Over the past few years, several states, including Oregon, California, Washington, and New Jersey, have enacted legislation allowing patients to get birth control from certain pharmacies without having to make a doctor’s appointment.
In these states, pharmacists can prescribe and dispense hormonal birth control, including the pill, patches, shots, and vaginal ring, without a physician’s prescription. Pharmacists who want to provide such a service must complete any trainings mandated by the state.
Patients fill out a self-screening questionnaire, similar to immunization questionnaires, providing pharmacists with the relevant medical history, pregnancy status, and medication history. Based on the screening results, pharmacists can either provide or decline a prescription. If the pharmacist decides to prescribe birth control, they must provide a visit summary and any counseling the patient may need regarding the medication. If the pharmacist declines, the patient can go to a physician for further evaluation and counseling on birth control alternatives.
Women are typically required to make annual appointments with their doctor to receive a prescription for birth control. However, appointment costs and the need to take time off from work can be significant barriers that force many women to forego contraceptives altogether, resulting in a higher likelihood of unintended pregnancy. The removal of such barriers can help women reduce the risks of unwanted pregnancy. One study found that Medi-Cal insured women in California who received a 12-month supply of birth control had a 30% lower chance of becoming pregnant compared to women who only received 1- or 3-month supplies.
With the convenient locations and extended business hours of pharmacies, patients who may not otherwise have time to make a doctor’s appointment can instead get their birth control by visiting a local pharmacy on their own time. Such expanded access is important for low-income women, especially those in rural areas who may face financial or transportation barriers to doctor’s visits.
In addition, despite the shortage of primary care providers, the number of pharmacists continues to increase. Pharmacists who provide birth control can help relieve some of the high patient volumes burdening primary care physicians. And to ease physician concerns about patients skipping annual visits, pharmacists cannot write prescriptions for women who are unable to prove that they visited their doctor within three years of the pharmacist’s initial birth control prescription. This is to ensure that women still receive recommended screenings like the Pap test, which is usually recommended every three years.
Patients have generally reacted well to this alternative way of getting birth control. A study in Washington showed that 70% of women evaluated by a community pharmacist for hormonal birth control reported continuous use of the contraceptive after twelve months. Nearly all of the women were willing to continue seeing pharmacists for their prescriptions. The study shows that patients can accept pharmacists as care providers and trust their ability to prescribe the appropriate birth control.
However, there are still other barriers to overcome when it comes to birth control access. For example, even if the prescription birth control itself is covered by an individual’s insurance, pharmacies can still charge an additional fee for the pharmacist’s assessment. Insurers are not required to reimburse the pharmacist’s services, so pharmacies charge the patients instead. This additional fee could become a burden on lower-income patients for whom it may not be economically feasible.
As nice as it sounds, women are only be able to take advantage of these services if pharmacies in their area provide them. A study from the University of California, Berkeley found that a year after pharmacists were given the authority to prescribe birth control, only 11% of the state’s retail pharmacies offer such birth control services, and over half of them charge a fee for the service ($40-45). The Berkeley study also highlighted pharmacists’ concerns about liability, lack of reimbursement, and limited time for counseling.
Despite these challenges, Colorado, New Mexico, Maryland, Hawaii, and several other states are either considering legislation that allows pharmacists to prescribe hormonal birth control or are already developing statewide protocols for pharmacists to prescribe and dispense hormonal birth control. Such steps will help expand women’s access to birth control in those areas, which will hopefully give women more options for preventing unwanted pregnancies.
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