States Authorize Pharmacists to Prescribe and Dispense Contraceptives

June 06, 2019|12:13 p.m.| ASTHO Staff

An increasing number of states have adopted laws setting out conditions under which pharmacists may prescribe and dispense contraceptives. Allowing pharmacists this role can increase access to contraceptives which, when used properly, can help avoid unintended pregnancies and delay subsequent pregnancies. Research shows that 45 percent of U.S. pregnancies are unintended and almost one-third of U.S. births occur within too short a time period from a previous birth (i.e., 18 months). Both of these circumstances are associated with higher rates of later access to prenatal care, premature birth, and low-birth weight. With women often facing economic, informational, and systematic barriers to contraceptive access, expanding the role of pharmacists in providing such care could be viewed as a way to improve maternal and child well-being and health outcomes.

The District of Columbia and 11 states (California, Colorado, Hawaii, Maryland, New Hampshire, New Mexico, Oregon, Tennessee, Utah, Washington, and West Virginia) now allow pharmacists to provide contraceptives without a prior prescription via one of several mechanisms, including standing orders, practice protocols, or an expanded scope of practice. For example, California, Colorado, and New Mexico have established protocols, while Utah’s state health officer has issued a standing order. The forms of contraceptive that can be prescribed and administered by pharmacists are also set out by the laws. All the jurisdictions allow pharmacists to prescribe and dispense self-administered contraceptives, while some states, such as Oregon, also allow pharmacists to prescribe and administer injectable contraceptives.

These laws seek to establish timely access to contraceptives while also ensuring adequate, safe care. To ensure timeliness in obtaining contraceptives, Colorado, Hawaii, Oregon, and Tennessee prohibit pharmacists from requiring the scheduling of an appointment and require that the contraceptives be dispensed as soon as practicable. The law in Washington, D.C. requires that a pharmacy list the times when a pharmacist who dispenses contraceptives is available, while in Washington state a pharmacy that furnishes contraceptives is identified by a specially designed window sticker or sign.

Beyond access and availability, these laws also set out requirements to ensure that care provided by pharmacists is appropriate and informed. Most of the jurisdictions only allow the pharmacist to furnish contraceptives after the pharmacist receives education or training on prescribing and dispensing contraceptives. Almost all the jurisdictions also require pharmacists to assess patients before prescribing and dispensing contraceptives, typically with a self-screening risk assessment. Assessment questionnaires used in Oregon and Utah are available for reference. Many of the laws also require pharmacist to provide the patient with a standardized information sheet about contraceptives, a written summary of the consultation, advice about follow-up with a patient’s primary care provider (PCP), and a referral to a reproductive care provider or clinic if the patient does not have a PCP.

Tennessee, Utah, and Washington state limit a pharmacist to prescribing and dispensing contraceptives to persons 18 years of year or older, whereas Oregon allows a pharmacist to provide contraceptives to a person under the age of 18 if there is evidence of a prior contraceptive prescription. Tennessee allows prescribing and dispensing contraceptives to anyone under 18 who is emancipated; Oregon’s age limitation will expire in 2020. A few states also limit the amount of time a pharmacist can continue to prescribe and dispense contraceptives without evidence of a clinical visit by the patient. For example, Colorado limits pharmacists to three years without evidence of a clinical visit. In Utah, this limitation is two years, in West Virginia one year.

Even as states expand access to contraceptives through pharmacists, other barriers to access remain. For example, in California, researchers found that only 11 percent of pharmacies provided contraceptives one year after its law went into effect. Additionally, lack of reimbursement presents another barrier since health insurance may not cover the cost of a pharmacist consultation. ASTHO will continue to inform its members as states set out conditions under which pharmacists may prescribe and dispense contraceptives.

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