Don Downing
Member, Board of Directors, Association of Reproductive Health Professionals
A tearful 15-year-old approached the pharmacist working in a community pharmacy in a small town in Washington state. She had been raped the night before. Afraid to tell her parents, the police or her doctor, she came to the pharmacy because it was “less scary,” and she had heard that pharmacists in Washington could prescribe emergency contraception. The pharmacist escorted the young patient to a private counseling room, prescribed and provided her with emergency contraception, and with her consent, referred her to a local clinic for follow-up care.
The pharmacy’s role
Timely, convenient access to effective contraception is often challenging to provide, especially to young people. Recognizing the role pharmacists can play in providing convenient, cost-effective health care, my home state of Washington, in 1979, became the first to allow pharmacists to collaborate with other health care professionals to provide all prescription medications to patients without a trip to the doctor.
Forty-eight U.S. states now provide ways for pharmacists to partner with other health care providers to provide prescription contraception and other medicines. Eight states — including California — now allow pharmacists to independently prescribe birth control. Washington, D.C., earlier this year became the latest jurisdiction to adopt this important health care reform.
At an impass
However, many patients aren’t aware of the expanded authority their local pharmacists have. California authorized this role for pharmacists in April 2016, and pharmacists in many of the state’s major retail pharmacies have been trained to provide the service . However, a December 2017 survey found that only 11 percent of California pharmacies dispense prescription birth control without a patient first obtaining a prescription from a doctor.
The survey found that pharmacists are reluctant to prescribe contraception because of liability concerns, inadequate staffing to provide necessary one-on-one counseling and no insurance compensation for the time pharmacists consult with patients needing birth control. While the Affordable Care Act requires insurance companies to provide no-cost birth control, California’s law doesn’t require compensation to pharmacists for the additional time they spend with patients, or for liability issues. To offset those costs, many California pharmacies charge a $45 birth control consultation fee, which some patients find cost-prohibitive. A new law will require the state’s Medicaid program to compensate pharmacies for the service by 2021, but it only applies to patients with Medi-Cal insurance, not with private insurance.
These factors create a chicken-and-the-egg scenario: pharmacies are hesitant to invest in providing a service they’re unsure patients will use and for which they’re not fully compensated for providing, while patients aren’t aware pharmacies offer prescription contraception, so they aren’t requesting it.
The patient’s role
What can you, your friends and family do to ensure more patients can easily and conveniently obtain birth control at their pharmacy, without a visit to a doctor?
If patients live in one of the only two states that still don’t allow pharmacists to collaborate with other health care providers to provide contraception — Alabama and Oklahoma — they should let their pharmacies and elected officials know they want this service. Similarly, if you live in one of the 42 states where pharmacists can’t independently prescribe contraception, let your pharmacies and legislators know this is an important, long overdue reform your state needs. And if you’re lucky enough to live in one of the jurisdictions where pharmacists can prescribe birth control, let your local pharmacies know that demand exists by asking for it, and then tell your elected officials that insurance carriers should be required to compensate pharmacists who see patients in need of contraception.
Many sexually active people don’t regularly see doctors or other health care clinicians, but they often visit pharmacies. We should allow and encourage trained and skilled pharmacy staff to provide better, more accessible reproductive health care to these patients.
