Home Pharmacy practice Pharmacists play a vital role in patient access to contraception

Pharmacists play a vital role in patient access to contraception

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Legislation allowing pharmacists to prescribe contraceptives is becoming widespread.

Until recently, a pharmacist’s responsibilities were almost exclusively limited to counting pills, affixing a label to the prescription bottle, and dispensing medications. At most they would advise patients whose prescriptions were a bit complicated.

However, as healthcare in the United States has progressed, pharmacists have taken on a more active role. Some of their new responsibilities include providing comprehensive drug reviews to patients, conducting research, and administering vaccines.

Idaho is the most progressive jurisdiction in the United States in terms of scope of practice for a pharmacist. State practitioners can prescribe low-risk drugs like contraceptives as long as the circumstances and agents in question fall within the parameters set by the Idaho legislature.1 And other states have followed suit.

In New Jersey, for example, Assembly Bill A5810 was passed by the Senate in June 2021 and referred to the Assembly Health Committee. This bill would allow pharmacists to dispense self-administered oral contraceptives under a standing prescription and in accordance with protocols of the New Jersey Board of Pharmacy and Board of Medical Examiners.2 If passed, the bill would require pharmacists to undergo a training program run by councils, and women would have to take a self-screening test before receiving contraceptives.2 If, after the self-screening, the pharmacist decides that the drug is inappropriate for the patient, he can refer the woman to her primary care physician.

Currently, 15 states allow pharmacists to prescribe oral contraceptives.3 The extent of their authority in the matter (the type of contraceptive and the circumstances in which they can provide it) varies by state. In addition to expanding the role of pharmacists, passing more such laws could improve access to birth control for large numbers of women, including the estimated 435,000 women aged 13 to 44 years old in New Jersey who need publicly funded contraceptive services and supplies.4

Research also shows that access to birth control significantly improves women’s quality of life. Such access has dramatically increased the number of women enrolling and graduating from college.5 These women also have the opportunity to delay childbirth and invest in themselves by pursuing a career.5 This is not only liberating for women, but it can also help the economy by increasing the number of people employed. In the 1970s, women began to make up a larger percentage of the workforce, especially in fields like medicine and law,5 and part of this increase can be attributed to the greater access to oral contraceptives they had at the time.

Unwanted pregnancies are higher in the United States than in other developed countries, and this problem disproportionately affects low-income women.6 Although, as currently written, New Jersey’s Bill A5810 would not reduce the cost of contraceptive coverage, it would spare patients a trip to the doctor and the associated costs. It would also be much easier for people living in rural areas and lower socio-economic groups to obtain contraceptives, as they can get to their local pharmacy much more easily than the nearest doctor’s office. Patients would also experience shorter wait times and their health care would be more cost effective.1

Making contraceptives more accessible has many benefits, but it is not without risks. Primarily, easier access to contraception could increase the incidence of certain adverse effects associated with it, including blood clots and depression. Pharmacists should be vigilant in advising patients about the risks as well as the benefits. As with most prescriptions, pharmacists should also monitor potential interactions between all patient medications. Given the heavier workload that community pharmacists have faced since the onset of the COVID-19 pandemic, some may feel overwhelmed by the prospect of yet another responsibility, and the quality of care may suffer.

However, legislation like A5810 could also have a positive impact on pharmacy students. New positions — specifically to prescribe oral contraceptives — could become available for pharmacists at publicly funded institutions like Planned Parenthood. Pharmacists would be needed
take additional training, but as the practice becomes more common, schools of pharmacy may begin to offer this training as part of the program. Overall, enabling pharmacists to prescribe these drugs will be beneficial not only for women but for society as a whole, and it can also allow pharmacy students to grow in a field that was previously limited to a single brief courses during their university years.

Adrian Michelet is a P3 student at the Ernest Mario School of Pharmacy at Rutgers University.

References

1. Broughel J, Amez-Droz E. Extending pharmacists’ prescribing power: options for reform. Mercatus Center. December 15, 2021. Accessed February 5, 2022. https://www.mercatus.org/publications/healthcare/expanding-pharmacists%E2%80%99-prescriptive-authority-options-reform

2. S404 (2020-2021). Accessed October 15, 2021. https://www.njleg.state.nj.us/bill-search/2020/S404

3. Contraceptives prescribed by the pharmacist. Guttmacher Institute. Published October 6, 2021. Accessed October 26, 2021. https://www.guttmacher.org/state-policy/explore/pharmacist-prepressed-contraceptives

4. Access to birth control 2021. Power to decide. Accessed October 26, 2021. https://powertodecide.org/what-we-do/access/birth-control-access

5. Center for the Economics of Reproductive Health at the Institute for Women’s Policy Research (IWPR). The economic effects of access to contraception: a review of the evidence. 2019:1-44. https://iwpr.org/iwpr-issues/reproductive-health/the-economic-effects-of-contraceptive-access-a-re-view-of-the-evidence Committee Opinion no. 615: access to contraception.

6. Obstet Gynecol. 2015;125(1):250-255. doi:10.1097/01.aog.0000459866.14114.33