By Melinda Young
Increasing evidence shows that pharmacists are capable of prescribing hormonal contraception and even prescribing abortion medication in states with laws protecting women’s access to abortion care.1,2
The District of Columbia and 30 states allow pharmacists to prescribe hormonal contraception without a physician’s prescription.3 The laws include allowing pharmacists to prescribe contraceptives in person or through telehealth, and data show that both practices are safe and effective.3
A new paper concludes that policies that increase contraceptive access, such as pharmacist-prescribed contraception, are a potentially low-cost way to reduce unintended pregnancies. They also could improve patients’ lives.4
Researchers theorized that laws that allowed pharmacists to prescribe contraceptives would increase birth control access and decrease the overall fertility and decrease unintended births in states.4 They used data from the U.S. National Center for Health Statistics’ Natality files for 2014 to 2020, comparing differences in 13 states that enacted these policies as a treated group and the 15 states that passed the law after March 2020 as the control group. When investigators compared fertility rates, they found there was a significant difference: There were 0.51 fewer births per 1,000 women per quarter — a 4% decrease — after implementation of a pharmacist prescribing law.4 “It’s a meaningful decrease,” says Daniel Grossman, PhD, an associate professor of economics at West Virginia University in Morgantown.
States that enacted laws allowing pharmacists to prescribe contraceptives had a decrease in fertility rate compared with those that did not enact these laws, Grossman explains. They looked at data prior to the time period when the COVID-19 pandemic resulted in an explosive growth of telehealth and alternatives to in-person medical clinic visits.
“There are a couple of things here, and one is that within 10 years time pharmacist prescriptions of contraceptives went to being a policy that didn’t exist to being a very popular policy in state legislatures,” Grossman says. “At the same time, we see a decrease in fertility rates.”
Fertility rates do not equal unintended pregnancy rates, but the latter proved challenging to study. “We attempted to look at the unintended pregnancies,” says Allyssa Wadsworth, PhD, an assistant professor of economics in the department of decision sciences, economics, finance, and marketing at the University of Houston — Clear Lake in Houston.
Data were collected to ascertain unintended pregnancies by asking mothers about their intentions many months — even as long as a year — after the child was born. By then, the women’s memories of whether they had wanted the pregnancy could have been distorted.
The fact that overall fertility rates were lower could mean that having a streamlined process for women to obtain contraceptives quickly and easily at their pharmacy works well. “The pharmacy prescribing policy allows them to get contraceptives in one step,” says Arijit Ray, PhD, a real estate researcher at Kelly A. Bergstrom Real Estate Center at Warrington College of Business, University of Florida in Gainesville.
“This cuts down a two-step process to a single process where you go to a pharmacist and ask for contraceptives directly, instead of going to a doctor’s office,” Ray adds.
The study’s findings also suggest that additional research could reveal more changes in fertility rates. For example, telehealth options for obtaining contraceptives also can lead to easier access for more people. The first over-the-counter birth control pill, Opill, which has been on pharmacy shelves for about a year, is another potential factor. If Opill becomes very popular, it could impact fertility rates, Ray notes. “We’re interested in following up on this research if we have appropriate data,” Ray says.
“If we have more specific data on which pharmacists are implementing them, then we might further follow up, or we might look at other contraceptive policies to see if they’re interacting with these policies, as well,” he adds.
The pandemic might have been a driving force for additional states to pass laws that allow pharmacist prescriptions of contraceptives. That era showed that pharmacists could do some of the same tasks previously delegated to doctors’ offices and clinics. “I think a lot of this came out of the pandemic, where pharmacists were called upon to provide vaccines and administer vaccines,” Grossman says. “Going forward, it would be logical for pharmacists to provide additional services.”
Whether the success of pharmacist-prescribed contraceptives results in more states allowing pharmacists to prescribe abortion medication is uncertain. Since abortion is banned in more than a dozen states, this change could not be as popular nationwide.
However, some states with laws to protect access to abortion are leading the way to pharmacist-prescribed abortion medication. For example, Washington state had a pilot program in the fall of 2024 that allows pharmacists to prescribe abortion pills. The telehealth program cost patients $40 and was available to people up to 10 weeks pregnant. There were 43 patients.1
A mail-order pharmacy shipped pills to patients, and pharmacists contacted patients to find out how they were doing. There was a hotline available, and the pilot program reported no seriously negative outcomes. The state intends to expand pharmacist prescribing for in-person pharmacy visits, where they receive a prescription and pills during one visit.1
Pharmacist-prescribed hormonal contraception also could be expanded in the near future as states explore this option and studies show acceptance among pharmacists — even those in states with abortion bans and restrictions.2 For example, a recent study found that a majority of Georgia pharmacists who answered the survey said they felt well trained to prescribe hormonal medication and they believed these prescriptions were within their scope of practice. More metropolitan pharmacists said they were well trained than did community pharmacists, however.2
“We only surveyed pharmacists in Georgia,” says Rebecca H. Stone, PharmD, BCPS, BCACP, FCCP, a clinical professor in the College of Pharmacy at the University of Georgia in Athens. “Contraception tends to be very well accepted, and pharmacists don’t have any hesitation about prescribing it,” she adds. There do not appear to be major obstacles due to personal beliefs, Stone notes.
The chief barriers cited by pharmacists surveyed were logistical, including these factors:
- A lack of access to patients’ medical records and a concern that patients would not fully answer questions in a screening tool;2
- Pharmacists’ time constraints;2 “Everyone in the field says, ‘I don’t have time to go to the bathroom anymore, how can I spend 18 minutes to prescribe contraception?” Stone says.
- Concerns patients would skip preventive visits for reproductive health if they did not have to visit an OB/GYN or primary care provider for their contraceptive prescriptions2; and
- Inadequate compensation for the time they spent with patients.2
“There has been a lot of data that assessed all different groups about whether they support pharmacists prescribing, and it was all supportive,” Stone says. “The problem in other states has been that pharmacists say they’re interested, but once they roll it out, the uptake is slow — maybe only 10% of pharmacists in the first year do this.”
The biggest obstacle to pharmacist-prescribed hormonal contraception in Georgia is legislation. State legislators have considered passing a bill to allow the prescriptions for the past half decade, but it has never passed, she notes.
In 2023, it was proposed in the first few weeks of the legislative session but was dropped, she says.
“So far, there has only been two years where I feel like it was considered for legislators: The first was pre-COVID in 2019, and our group was trying to get pharmacist contraception passed, and it didn’t make it,” Stone explains. “Then in 2023, it was proposed and then dropped in the first few weeks of the legislative session.”
The legislative obstacle is there has not been a legislator to champion the bill. Advocacy groups need to find one who will take the bill beyond initial talks. The other problem is that physician groups sometimes oppose these kinds of bills because of what they fear is scope creep among mid-level providers, she says.
Another obstacle is reimbursement. Insurers need to allow pharmacists to bill for reimbursement for their time with patients. In a couple states, pharmacists can bill for their time, and Georgia should permit this, as well, because the state has very poor access to OB/GYNs in many areas, Stone says.
Pharmacists are expected to work more intently with less focus on client-facing interactions because of how reimbursement has changed, making pharmacy profit margins tighter and tighter, she says.
“This is why it’s important to have reimbursement for services, and this usually starts with Medicaid — allowing pharmacists to bill Medicaid for the visit,” Stone says. “Some states allow pharmacists to bill Medicaid the same as with a physician.” Other states may reimburse pharmacists a percentage of what physicians receive.
As the nation increasingly sees OB/GYN deserts, the need for pharmacists to be part of the solution is apparent. “There are blocks of counties with no OB/GYN,” she adds. “The more access points you can provide for access to contraception, the better.”
Pharmacies also are open for more hours than physician offices. Pharmacists are available at night and on weekends and holidays. In addition, pharmacies are available in every county, which makes them a convenient place to obtain contraceptives for rural patients.
“Pharmacies are dispersed across the state, and we could improve reproductive access,” Stone explains.
“Every health department in Georgia provides contraceptive services, but they don’t provide all the methods, and I think we can do better,” she adds. “Adding pharmacies will only improve the situation and make it more convenient for people to access contraception.”
States that allow pharmacists to prescribe contraception are making it easier for women to obtain the contraceptives they desire and helping them prevent unintended pregnancies.
“When it comes to women’s health specifically, I think this is a program that so far has been pretty successful, Grossman notes.
Pharmacists prescribing contraception tends to reach populations that might otherwise have access problems with obtaining contraceptives, and it is a policy that could be implemented nationwide, he adds.
“Allowing pharmacists to enter this field is to give women an option, and it’s helpful,” Wadsworth says. “There are a lot of unknowns happening with other changes in policy in the United States, so allowing women to have the option is very important.”
References
1. Belluck P. Abortion pills prescribed by pharmacists are newest effort in abortion fight. The New York Times. Jan. 7, 2025. https://www.nytimes.com/2025/01/07/health/abortion-pills-pharmacist-prescribe.html
2. Stone RH, Patel MD, Beene LL. Pharmacist-prescribed hormonal contraception: A survey of perceptions of Georgia community pharmacists and non-community pharmacists. Pharmacy (Basel). 2024;12(5):156.
3. Pharmacist-prescribed contraceptives. Guttmacher Institute. Nov. 8, 2024. https://www.guttmacher.org/state-policy/explore/pharmacist-prescribed-contraceptives
Increasing evidence shows that pharmacists are capable of prescribing hormonal contraception and even prescribing abortion medication in states with laws protecting women’s access to abortion care.
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