e96-e105.