Women's Health

Sonya Collins

Since 2016, California pharmacists have had the authority to prescribe hormonal contraception. In 2017, the state of Colorado followed suit. Today, community pharmacists in 20 U.S. jurisdictions can prescribe birth control. In several other states, similar legislation is in progress, which would bring the tally to half of U.S. states where pharmacists can provide birth control directly to patients.

The service expands access to essential health care for patients and can provide professional satisfaction and additional revenue for pharmacists.

“It’s an extremely rewarding service to provide,” says Sally Rafie, PharmD, BCPS, APh, NCMP, FCCP, FCPhA, a pharmacist specialist at UC San Diego Health and founder of BirthControlPharmacist.com. “My patients generally express positive feedback, and many have been coming back to see me for several years. It’s a great way to expand clinical services and reach a different, younger population than you do with medication therapy management and vaccine services.”

State policies

Policies regarding pharmacist prescribing of birth control vary from state to state. States may give pharmacists prescribing authority through statewide protocols, standing orders, a contraceptive collaborative practice agreement, or general collaborative practice agreement.

The policies of all participating states include oral and transdermal hormonal contraception. Most state policies also allow for the prescribing of contraceptive rings and injections.

In several states, pharmacists’ authority only applies to patients aged 18 years and older; in others, there is no age restriction.

In each of these states, pharmacists must complete additional training before they offer the service. Training covers types of hormonal contraceptives, how to assess patients for eligibility, key counseling points, and implementation of the service in the community pharmacy.

“The training prepares you to get started right away,” Rafie says, adding, “You don’t have to be able to provide contraception care to all patients. You can refer them to other trusted providers if the case is too complex.”

Patient outcomes

Pharmacy-based birth control services could significantly increase access for those who otherwise face barriers to obtaining contraception. Consider that 90% of Americans live within 5 miles of a pharmacy, and an estimated 45% of pregnancies in the U.S. are unintended.

In Oregon, one in ten Medicaid beneficiaries who start a new prescription for oral or transdermal contraception get it directly from a pharmacist.

A study of Oregon Medicaid recipients considered high-risk for unplanned pregnancies found that pharmacist-prescribed contraception helped prevent an estimated 51 pregnancies and saved the state $1.6 million in its first year.

While more than two-thirds of people with uteri who access birth control in this way are insured, a survey found that uninsured people consider the cost of the pharmacy visit for contraception an advantage of this service.

The policy may raise questions as to whether people who use this service stay up to date with routine preventive care if a doctor visit is not necessary to obtain a prescription for contraception. However, studies show that 89% of people who receive pharmacist-prescribed birth control saw their primary care provider in the last year.

“Pharmacists can help advise patients on any routine screenings that are due, such as breast and cervical cancer screening, HIV and other STD screenings, and provide referrals,” Rafie says.

Contraceptive prescribing in practice

During a contraception consultation, pharmacists use a screening tool to determine the patient’s eligibility, take blood pressure, take a medical history, ask about patient’s preferences, and provide a prescription or a referral.

These visits take less than 10 minutes and in Oregon they lead to pharmacies filling about 61 pharmacist-prescribed prescriptions for contraception per month.

It’s unknown to what degree private payers cover contraception consults with a pharmacist. Pharmacies must contract directly with payers to be reimbursed for this patient care service. Some states, however, require that Medicaid cover these consultations. Pharmacies tend to charge $30 to $50 for the visits.

In states where it is legal, Rafie says, “It’s my wish that all pharmacists who support patient choices and value patient-centered care will offer contraceptive care services.” ■