How States Can Improve Contraceptive Access

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A recent report proposes state-level reforms to allow pharmacists to prescribe contraceptives.

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Nearly 20 million people in the United States need access to contraceptives, but many face difficulties acquiring them. As some states begin to develop policies limiting the availability of contraceptives, other states have instituted policies to broaden access for individuals hoping to manage their reproductive health.

In a report issued earlier this year by the Center for American Progress, policy analyst Kierra B. Jones urges state governments to allow pharmacists to prescribe birth control. Specifically, Jones recommends that states adopt guidelines for when pharmacists can prescribe specific medications.

As pharmacies often serve as an accessible community resource, expanding pharmacists’ ability to prescribe contraceptives could improve the overall accessibility of such medications, Jones argues. In turn, the convenience of this model might prompt more consistent contraceptive usage by patients and allow them to better manage the risk of pregnancy.

At face value, allowing pharmacists to prescribe contraceptives would broaden access to such medications, as patients would no longer need to arrange a visit with a medical doctor, Jones emphasizes. Individuals would also no longer be burdened by needing to find child care, take time off of work, or find transportation to appointments. In addition, individuals in underserved or rural areas often can access a pharmacist more easily than a physician.

Allowing pharmacists to prescribe birth control would be cost effective as well, Jones contends.

To illustrate the cost savings, Jones points to Oregon’s pharmacist-prescription model, which saved the state an estimated $1.6 million.

Alongside Oregon, several other states, including Hawaii, Maryland, and New Mexico, have recognized the benefits of pharmacist-prescribed birth controls. Presently, 24 states and Washington, D.C. have started to implement such policies.

In light of the recent push toward the establishment of protocols for pharmacist prescriptions of birth control, Jones identifies five issues that legislators should account for when considering the adoption of these protocols.

First, Jones emphasizes that state lawmakers must adequately inform both the public and relevant health care professionals of new protocols to ensure a seamless transition. Jones suggests disseminating policy updates and creating public, accessible, and up-to-date databases accounting for all pharmacies and pharmacies that can prescribe birth control.

Second, Jones recommends that states ensure pharmacists have adequate training for prescribing contraceptives. Allowing pharmacists to prescribe such medications requires a level of knowledge about hormonal changes, eligibility, counseling, and any state-specific practices or limitations related to prescriptions. According to Jones, states can implement task forces to create and monitor educational materials for pharmacists. Oregon, for example, created a task force to create training on the efficacy and referral process for certain contraceptives. Jones also highlights Maryland’s online training program, which educates pharmacists on contraceptive options, protocols, and resources for patients.

Third, Jones recommends states work to overcome billing complications. At present, pharmacists are not able to receive payment from insurance plans for the additional work involved with prescribing contraceptives. States should formulate specific billing protocols that adequately reimburse pharmacists for their role in prescribing contraceptives, contends Jones. New Mexico, for example, has adopted a policy mandating that insurance plans pay pharmacists the same rate for prescribing contraceptives as other health care professionals.

Fourth, Jones argues that states must address patient privacy. One study noted that privacy concerns hinder patients from accessing pharmacist-provided birth control. But a California pharmacy law addresses these concerns by explicitly requiring pharmacists who prescribe contraceptives to maintain and uphold patient privacy standards.

Lastly, Jones urges states to address safety and pharmacist liability. Because some patients might suffer from adverse health conditions requiring particular care when prescribing contraceptives, pharmacists face a risk of liability if they fail to perform a full and thorough patient screening.

As a potential solution, Jones references recommendations issued by the National Alliance of State Pharmacy Associations and the National Association of Boards of Pharmacy. Under these recommendations, states should adopt a uniform protocol requiring that pharmacists screen and assess patients before prescribing contraceptives. The majority of patients accurately provide their medical histories during screenings, and pharmacists generally maintain a high accuracy rate in prescribing contraceptives.

Allowing pharmacists to prescribe contraceptives will address barriers to accessibility, argues Jones. Pharmacist-prescribing protocols can work in tandem with other state policies to protect individuals from unwanted pregnancies and any resulting health complications, concludes Jones.