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Contraceptive access issues highlight
pharmacists’ role
Requirements for birth control
dispensing, decision on nonprescription emergency contraception pending
even as more states allow pharmacists to prescribe EC.
Women’s access to hormonal
contraception
continues to be a hot political issue, and the role of
the pharmacist
in providing this access is at the center of much of the
debate
and, sometimes ill-considered, actions. The questions of
whether
pharmacists will be required to dispense prescriptions
for contraceptives
regardless of personal moral or religious objections or
medical
appropriateness and whether a product for emergency
contraception
(EC) will become available without a prescription in the
United
States remain unsettled. At the same time, pharmacists
are increasingly
gaining the authority to provide EC.
On April 1, Illinois Gov. Rod Blagojevich responded to
two alleged
incidents of women being unable to have prescriptions
for EC
dispensed at a pharmacy in Chicago by issuing an
emergency order
requiring “pharmacies that sell contraceptives to
fill
prescriptions for birth control without delay.” As
originally
written, the order did not even permit pharmacists to
consider
contraindications to hormonal contraception or to
exercise their
rights of conscience, stating only that “if the
contraceptive,
or a suitable alternative, is not in stock, the pharmacy
must
order or obtain the contraceptive or … transfer
the prescription
to another local pharmacy of the patient’s choice
or return
it to the patient.”
The order, which will be in effect through August, was
modified
several days later to allow pharmacists to continue to
rely on
their professional judgment in determining whether a
birth control
prescription was appropriate. The revision was prompted,
in part,
by a letter the Illinois Pharmacists Association, APhA,
and the
American Society of Health-System Pharmacists sent to
the governor
in which the groups noted that “the order creates
a professional
dilemma for pharmacists: the requirement to dispense a
valid,
lawful prescription ‘without delay’ could
require
a pharmacist to dispense a valid, lawful—but
clinically
inappropriate—medication ‘without
delay’. This
requirement conflicts with the responsibilities outlined
in the
Illinois Practice Act, specifically requiring
pharmacists to
conduct prospective drug utilization review.”
Following Blagojevich’s lead, a group of federal
legislators
led by Rep. Carolyn Maloney (D-N.Y.) in the House of
Representatives
and Sen. Frank Lautenberg (D-N.J.) in the Senate
introduced the
Access to Legal Pharmaceuticals Act (H.R. 1652/S. 809)
on April
14. The language of the federal bills is similar to that
of the
Illinois emergency order. However, H.R. 1652 explicitly
states
that pharmacies that employ a pharmacist who
“refuses on
the basis of a personal belief to fill a valid
prescription” is
subject to civil fines of up to $500,000 if another
pharmacist
is not found to dispense the prescription.
In a press release issued as part of June 7 media
briefing,
Maloney and other bill sponsors noted the proposal is
intended
to “protect an individual’s access to legal
contraception
by requiring that if a pharmacist has a personal
objection to
filling a legal prescription for a drug or device, the
pharmacy
will be required to ensure that the prescription is
filled by
another pharmacist employed by the pharmacy who does not
have
a personal objection.”
The federal proposal attempts to support APhA’s
policy
regarding balancing pharmacists’ rights of
conscience with
patients’ rights of access to appropriate therapy.
The
Association supports pharmacists who choose to
“step away” but
not those who choose to “step in the way.”
This two-part
policy supports the ability of pharmacists to choose not
to dispense
certain prescriptions and the creation of systems to
make sure
patients are served.
However, as much as the sponsors believe they are
balancing
the needs of pharmacists and patients, as written, the
federal
proposal creates a single system that may not work in
every situation.
The result may be the establishment of a duty to fill.
As clouded as issues relating to prescription birth
control
are, those surrounding EC are even more unclear. Despite
Health
Canada’s April decision to grant the
single-ingredient
EC product Plan B (levonorgestrel) nonprescription
status and
a long-past deadline to make a final determination
regarding
an Rx-to-OTC switch here in the United States, FDA has
yet to
say whether women 16 years or older can get EC without a
prescription.
In contrast to FDA’s foot-dragging, several
states have
made it possible for pharmacists to provide EC under
collaborative
arrangements with prescribers. Women in Alaska,
California, Hawaii,
Maine, New Hampshire, New Mexico, and Washington are
currently
able to get EC directly from pharmacists. This is likely
to become
the case in several other states before the end of this
year.
In each state that authorizes pharmacist-provided EC, an
opt-in
system is in place. No pharmacist is required to
dispense EC.
Also, in each state, pharmacists must screen patients to
ensure
that they are appropriate candidates for EC, counsel the
women
on proper use of the medication, and inform them of the
necessity
for a follow-up visit to a health care provider.
APhA Director for Federal Government Affairs Kristina
E. Lunner
shared this information with legislators and family
planning
advocates during a panel discussion on Capitol Hill on
June 8.
Lunner’s message to attendees was that
“pharmacists
are important collaborators when working to advance
appropriate
patient access to medications. The success of the
pharmacist
prescriptive authority programs, which authorize
pharmacists
to prescribe emergency contraception, is evidence of the
important
role pharmacists can play in helping patients gain
access to
and make the best use of medications.”
Web links
Related resources on
www.pharmacist.com
Contact the writer: Ed Lamb (elamb@aphanet.org), Pharmacy
Today
Posted June 9, 2005, 3:45 pm EDT
| Requirements for birth control dispensing, decision on nonprescription emergency contraception pending even as more states allow pharmacists to prescribe EC. |
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