States give pharmacists more prescriptive authority

Oregon is the latest to pass legislation allowing pharmacists to prescribe hormonal contraceptives

Oregon now joins California as the only other state that allows women to purchase hormonal contraceptives at a pharmacy without a doctor’s prescription.

On July 6, Oregon Gov. Kate Brown signed HB 2879, legislation that gives pharmacists prescribing authority for some hormonal contraceptives after a woman completes a self-administered risk-screening test.

"It makes no sense that men should have unrestricted access to contraceptives, while women must first get a prescription from their physician,” said Oregon Rep. Knute Buehler, an orthopedic surgeon who introduced HB 2879. “As a doctor, I believe birth control should be as easy and accessible as possible. If a woman wants to purchase birth control at her local pharmacy, she should be able to do that without having to schedule an appointment with a doctor."

California passed a similar law, SB 493, in 2013. The legislation allows pharmacists to initiate prescriptions for hormonal contraceptives and also gives them authority to prescribe other types of medications, such as nicotine replacement therapy. The protocols and state regulations for SB 493 are now entering the final stage. Jon Roth, CAE, CEO of the California Pharmacists Association, told Pharmacy Today in a June interview that by next quarter, pharmacists will be implementing SB 493.

Interpreting Oregon’s new law

Oregon’s law specifically states that pharmacists can prescribe hormonal contraceptives based on guidelines developed, and that they will need to be trained first to carry out this new duty.

“We’re hopefully going to have the training program up and online by the beginning of November,” said Lorinda Anderson, PharmD, BCPS, Pharmacy Instructor at Oregon State University, who is working with the Oregon Board of Pharmacy to put the training program together.

If all goes according to plan, Oregon pharmacists will be able to exercise their new prescribing authority beginning in January 2016. 

The Oregon Health Authority and Oregon State Board of Pharmacy are responsible for structuring rules to ensure safe prescribing by pharmacists, creating a self-screening test for contraindications, and notifying the patient's primary care provider, according to Buehler’s office. Contraceptives under the new law would still be covered by insurance.

However, Oregon pharmacists will be limited to prescribing oral and transdermal hormonal contraceptives. Gary DeLander, BSPharm, PhD, Oregon State Pharmacy Association President, said the association had hoped to include vaginal rings but was unsuccessful. He said the group may pursue the addition following successful implementation of the current statute.

Pushing greater access to contraceptives

In June, Brown signed another bill, which complements HB 2879, allowing women to pick up a 12-month supply of oral contraceptives in a single visit. Pharmacists could eventually be involved in initiating prescriptions under this law, according to Anderson. The law will also take effect next year.

The idea to improve contraceptive access has also gained traction on the federal level. Sens Cory Gardner (R-Colorado) and Patty Murray (D-Washington) have both introduced bills that would increase access to hormonal contraceptives.

However, what makes the bills in California and Oregon attractive is that a pharmacist has permission to prescribe following a protocol rather than merely making hormonal contraceptives OTC. This keeps professional oversight intact while also improving access.

California legislation SB 493 allows pharmacists to do more than initiate prescriptions for hormonal contraceptives. It also enables pharmacists to provide nicotine replacement therapy to patients, prescribe medications for travel abroad, and order tests to monitor and manage the efficacy and toxicity of drug therapies for patients with diabetes, hypertension, and other conditions.

“There is growing recognition across the U.S. that pharmacists are a perfect resource to enhance access to public health services due to their expertise in medications and wellness and their exceptional accessibility,” said Krystalyn Weaver, Director of Policy and State Relations for the National Alliance of State Pharmacy Associations.

She said they are seeing more and more states implementing policies giving pharmacists prescriptive authority for certain products important to public health, such as naloxone, smoking cessation products, hormonal contraceptives, and travel medications.

Oregon’s newly enacted provider status law also authorizes the Oregon Health Authority to work with the state Board of Pharmacy to establish statewide protocols, primarily for postdiagnostic clinical services such as smoking cessation and travel medicine.

Other states, including New Mexico and Idaho, also have statewide protocols giving pharmacists prescriptive authority for certain products.

Weaver said looking to pharmacists to provide a variety of health and wellness services is a perfect solution to improve health.