Advancing Contraception Access in States Through Expanded Pharmacist Prescribing

This is the second installment in the Center for American Progress’ series highlighting best practices to improve and expand access to contraception at the state level.

from Center for American Progress, January, 2023 (excerpts)

Introduction and summary

An important policy strategy to expand and improve contraceptive access at the state level is to broaden pharmacists’ prescriptive authority so that they can not only dispense but also prescribe contraceptives. Currently, almost half of states allow pharmacists to do so. Many of these states have encountered significant implementation challenges, however, such as building sufficient billing infrastructure and reimbursing pharmacists for services, meeting privacy and confidentiality standards, and training pharmacists and updating protocols. Any effort to broaden pharmacists’ prescriptive authority must also address these issues for it to be effective….

Case studies: Approaches to implementing pharmacist prescribing

Although pharmacist-prescribed contraception laws vary from state to state, most of them cover two or three hormonal contraceptive methods.23 All states that allow pharmacist prescribing cover birth control pills. Most states also cover monthly birth control patches and rings. A few states cover injectable hormones and other self-administered methods approved by the Food and Drug Administration (FDA). The following case studies are not designed to be comprehensive—and the Recommendation section below describes some additional statistics from states to further explain the need for certain changes—but they demonstrate some notable trends in implementation.

Hawaii

In 2017, Hawaii became the sixth state to extend pharmacist prescriptive authority to contraception,24 passing and enacting Act 067, S.B. 51325—a statewide protocol allowing pharmacists to “prescribe and dispense” hormonal contraceptives.26 The purpose of this protocol “is to expand access to prescription contraceptives by: (1) Authorizing pharmacists to prescribe and dispense self-administered hormonal contraceptive supplies; and (2) Specifying requirements pharmacists must meet prior to prescribing and dispensing contraceptive supplies.”27

Some experts have emphasized the critical importance of Hawaii’s action in giving pharmacists this authority given the state’s ongoing shortage of health care providers, which the COVID-19 pandemic has only exacerbated.28 The law requires pharmacists who prescribe and dispense contraceptive supplies to complete an Accreditation Council for Pharmacy Education program; provide patients with a self-screening risk assessment tool; refer patients to their primary care providers upon prescribing and dispensing contraceptives or conducting consultations; give patients a written record of the contraceptives prescribed and dispensed; and dispense the contraceptives to patients “as soon as practicable” after prescribed.

In a survey of 175 pharmacies in Hawaii, researchers found that only around 30 percent offered pharmacist-prescribed contraceptives, with variability across geographic areas.29 When researchers asked the remaining pharmacies why they did not offer pharmacist-prescribed contraceptives, the primary reasons cited were lack of training and knowledge about the new protocol.

Additionally, although insurers are required to cover the cost of the full range of FDA-approved contraceptive products under the Affordable Care Act (ACA),30 70 percent of pharmacies surveyed still charged patients for the cost of a consultation (averaging $35), which introduces a new payment barrier to patients. The researchers concluded that a key reason pharmacists charged a consultation fee was that they lacked a mechanism to receive insurance company reimbursement for consultation services.31…

New Mexico, Maryland, and Hawaii all offer good examples of how to ensure that pharmacists are paid for the time they spend on prescribing not only contraceptives but also other related services:62…

• Hawaii requires pharmacists to be reimbursed for “medical services intended to promote the effective use of contraceptive supplies or devices to prevent unwanted pregnancy.”63 Some insurers have also implemented billing codes that pharmacists can use.

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AP: 20 attorneys general warn Walgreens, CVS over abortion pills