Birth Control
Sonya Collins
This year, pharmacists in Michigan joined the ranks of birth control prescribers. Thirty-five U.S. states and Washington, DC, have granted this authority to their pharmacists. Nearly 60% of the country’s 44,000 pharmacies are located in one of these 35 states—more than the number of public clinics that offer birth control. But relatively few of these pharmacies offer hormonal contraception without a prescription.
While pharmacists are well positioned to substantially expand access to birth control across the country, only a minority of those who have prescribing authority exercise it, according to a recent report by Ramaswamy and colleagues published online on March 19, 2025, by Kaiser Family Foundation.
“At the root of it is that not all of the policies that these states are passing are created equal,” said Sally Rafie, PharmD, founder of The Birth Control Pharmacist. “There are a lot of barriers built into the policies themselves.”
Lack of reimbursement
Prescribing the right hormonal contraception requires discussion and counseling, which takes more time than simply filling a preexisting prescription for birth control. But whether a pharmacist is reimbursed for this time depends on the state where they practice.
Some state laws require coverage parity so that pharmacists are reimbursed for counseling at the same rate as any other birth control provider. Other states may only require Medicaid, but not commercial payers, to reimburse for counseling. Still others don’t address the issue of payment, beyond the cost of the prescription itself, at all.
“One of the toughest nuts to crack is the billing piece,” Rafie said. “Getting pharmacists the ability to bill the patient’s health plan for the visit rather than directly charge patients so patients can use their insurance for the visit.”
Workflow challenges
Even with reimbursement for their time, many pharmacists find it challenging to work birth control consultations into a tight workflow.
“How do you incorporate a patient visit for contraception that may take 5, 10, 15 minutes into a workflow where you’re filling prescriptions and counseling patients in increments of 1 to 2 minutes?” Rafie said.
Training requirements
Pharmacists who struggle to fit birth control consultations into their workflow may also be unable to spare the time for the additional training that most states require.
Both national surveys and surveys of pharmacists in individual states have found that though most pharmacists are interested in prescribing birth control, they cite time constraints as the biggest hurdle to providing the service, according to the Kaiser Family Foundation report. A survey of Oregon pharmacists ranked both time constraints and training requirements among the clinicians’ chief concerns about offering birth control.
Lack of public awareness
Even after pharmacists successfully meet all the requirements needed to add birth control services to their pharmacy’s offerings, patients may not seek the service—especially in areas where they have other more well-known options, Rafie explains.
“There have been zero implementation dollars attached to these bills. There’s been no coordinated efforts to implement them,” she said. “It’s left up to individual pharmacies to spread the word in their local communities, which is tough. That’s an extra burden on them.”
It’s just a matter of how
The barriers are not insurmountable.
“We know that the majority of pharmacists want to do this,” Rafie said. “They believe in the mission of helping people access birth control. It’s just a matter of how to do that.”
APhA, the World Health Organization, state pharmacist associations, The Birth Control Pharmacist, and other companies offer continuing education training and additional resources to prepare pharmacists to prescribe birth control in their pharmacies.
Pharmacists who cannot or choose not to prescribe birth control can also help increase access to hormonal contraception:
- Educate patients about Opill, an OTC hormonal contraceptive pill. Only one in four women are aware it exists.
- Refer patients to public health clinics where they can access comprehensive birth control options.
- Proactively contact prescribers when patients are out of refills.
- Encourage prescribers to approve 12 months at a time rather than 3 months.
“Anything they can do,” Rafie said, “to educate patients, raise awareness and be proactive.” ■