Study: Pharmacist Prescribing of Contraceptives Not Working as Well as Intended
Although 20 states have passed policies to allow pharmacists to prescribe short-acting hormonal contraception, these services are not used much, new research suggests.1
“We were working with healthcare providers across the state to increase access to family planning, and we thought pharmacists were this new area of prescriber. There’s a lot of evidence that no one is doing it,” says Rebecca Simmons, PhD, MPH, an assistant research professor in the department of obstetrics and gynecology at the University of Utah. “We asked if we could see how well standard contraceptive access initiatives map into a pharmacist-specific project. The goal was twofold: to say what are the specific state issues that are limiting people’s ability to access this, and the pharmacist’s ability to prescribe through barriers.”
Utah passed a law allowing pharmacy prescribing in 2019, Simmons says.
To participate, pharmacists had to register with the state health department and take prescriber training, which was behind a paywall. “What we heard from colleagues at the department of health is no one was doing this,” Simmons says. “Some pharmacists paid to get training, but no one was prescribing. Even if they did all this work to get training, they wouldn’t [have] any clients, and they had to keep training every year.” The health department saw a drop-off of pharmacists who were registered to prescribe contraceptives, she adds.
Simmons and colleagues interviewed people involved in pharmacist prescribing practices to see why they were not prescribing contraceptives as the law was intended to promote. “We looked at barriers and facilitators to pharmacy prescribing,” Simmons says.
Simmons and colleagues used a tool by the Consolidated Framework for Implementation Research to identify barriers and compare what was happening with standard contraceptive access methods. They presented the results of their findings to a group of pharmacy and contraceptive stakeholders in Utah, including the state Department of Health and Human Services, the board of pharmacy, and commercial pharmacies.
“We got everyone in the room and presented the results and asked for their feedback on whether they thought it was a fair representation of the problem and what the challenges were,” Simmons explains. “They gave us feedback and we utilized it with all other information we’d acquired from interviewees and created a science logic model, outlining what we think is a strategy that could apply.”
The barriers they discovered are not unique to Utah. They were similar to previously published findings. “Other states that are interested in improving access through pharmacy prescribing could take the last two steps and apply these to their own situations,” Simmons says.
For example, one of the problems with pharmacy prescribing is that pharmacists often do not receive reimbursement for their services through Medicaid or traditional payers. In a specific context, they might be reimbursed, but the amount is significantly less than if a provider had been the prescriber. This is a disincentive.
“If pharmacy reimbursement is a big problem, the state Medicaid office is the one that needs to talk about having this meeting with payers or find a legislator willing to sponsor a bill to improve reimbursement rates for XYZ things,” Simmons says. “It can’t be generalized solutions. State-specific action items come into play.”
To solve the problem, states should take these tactics to stakeholders, get their feedback, and make a plan with actionable approaches to pharmacy prescribing, Simmons suggests. Depending on a state’s laws and processes, one way to do this most efficiently is to work out the pharmacy reimbursement issue at the state level because many of the pharmacists in rural areas work for commercial pharmacy chains.
“You get some independent pharmacies in rural areas, and they could benefit from targeted outreach,” Simmons adds. “State context is what influences their ability to do those things in their rural pharmacy.”
Another barrier is public awareness that the service even exists.
“We did a population survey in December 2022, where we asked people across Utah, Idaho, and Nevada if they knew pharmacy prescribing was available in their state and if they’d use it in the future,” Simmons says. “People in rural areas were much more likely to say they both knew about it and wanted to use it in the future.”
Ideally, everyone would know they could obtain their contraception from a pharmacy in their neighborhood. To reach the ideal, there would need to be a public information campaign.
That action also comes with a barrier. “One of the biggest challenges is because not every pharmacy offers the service,” Simmons notes. “It could be disheartening for a person to go to the pharmacy and say, ‘I’m here for contraception,’ and the pharmacists say, ‘I don’t do that here.’”
Providing a list of pharmacies that offer the service would be a challenging task — even in lower-population states. “Keeping the list updated is challenging because the ability to prescribe is specific to an individual pharmacist,” Simmons explains. “In an independent pharmacy, the main pharmacists have the ability to prescribe, but the other pharmacists may not. On a given day, a person who could do this may not be there.”
Any marketing campaign would be tricky and may backfire if it raises awareness but access to the service cannot meet the demand. “What we think is a potential solution is to do a pharmacy-specific access initiative,” Simmons says. “Partnering pharmacists would receive additional training and support, and there would be a public information campaign for pharmacies that participate.”
When that tactic is employed, it raises the tide. Once the service gains broader public knowledge, more pharmacists are incentivized to do it, and they seek out the additional training.
“In states like Utah where there is a lot of interest, the answer is to give a demonstration to show how this can be done successfully,” Simmons says.
As pharmacists deliver more healthcare services directly to people, there need to be improvements in reimbursement. “One of the main limitations to their doing these services is they don’t reimburse, or payers don’t reimburse them fairly,” Simmons explains. “Contraceptive prescribing — if it could work from a reimbursement perspective — has a lot of implications for other things that pharmacists do.”
- Simmons RG, Baayd J, Tak C, et al. A stakeholder-developed logic model to improve utilization of pharmacy-prescribed contraception in Utah. Implement Sci Commun 2023;4:124.
Although 20 states have passed policies to allow pharmacists to prescribe short-acting hormonal contraception, these services are not used much, new research suggests.
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