There are 73 million women of reproductive age in the United States, and 14 percent of them use oral birth control pills.
Hormonal contraception is so commonplace that many states have begun to allow pharmacists to prescribe it without establishing a collaborative practice agreement with a physician’s office, giving pharmacies a new way to connect with their patients.
Read on for answers to frequently asked questions about pharmacist-prescribed contraception.
Where can pharmacists prescribe contraception?
In 2016, Oregon became the first state to allow pharmacists to prescribe birth control, and California followed soon after.
In the intervening years, a total of 20 states and jurisdictions have passed legislation that gives pharmacists prescribing authority for contraception without a collaborative practice agreement. Here’s a complete list:
- Arizona
- Arkansas
- California
- Colorado
- Delaware
- Washington, D.C.
- Hawaii
- Idaho
- Illinois
- Maryland
- Minnesota
- Nevada
- New Hampshire
- New Mexico
- North Carolina
- Oregon
- Utah
- Vermont
- Virginia
- West Virginia
Many other states have legislation in the works to allow pharmacists to prescribe contraceptives, so this list may grow in the future.
Why should pharmacists have the authority to prescribe contraception?
Hormonal contraceptives are critical in reducing the number of unintended pregnancies, and 45 percent of all pregnancies in the United States are still unintended.
When pharmacists have the authority to prescribe hormonal contraceptives, more people will have access. Ninety-three percent of people live within five miles of a community pharmacy, and unlike physician’s offices, pharmacies typically do not require an appointment. They also tend to have longer hours, which means patients do not have to take time out of their regular workday to visit.
With this increased access, patients will be more likely to initiate a contraceptive regimen and more likely to stay adherent.
Evidence shows that patients are taking advantage of pharmacist-prescribed contraception in states where the practice is legal. In Oregon, 10 percent of all prescriptions for contraception are now written by pharmacists.
What is the procedure for prescribing?
Each state has its own protocol for pharmacist-prescribed contraception, but typically it will follow this process:
Screening: Pharmacists ask the patient about their medical history and pregnancy status, and they check the patient’s blood pressure. The CDC’s U.S. Medical Eligibility for Contraceptive Use guidelines can help pharmacists determine if a patient is eligible for the prescription and which method to choose. Pharmacists should also take the patient’s preference into account.
Counseling: Just like any other prescription, offer the patient counseling on the appropriate use of their new medication. Be sure to cover the prevention of sexually transmitted infections.
Reporting: Pharmacists should keep meticulous notes about each visit, and if the patient has a regular primary care provider, they should notify the PCP about the new prescription. Some states also require that pharmacists provide separate reports to local health departments or boards of pharmacy.
Follow-up: After the contraceptive has been prescribed, provide refills as necessary. Depending on the patient, you may want to monitor blood pressure or recommend they make an appointment with their primary care provider.
What training is needed?
Training requirements vary from state to state, but most pharmacists will need to complete a program approved by the state board of pharmacy or an ACPE-accredited continuing education program before they are able to prescribe hormonal contraceptives.
Are there any downsides to pharmacist-prescribed contraception?
Some groups have expressed safety concerns about pharmacist-prescribed contraception because pharmacists often don’t have access to their patients’ full medical history. However, these safety concerns can be mitigated by screening questionnaires and a blood pressure assessment. There’s also robust evidence that patients are competent at using self-screening tools to determine their own eligibility for contraceptives.
Others point out that if pharmacists are able to prescribe contraceptives, patients will forgo regular health screenings. But studies from countries where hormonal contraceptives are available over the counter show that people who received OTC contraceptives still received recommended Pap tests, pelvic exams, breast exams, and STI screenings.
One known downside is that pharmacists cannot administer long-acting reversible contraception (LARC) like an IUD or implant. When counseling patients on contraceptive options, pharmacists should be prepared to refer patients who are interested in LARC to an OB/GYN.
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