Contraception Access Learning Community: Resources

SOPHIA DURANT:
Hello, everyone! Welcome!

I'm showing one past the hour, so we're going to be getting started. So welcome to this webinar! It's hosted by the Implementing Pharmacists Prescribed Contraception Learning Community. My name is Sophia Durant, I'm a Senior Analyst of Family and Child Health at the Association of State and Territorial Health Officials, or ASTHO.

A few brief housekeeping items. This webinar will be recorded and be made publicly available on ASTHO's website. The recording and slides will also be emailed out to all registered participants within a week or two.

For those of you who aren't familiar with ASHO's work in this space, ASHO kicked off an implementing pharmacists' prescribed contraception Learning Community in April of this year.

This learning community is really focused on technical support and capacity building for a group of four jurisdictions as they develop sustainable strategies for pharmacist-prescribed contraception implementation. This includes really thinking about how do we build workforce capacity, what does reimbursement look like in a sustainable way, and what does patient awareness look like.

A big focus of our project is really bringing together stakeholders from the pharmacy field, and also the sexual and reproductive health partners.

And with this grant, we produce publicly available materials, like this webinar, to promote improved public health through advanced contraception access. And if you're interested in learning more on this project, feel free to send us an email at contraceptionaccess at astho.org.

And we will be putting that email in the chat as well.

I wanted to review, what we're going to be spending our time on today. So, I'll be doing a brief overview from a national perspective about pharmacists prescribed contraception, and look at some key policy and implementation trends.

And then I'll be facilitating a roundtable discussion, with our panelists about each of their own state's approach to implementing pharmacist-prescribed contraception, and what sort of innovative strategies that they've been using.

And we'll also be holding a bit of time at the end of our discussion with panelists for a Q&A from the audience.

So, with that being said, I am going to jump into just a quick level set, so we're all coming into this discussion with a little bit of a shared understanding of pharmacist prescribed contraception, or PPC.

PPC refers to a policy approach that allows pharmacists to assess a patient and directly provide contraception, without the patient first needing a prescription from another clinician. In other words, the pharmacy becomes an access point both for assessment and direct access to contraception.

And this matters because pharmacies tend to be more accessible than clinics. Most Americans live within 5 miles of a pharmacy, so pharmacists prescribed contraception leverages a place people already go to expand access to contraception.

And this access point is especially critical now. Federal and state actions have taken steps that limit or remove sexual health services for many communities. And even before the current political climate, access barriers for contraception were incredibly common.

One study found that 29% of women who tried to obtain hormonal contraception encountered difficulties getting an initial prescription or refills. And this study specifically refers to accessing contraception through a healthcare provider, like a primary care doctor or an OBGYN.

We also know that structural disparities remain.

throughout public health, but especially around contraception access. So, some communities face far steeper hurdles in accessing contraception, and one recent Kaiser Family Foundation analysis found that 3.8 million women of reproductive age with incomes under the federal poverty level live in counties with no or low access to publicly funded clinics providing contraceptive care.

That means that there are a lot of women who are in low income who don't have easy access to clinics to provide contraceptive care.

And about half, 1.8 million, live in states without pharmacists prescribing laws. This tells us that pharmacists prescribed contraception can help close these geographic and policy gaps in accessing contraception.

So, pharmacists prescribed contraception have gotten increasingly popular over the past decade.

As of June of 2025, over 30 states, along with Washington, D.C, have passed legislation allowing pharmacists prescribed contraception.

And policy that permits pharmacists prescribed contraception can look… can look a little different based on the state. There are a couple different pathways that states can use, and I'm gonna briefly touch on what those different pathways look like.

So one of those pathways is a collaborative practice agreement, or a CPA. A CPA is a signed partnership with a prescriber that lets an individual pharmacist furnish contraception under specific agreed-upon protocols.

Another pathway to pharmacist-prescribed contraception is a standing order, and this is a statewide clinician-signed directive that's usually signed by the state health authority's medical director.

That allows pharmacists to dispense certain contraceptives to certain patients without a specific prescription for each patient.

Another pathway is a statewide protocol, which empowers pharmacists to prescribe and dispense contraception under rules set by a board of pharmacy.

It's sort of similar to a standing order, but it's not tied to a certain prescriber, like the standing order is.

And then finally, there's the standard of care model, which is similar to independent prescriptive authority.

And this expands a pharmacist's scope so that they can independently prescribe within defined clinical conditions using their professional judgment that aligns with the medical standards, rather than having to prescribe certain medications on a specific drug-by-drug basis.

So those are some of the… levers the policy mechanisms used to create pharmacists prescribed contraception within different jurisdictions, but passing a policy that legalizes pharmacists prescribed contraception is just the first step. Implementing pharmacist-prescribed contraception can be really difficult.

Due to policy, administrative, clinical, and logistical barriers.

A diverse set of public health agencies, private entities, and healthcare professionals must work collaboratively to successfully implement a pharmacist-prescribed contraception program that meets the needs of pharmacists, patients, and the wider community.

And this slide really walks us through some of the common barriers we hear around implementing pharmacist-prescribed contraception. So, those barriers include reimbursement, workforce readiness and training, and then public awareness.

And I'll briefly touch on each of these barriers a little bit more.

We routinely hear from pharmacists and other key stakeholders that identify payment for services as a key barrier to widespread implementation and uptake of pharmacists' prescribed contraception programs.

Many pharmacists report resistance to participating in pharmacist-prescribed contraception without mechanisms in place that reimburse them for all of the relevant services they provide. So, specifically for the cost of counseling and the assessment services, as well as the cost of the medication and the standard dispensing fee.

On top of that, pharmacists have also raised concerns about reimbursement rates for services, and a need to make sure that those are on par with other healthcare providers who also are prescribing contraception.

Another group of barriers around pharmacist-prescribed contraception is related to workforce readiness and training.

Once a… pharmacist-prescribed contraception policy is enacted, pharmacists and pharmacy leaders must be able to promptly and clearly inform the pharmacy workforce what the law permits, what required steps need to happen, and where to find guidance.

And there's often a delay between when the policy is passed in legislation and when the answers to all of those questions happen. So, what are the required steps often has to come in the form of regulations from a state health agency.

And sometimes that can take a while to be created.

On top of that, standard and accessible training on pharmacist prescribed contraception usually needs to be developed for each state.

And made available to pharmacists, and being able to be scaled out and maintained over time often presents challenges.

Additionally, workflow considerations can impact implementation. Pharmacists prescribed contraception must integrate into existing workflows, including scheduling, privacy and space considerations.

Standardized screening tools, documentation, and critically, billing workflows. Thinking through what codes pharmacists can use, what payer policies exist around pharmacist credentialing and enrolling as providers, and other revenue cycle processes.

Finally, thinking through public awareness can also be a barrier to implementation. There's this balance between education and awareness campaigns. If done too early into pharmacist prescribed contraception's implementation, there's this risk that not enough pharmacists will be offering services, which could confuse and turn away potential patients from seeking out that service in the future.

However, if education campaigns are doing too late, pharmacists may question the worth of offering a service if there isn't a patient demand to meet that service.

Despite these barriers, many states are implementing pharmacist-prescribed contraception successfully. Research tells us the pharmacist-prescribed contraception is a safe and effective way to increase access while reducing cost.

It also reaches communities that have historically faced more barriers in accessing contraception.

One study found that larger shares of women with incomes under 200% of the federal poverty level and those who are uninsured report accessing pharmacist-prescribed contraception for their most recent birth control visit.

And then other research supports this, and also expands that women who are younger and have received less education also tend to use pharmacies as access points for contraceptive care.

This tells us that pharmacies can become a critical access point for contraceptive care for communities who may traditionally have difficulty in accessing this care.

So that's a very brief overview from a national landscape and some implementation challenges that we're seeing. If you're interested in learning more, ASDO did a series of four webinars, all focused on implementing pharmacist-prescribed contraception.

They were recorded, they are publicly available on our website. You can find that website in the chat. Thank you, Brittany.

And it's also linked in these slides. So, with this grounding in place, I would love to turn to our panelists to explore how states are putting pharmacist-prescribed contraception into practice, and how they've been navigating some of these barriers I shared.

So these are the panelists who will be joining us today. We are so excited to welcome them and hear all from their expertise.

We are going to be introducing each panelist, as I ask them their first question. And as a reminder, all of those participants who are joining us today, welcome. Feel free to put questions in the chat or the Q&A Zoom function, whichever you're more comfortable with.

All right. So, first, I would love to introduce Jenna Bimby, founder and co-executive director of New York's Birth Control Access Project. Jenna founded the New York Birth Control Access Project in 2020 to engage a new generation of reproductive health advocates.

who focus on birth control access. Under her leadership, New York Birth Control Access Project drives statewide policy and implementation efforts to expand access to contraception through pharmacist prescribing.

She has spent the past 5 years working closely with pharmacists in New York and across the country to address barriers to the implementation of pharmacists' prescribed contraception services, build out scalable support models, and advance systems-level change.

Through this work, New York Birth Control Access Project has become a recognized bridge builder between public health experts, pharmacists, and policy makers in New York and beyond. Jenna, welcome, thanks for joining.

So I'd love to hear what… a little bit about what's the current status of pharmacist prescribed contraception within the state, and what are some of the opportunities and challenges y'all are currently navigating.

JENNA BIMBI:
We were thrilled that the Birth Control Access Act, which allows pharmacists to prescribe birth control in New York, was passed in 2023.

Unfortunately, it had been stalled for 10 years, nearly 10 years prior to that, but when we were able to pass it, it was passed with the statewide standing order.

So you were mentioning earlier the different ways that, the different ways that pharmacists might be able to prescribe, and we were really happy that we ended up having a statewide standing order, which was signed by Commissioner John McDonald in 2024, and so now all pharmacists in New York State have access to that standing order, and theoretically can prescribe. They are ready to prescribe after they take a state-mandated training that meets the requirements laid out in the Birth Control Access Act.

There are several of those available trainings. There are several of those trainings available to pharmacists in New York. And then to get to your payment piece, right now, Medicaid is reimbursing… well, is paying pharmacists for their time and consultation. Unfortunately, the governor, Governor Hochul.

just vetoed legislation that would, require private insurance companies to pay a pharmacist for their time in prescribing. So.

We have an action fund as well, and our action fund had worked very hard to get that legislation across the finish line this year, and then, unfortunately, it was vetoed a couple of weeks ago.

we are… we have… I guess I'll say, in terms of challenges, right, we're facing the same challenges that everyone else is facing.

That you've kind of gone over here, but I will say that one of the things that makes it trickier for us is that we don't have real data on how many pharmacists are already doing this? And without that data, it kind of makes it hard for us to make the case. We really need to be creating this implementation model. There are about 13,000 pharmacists in New York, and we have fewer contraceptive providers than most other states in the nation. So what we have with these 13,000 providers is a real opportunity to increase the access to patients.

If we can get these pharmacists ready to prescribe. In fact, we could increase by about 80%.

Because we've got 16,000 contraceptive providers and about 13,000 pharmacists.

So we have a real opportunity here, and that's what we're trying to focus on, is… is how we… how we can… How we can get those pharmacists online so that patients have more access to birth control.

DURANT:
Thank you for sharing that. I didn't, realize how many pharmacists were within the state, and also how many, kind of other reproductive health providers existed. So, yeah, it seems like there's incredible opportunity to really expand that access in such a tangible way. So, thank you, Jenna.

I am going to introduce our next panelist now and hear a little bit more about what's going on in their state. So, I'd love to introduce Aaliyah Nori-Horton. Aliyah Nori Horton has served as the executive director of the Maryland Pharmacists Association since 2015. She is also the immediate past president of the National Alliance of State Pharmacy Associations.

She, during her tenure, she has worked with stakeholders to advance independent prescriptive authority for pharmacists and parity in pay for clinical services. She's spent nearly 30 years in the association management and public policy arenas for state, national, and international organizations.

Before joining the Maryland Pharmacists Association, she served as the Associate Executive Director for Strategic Initiatives and Government Affairs for the Institute of Transportation Engineers. Early in her career, she served as the Public Policy Specialist and Lobbyist for Interaction in Washington, DC, as a legislative assistant for the late Congressman Elijah E. Cummings. Aliyah, thanks for joining.

So, similar question, can you share a little bit about the current status of implementing pharmacist prescribed contraception in Maryland, and some of the opportunities and barriers y'all are currently facing?

ALIYAH HORTON:
Sure, so the… the current status is that pharmacists are able to independently… to… are able to independently prescribe hormonal contraceptives in the state.

There's obviously, steps that have to be taken in terms of, continuing education, that has to be approved by the Maryland Board of Pharmacy before a pharmacist can do that, and so that they get in… are then in the system once they complete that process.

So we have the ability, but as many of us know, it's the implementation.

And there's the whole battle of getting bills passed, and when you're talking about innovative strategies, I would say getting any bill passed, there's not anything really innovative. The process for getting bills passed are… it's very, it's a standard process of collaboration, engagement, education, getting your champions, the follow-through, all of that. So where we are, we have this authority.

And when we passed our bill, we made sure that we had language in that, required payment, whether it was in Medicaid or in the commercial space. So we got that. Now.

That's the other part. Again, it goes back to implementation. We got all the language that we wanted in the bill, but when it comes down to the implementation and payment for those services, within our Medicaid department, the Department of Health decided that for, the payment for services would only be within our fee-for-service program.

And so, in Maryland, fee-for-service is behavioral health.

People who are on behavioral health medications.

So that is where they're paying from the state's perspective. Commercial payers, we have heard back that Care First, which is the Blue Cross Blue Shield in Maryland, is paying. But that's a challenge, because we're looking at covering vulnerable populations, which would be the Medicaid population, but it's only covered for a smaller percentage.

And that's not anywhere in the statute.

That's not in the regulations. That's something that the Department of Health decided that they were going to do.

So just to back up a little bit, when we passed the bill, like I said, we got the payment there. And as we were passing different scope advancements for pharmacists, we were trying to make sure that we had that payment piece.

In 2023, we were able to pass legislation that said for any, basically any clinical service that a payer covers for another healthcare provider, if it is within the pharmacist's scope of practice, then the payers need to cover that as well. So we have broad… coverage for clinical services. But again, for all of the scope advancements that we've made in Maryland, the Department of Health has determined that it's only going to be in that fee-for-service pipeline.

And so that is… a challenge, because as many of you know, the pharmacy space is a challenging one right now, or if you don't know, the pharmacy space is a challenging one. Let me make that a statement, in terms of reimbursements for drug acquisition costs, as well as for reimbursements, and even more challenging within the Medicaid space.

So, with that said, there is an opportunity for pharmacists to be more engaged in clinical services if they're getting covered. It's a pathway of addressing patient needs by the healthcare provider that they want in the space that they want.

And there's an opportunity for that coverage.

And, what we're finding is that, particularly for because of the barriers to the reimbursement for contraceptives, we have not had the uptake like we would want.

And, the other piece is that the pharmacists are able to charge a kind of cash fee.

that a patient can come in, and they'll say, okay, I'm putting this number out, I've heard it, it varies, but let's say it's $35 to get the assessment and to potentially be prescribed contraceptive. The pharmacist may go through that whole process, and then determine that the patient is not an appropriate person to, to receive it.

To get that prescription, and so the patient still has to pay. That's very awkward in the pharmacy setting. In the doctor's office, that's pretty standard. You go in, you may ask for something, say something hurts, the doctor says nothing wrong with you, or we can't do anything about it. You go about your business, you pay your co-pay.

That is… it's not… how pharmacy has worked, and so that makes an uncomfortable situation for the patient, as well as for the pharmacist in kind of navigating that space. We have been working… so that's one part. The other part is really just the broad implementation of the service as part of the workflow.

And, there are… Different entities that are working on doing that.

within the independent pharmacy space, we have provided, I would say more in-kind support and helping to raise money is, support for the CPESN in Maryland. If you're not familiar with CPESN, it's Community Pharmacy Enhanced Services Network, and it's essentially a network of pharmacies, independent pharmacies, that agree to provide a certain level of service and clinical services to patients.

And they work together to, get contracts with… and get in networks for, their services. So they're a great, kind of, pool of pharmacies to work with. So, RCPSN Maryland has a con… has a grant with the Community Pharmacy Foundation to support implementation of contraceptives. So they're working with, community partners.

within the schools of pharmacy, with residents, to really figure out the workflow, to make it as efficient as possible, and to kind of work through all the kinks, for that. So, we have that in place, and we are supporting that work.

On the community… sorry, on the retail pharmacy side, there's… there are challenges there in that… chains, will not implement these practices unless they have a really if the regional opportunities are similar among states. So, in Maryland, it's got to be, you know, Maryland, Virginia, DC, and sometimes Delaware, Pennsylvania, depending on how the structure is worked out. And so.

It's really important, kind of moving forward, that we get similar policies in place in the kind of connecting states, so that the chains feel more empowered to, implement these services.

Across the board, because it's much easier to do it on a regional basis than kind of statewide and having to do the different, trying to implement different things in different stores.

So we're kind of working in all those fronts. We're trying to provide support.

education, and so our biggest piece now is working, circling back to the payment part, is a strong advocacy effort with the Department of Health and Medicaid to ensure that we can expand, the payment piece and get that cleared up, because it's… it is so limiting. So I talked about a lot, I'll leave it there.

Thanks.

DURANT:
Thank you so much for that overview, that was really helpful, and I had so many different, like, moments of, like, light bulbs in my brain that I'm excited to chat with y'all more about. But I would love to… introduce our final panelists next. So I'd love to introduce Ashley Meredith. Dr. Ashley Meredith is a clinical professor in the College of Pharmacy at Purdue University. She received her PharmD from the University of Pittsburgh and her Master's of Public Health from Purdue Global.

Dr. Meredith serves as the Director of Advocacy at the Purdue University Center for Health Equity and Innovation. She provides diabetes and cardiovascular disease state management for adult primary care patients in Indianapolis, and contraception prescribing at Purdue University Pharmacy.

Her teaching areas within the College of Pharmacy focus on reproductive health, and research and advocacy areas focus on expanding access to contraception via pharmacist prescribing models and assessment of outcomes for pharmacist management services, so… Hi, Ashley, great to see you. So, similar question is, would love just a overview of where Indiana is with pharmacists prescribed contraception, and some of those opportunities and barriers that you're facing.

ASHLEY MEREDITH:
Absolutely. So I would say, you know, based on what Jenna shared about what's going on in New York, in Indiana, it's very similar. We passed our legislation successfully in 2023. It's been rolled out under a temporary statewide standing order by our state health commissioner, while our board of pharmacy is working to make the official rules and protocols to then shift it.

Into more of that statewide protocol model. So, we're, you know, we made sure when we had the legislation passed that it accounted for this long period of time that it often takes for the board to come out with the rules and protocols. So, we do have pharmacists across the state who are prescribing part of our legislation does include Medicaid reimbursement, which they had about a 2-year runway, and we're now in that time where Medicaid reimbursement is feasible, and I say it that way because we're working through figuring out what the credentialing process looks like for pharmacists, and how pharmacists are actually then going to be able to submit for reimbursement and things like that. One of the challenges is we've done… there's nothing legislatively that requires commercial payers to reimburse for this service, so that's on our team's list of things, just to engaging conversations with some of the commercial payers to see, just sort of what that looks like and what the opportunities there may be.

I think that, you know, sort of just thinking about, you know, some of the challenges that maybe are a little bit different or that I haven't heard, brought up already is, you know, thinking about the way our language and our legislation was written, it's not perfect. We had to make concessions in order to get the legislation passed, and so there are certainly pieces of it that, if we could change it, we would love to change it. So, for example, we're limited to only being able to prescribe for 6 months at a time instead of a full year. And so, you know, that's just one example of we'd love to be able to go back and sort of address that.

However, the political climate within Indiana, if we were to bring up anything around reproductive health currently, it would immediately be dismissed. There's about a 0.1% chance that it would even be heard in committee, let alone get a vote on the, you know, the floor to have a chance at passing and could potentially open up the door to them revisiting this legislation that already exists.

So we are sort of… biding our time until hopefully we're in a little bit of a better place, where we feel safer to sort of reintroduce and bring this legislation to the forefront again, to hopefully modify it. So I would say that would be one of the challenges that we have that's maybe a little bit different than what I've heard from some of the other states here today.

And then, you know, similar to what Aaliyah was saying, I think the lack of, you know, major retailer or chain uptake as far as actually starting to implement the service is a bit of a challenge. We do have a lot of regional, you know, retailers and chains that have pharmacies that, now that we've got most of our independence up and sort of on board, we're shifting to see, okay, how can we engage some of those regional chains that maybe have a lower threshold for being willing to engage and implement the service compared to some of the national chains that are out there.

Wonderful, thank you so much, Ashley. I'd love to transition to check in with Jenna again. So, Jenna, I know that New York Birth Control Access Project.

BIMBI:
It has started a new program around pharmacist access to contraception, Technical Assistance Program, or PACTAP.

DURANT:
Do you mind sharing a little bit more about what inspired the creation of PACTEP? Jenna Bimbi: PACTAP, which is named way too long. I'm never allowed to name anything again in our organization, because I can't do a short one. So we call it PACTAP, but it is just a technical assistance program, and over the years, as I'd gone to conferences, and we'd done our research, and we'd talk to folks who know more than we do, we are not pharmacists, we are very honest about that, but we have been working in this space for years.

BIMBI:
And so, over the years, what we'd heard was plenty about the barriers, right? The barriers have been well documented, and we knew that as soon as the bill passed, we needed to start working on implementation, because rights are not laws until people know about them, and in this case, that meant both the pharmacists and the patients, but to Sophia, your point, we needed to be careful. You can't get your cart ahead of your horse.

So, if you're telling patients that they can go to their pharmacist, and they go to their pharmacist, and their pharmacist says, we don't know what you're talking about, we can't prescribe, that's going to be a problem because patients are not going to ask again. They're going to think that they heard wrong.

So we wanted to get on the ground talking to pharmacists, and to try to get at that barrier, that awareness barrier, as soon as we could. So… in doing this, like creating PACTAP, our goal was really to create some sort of implementation model, or at the very least, to take a look at what might improve uptake.

And so I mentioned earlier, we don't have a ton of data on the number of pharmacies providing the service now, but anecdotally, based on our work, I would say fewer than 100 in New York, and probably fewer than that, are providing this service. And we know that pharmacy access, like, from, like.

Access to birth control at the pharmacy is a real game changer for patients.

And evidence shows us that technical assistance among medical professionals can increase uptake of new policies, right? We weren't exactly capturing lightning in a bottle when we created PACTUP. We were just taking things that other people had done well and trying to apply it to this very specific policy. Our real goal here, and I will probably talk about it a little more later, but our real goal here was to see a compounding effect, right? We want our technical assistance program will set up, hopefully, 250 pharmacies at the end of 18 months, but we know that pharmacists talk to each other, and the same way that you saw with immunizations.

We're hopeful that this just creates exponential growth as we go out there and socialize the idea of you can prescribe birth control, and here's how you do it.

DURANT:
Thank you, Jenna.

I'd love to highlight another project that Ashley is working on. Actually, I'm gonna make sure I'm saying it. So, Pharmacy Access to Contraception for Hosers, or Patch Project.

MEREDITH:
It's Hoosiers, weird Indiana thing, but…

DURANT:
Okay, thank you, appreciate that. I live in Maine, so pardon my mispronunciation.

So I know that this project was… also came out of some of the navigating barriers to implementing pharmacist-prescribed contraception, so I would love to just hear a little bit more about what inspired its creation.

MEREDITH:
Absolutely. So, I mean, Sophia, that's exactly it. Because Indiana is sort of the middle of the pack in terms of states that had legislation approved to allow pharmacists to prescribe, I mean, we had the benefit of learning some lessons from other states, and hearing what was happening or not happening, or why it wasn't happening, or how could we support, you know, our pharmacists here. I had a couple of students and grad students over, you know, the years prior to our legislation passing who did some research projects and, you know, reached out to pharmacists in our state to say, okay, if this were available you know, what would that look like to you? What would you need to feel confident and supported in this? And so we were able to use some of that data, you know, at a national level, but also from pharmacists in Indiana to say, okay, these are the things that they say they want, and that would help them really, sort of be willing to take that step to become, you know, to start prescribing contraception. And so, that really was our goal, was what can we do to… help support the implementation. And so, we're fortunate that we were able to get, a pretty significant grant from the Indiana Department of Health that allowed us to bring together, folks from the three different colleges of pharmacy within Indiana, to get some perspectives, to get some ideas, as well as just some general reproductive health advocates.

To really help us drive what this looks like and what it includes. We've also partnered with our state pharmacy Association in this as well. So bringing lots of players to the table to really help us, support implementation in all the ways that pharmacists say they, they wanted. So whether that's training, whether that's, creation of resources, whether that's coming to the pharmacy and spending time and helping them figure out the workflow piece, whether it's providing reimbursement for the appointments while we're figuring out these other billing pathways. You know, so that's really our ultimate goal, is as holistically as possible, how can we support pharmacists in Indiana to allow them to be successful in this.

That makes a lot of sense, and it's so helpful to kind of have a, like, one source when you're trying to understand that, of, like, knowing where to go within the state to get that clarity.

And so I would love to chat with Aaliyah next to learn a little bit more about how the Maryland Pharmacists Association has partnered with CPSN to really, kind of, support those implementation efforts around pharmacist prescribed contraception.

HORTON:
Well, I would say that, MPHA and CPSN Maryland have… generally have, a cooperative agreement, so to speak, in that, we work closely together on whatever's happening. So, if they get a grant, we're in it in some capacity. If MPHA gets an opportunity to work on a project, then we incorporate CPSN in our work, because we know that we have pharmacy practice champions.

Within that space, they're independent pharmacies, so they have a lot of flexibility.

In… what they can focus on, and how they focus on it. And so… we're in… I would just say we're in regular communication and trying to support whatever they're trying to do. And so, as I mentioned earlier, CPSN Maryland received a grant from the Community Pharmacy Foundation.

And, so we have helped them in getting, additional support and providing in-kind support to the work that they're doing, because they have to have partners that also match some funds, and so we've worked with them through a partnership that we have with the University of Maryland to make sure that they get those matching funds, and through our own foundation to support their efforts. So, most of it has been monetary, and I say that because when we're working on projects and I need subject matter experts, I'm usually asking the people within CPSN for their feedback. So, we try to make sure that we're supporting each other in the ways that we need to.

DURANT:
Wonderful, thank you.

And also a follow-up, I know some of the work that y'all do was also inspired the creation of, you know, a landing page, based out of the Maryland Department of Public Health. I just was wondering what inspired that creation, and kind of how did that… how did you see it impact delivery of pharmacists prescribed contraception?

HORTON:
Yeah, so that… so we weren't involved in that development of that page, but I will say that as part of the legislation, the Board of Pharmacy had to develop regulations, and had to provide, had to approve any of the training that pharmacists take in order to be able to prescribe contraceptives. And so, it makes sense.

When there is an advanced scope, and there are all of these steps that the pharmacist has to take, that there is a central space, as the professional pharmacy organization, also curates those same resources. But what I will say, having worked with the pharmacy community for this long, I do understand that when there is a scope change like that, and there are specific criteria they still want a reference point that is official from the regulatory body. So, even if MPHA says, yes, you're allowed to do that, go through these steps, well, the response is, well, who says I can do that, and where is it? And so, I think it's been helpful to be able to include, that reference information in the information that we have, and we can point to say, the Board of Pharmacy has said this, the Department of Health has said this, this is where you can go for your billing information, and so it's… it's all there. And so I think that that's always really helpful.

And also one of the challenges, when you talked about the different ways that pharmacists can get their, ability to prescribe contraceptives, and the last one you mentioned was the standard of care model, and that's definitely, created a growing interest within the pharmacy community, but I will also say that there is, some trepidation within the pharmacy community on that.

Because it… it does open it up, and it, there's not a clear space to say, you can do this, this, and this, and this way. And so, I think that there is… not I think, there is a growing movement towards that, but I think advocates really need to understand, I would say the kind of collective personality of the profession.

is kind of step-by-step, and so understanding that as you move forward is really important.

DURANT:
Yeah, thank you for sharing that. I had two more questions that I wanted to ask everyone, and then we'll open it up for participant questions, so whoever feels inspired to answer first, feel free to.

So what are the next steps for implementing pharmacist-prescribed contraception within your state, or how do you want to see it be moving forward?

MEREDITH:
I can start off and share a little bit of what we're doing here in Indiana. So, you know, I've heard it come up a couple of times, like, what comes first, training pharmacists or letting the public know? So we've kind of reached that point now where we're shifting our focus. So we've had a solid close to 2 years of focusing on training pharmacists and making sure they feel supported, and now what we're hearing from them is no one knows we can do this, right? Like, our community doesn't know, the general public doesn't know, there's all these opportunities that we could be helping people, but no one knows that we can do this. So, our team is working to put together some, promotional, educational, sort of public service awareness announcement-type materials, focusing on the process for a patient who wants to get birth control from the pharmacy? What does that look like? What do they need to do? What can they expect? And then we will start, you know, sort of dispersing that video across media channels and things like that to hopefully increase that awareness. And then, as we're moving forward and looking over the next year or two, our team is looking at, okay, how can we get out to some of these community events, or health fairs, or different things, and just start spreading information that way, too. And we're encouraging our pharmacies, to engage in their communities in a variety of ways. We're partnering with the public health departments across all of the counties in Indiana to make them aware, based on one individual pharmacist who was like, I went and I did a talk for my public health department, and now they refer me patients to come to my pharmacy, right? And so we're like, that's a fantastic thing, let's… you know, let's lean into that as well, where they don't have the resources that maybe they need, so how can we work together? So we're at that shifting point of now looking at, okay, how can we get the public engaged in this, since we have a decent uptake across our pharmacies?

BIMBI:
I think I can, kind of piggyback off of that then, because we are still in the training of the pharmacist stage. Sorry, not… we aren't training them, but in terms of the pharmacists taking their state-mandated trainings and then getting up and running. So our… our real focus this year is going to be, the technical assistance program, and the way that that works is in order for a pharmacist to kind of fit into our 250 bucket, as we call it, they will report a 5. We send them an entry survey, essentially, on a Qualtrics survey, and we ask them, on a scale of 1 to 5, how confident are you? And do you know how to bill Medicaid? And have you taken the state-mandated training? And then based on their answers back to us, we start to provide them individualized support. So Iza Malik is the program director for PACTAP, and she works with three other fellows at NYBCAP who then just began reaching out to these pharmacists, and I think what's really unique about NYBHAP doing this work is that we are an organizing nonprofit by trade, right? What we do is organize young people in general, and so we've married that sort of skill set with the knowledge that we have about pharmacist-prescribed policy, and by marrying those things, we're able to take our fellows who know how to organize, and they can do the follow-up that you need to do with the pharmacists in order to support them and get them on the road to prescribing. And I will say, to Ashley's point.

We have been providing patient awareness materials to the pharmacists, and so the grant that we got, we had just enough money that we can… we've created some table tents, we have created cling films to put on the front of store windows, and then buttons. We didn't expect buttons to be so popular, but when we pulled the pharmacists about what they wanted, they wanted buttons, and so we've created buttons. And we send all of those materials to them so that we're creating this sort of point of access awareness, right? Once a pharmacist can do it, they can let their patients know, and they've got the materials to do that.

And then the second thing we are going to focus on is passing that piece of legislation. If the governor had signed that this year, we would be well on our way to having patients able to access birth control at their pharmacy without out-of-pocket costs if they have Medicaid or private insurance.

And so we were incredibly disappointed to see that piece of legislation vetoed, and we plan to come back next year, and… pass at this time.

HORTON:
Okay, well, I'll jump in. I would say… Where we are, as I mentioned, is really working on the workflow.

And, I would say a second round of education and training, because the implementation didn't really jump off when we thought it would, we've been hearing back from pharmacists saying, yeah, well, I took that training back then, but I don't feel like I'm… comfortable now, I need a refresher, I need some more supports to be able to do this, and so we're sort of revamping, the training that we had initially offered, so… we have that in place. And I just love what, Ashley and… Jenna are doing, in terms of the additional resources, because I will say, I did a quick look down on the folks that are on the call and not on the webinar, and I didn't recognize a lot of names from the pharmacy Association community, and what I will say is that the pharmacist associations don't have a lot of funds.

And so, we're often looking for partners to, help advance, our initiative. And so, the PAC… what is it? PACTAP? PACTAP, is a great resource that I think a lot of the state pharmacy associations would really benefit from, from having those resources. It's tailored, to be able to push through. So, I may be looking out for some funding to help create that, for us. So there's that, and I… And then the other piece is really, again, as I mentioned before, and it's… it's… because it's constant. This is a constant conversation about the payment, of really getting the Medicaid piece, straightened out.

That's gonna be really important, because pharmacists, particularly in the independent space, they have less, flexibility in who's working and determining whether I'm going to move someone from a dispensing space, which has its own challenges and reimbursement, but at least folks know that they're going to get reimbursed, to, a clinical service.

And not knowing, how much they're going to get reimbursed if they are in, investing in that when it's not necessarily a viable pathway to maintain. So we want to make sure that we shore that up. So that's really where our focus is.

DURANT:
Thanks, folks. Alright, one final question, and I'm gonna ask everyone to keep their response less than a minute, so we can make sure we have time for participant questions. Looking back, with all of your wealth of knowledge for how far you've gotten with pharmacist-prescribed contraception in your state.

You could do anything differently. What would it be, and why?

BIMBI:
I would say that it would have been great if our organization had existed 10 years earlier, so that the legislation had been passed, sooner and could have been being implemented, but short of having a time machine, I think one of the things that we are, some of the things that we're thinking about with implementation, there's little stuff that we could have been focused on as we were creating PACTAP, right? Like, we've got this 18-month grant. Vaccine season is happening right now. This is a hard time to get ahold of pharmacists. Thinking about the policies that were put in place, we had to make concessions about the Birth Control Access Act. We had to concede on the Depo-Provera shot, which I actually just mentioned in the chat. I think we still would have made that concession, but I wonder if we would have made it with maybe some more stipulations to the rest of, to the rest of the legislature, because they, they sort of stripped depot out at the last minute in 2023.

MEREDITH:
I think, you know, short of what I mentioned already, of, like, a couple of the quirky things that are in our language that were concessions we had to make, which I mean, I'm under no false illusions that any time we try to get reproductive health policy passed in Indiana, there are going to be concessions that are made to that, right? So I think, all in all, our language is… is… fairly decent for, where we are at in kind of allowing pharmacists enough flexibility in what they're able to prescribe that… I don't know that I would have major changes to the language itself. I think, you know, looking back, silly things, like when we got some of this funding, like, okay, should I have changed and said we want both a patient-facing website as well as a pharmacist-facing website, right? You know, things like that, that, you know aren't necessarily game stoppers or deal breakers, but would have made some of this implementation work a little bit easier or more streamlined now, I think would be some of the things that I think I would have… would have wanted to change. As well as getting more commercial payers to the table earlier, I think would have been something that… that would have been nice to have done in hindsight.

HORTON:
I have two. From a legislative perspective, I would have… held a harder line on saying that the regulations had to be developed in, consultation with the boards of nursing and physicians versus in conjunction with.

And so that's something for states that are still working through this, that, in conjunction means everybody has to approve. In consultation just means that you can send it to them, you can take their feedback. You have to get their feedback, but you can take it or leave it.

And so that would have given more authority of the Board of Pharmacy in shaping the regulations, and not adding so many things to it. The second thing would be, I would say we would have been better prepared with the training materials, Because this was something new, and again, when we talk about wanting to have step-by-step, we basically got some learning objectives, and so the we got mired down in, well, does that mean we can do it in an hour? Does it need to be a 20, you know, 8-hour certification course? And so all of that, but having a better idea of what was needed and being able to move quickly on that, I think I would… I would change.

DURANT:
Thank you, folks. This is so helpful. I know there are a lot of folks on this call who are maybe based out of states who are perhaps also doing pharmacist prescribing, so it's always helpful to hear lessons learned from folks who are doing it.

A couple questions I did want to highlight. So, one question in the Q&A was, has there been any pushback from the medical community around pharmacists prescribed contraception? And I will leave it open to whoever would like to speak to that first.

HORTON:
I can get into that a little bit, and I was trying to answer it in the question, and I clicked to answer live, but yes and no.

So, anytime pharmacists want to change scope of practice, the, physician community is against it, because they say it's scope creep, if you wanted to be a doctor, you should have gone to medical school, it's the whole thing, it's a standard trope, we know what all the talking points are going to be. So, yes. But once the bills pass.

you kind of get the rest of it. And, I would say that they recognize the role that pharmacists play in community and public health.

They… so… they're not still fighting it afterwards, because that does happen in regulations. You can push and push and try to get things to stop. But I would say that they just want to make sure that they want to make sure that pharmacists are doing everything that physicians are supposed to do. And so it gets mired in a lot of language, and that's why I mentioned the regulations. And so it's a little bit of both.

So it's, yes, they're opposed, but they will work with the community to kind of get the regulations where they want them.

Which is lots of requirements.

DURANT:
Thanks, Aaliyah.

Another question from attendees. So, is screening for IPV typically included in pharmacists' prescribed contraception visits? And if so, how are we preparing pharmacists to support these patients? I can take some of that. So, you know, there's no… there's no one standard, like, here's how you run one of these appointments, right? I think the best practice is to consider, you know.

MEREDITH:
Reproductive coercion, IPV, all of that as a piece of it. I can say within Indiana, we engaged a large group of reproductive health experts to help us develop our training, and we do have a component for our pharmacists that focuses on, you know, not necessarily specific screening for IPV, but, things to be aware of, and then resources and ways to help patients if you suspect IPV, or if it's disclosed to you. And so, we don't say, oh, here's this checkbox on the form, you need to, you know, make sure you ask everybody, but if you suspect it, or the patient discloses something to you, here's how you can help them.

Thanks, Ashley.

HORTON:
I'm actually not familiar with IPV, someone could say that. It has not come up in anything I've looked at.

DURANT:
It's interpersonal violence, so any, like, DV or anything like that.

HORTON:
I hadn't heard it said that.

DURANT:
Yep, no, no problem. Thank you for asking. I'm sure other folks also had that same question. Unfortunately, y'all, we only have one minute left, so I'm going to have to close out our questions here. If there aren't any… if there are a couple questions we didn't get answers to, I will… we'll circle back with the panelists and hopefully send out responses and our follow-up email to all registered attendees, so folks will be able to get that information as well, so… Ashley, Jenna, Aliyah, thank you so much for sharing all of your expertise. It's been such a joy to learn more about what each of your states are doing. I also just want to invite folks who attended this webinar to fill out the evaluation that's in the chat.

We routinely kind of hold webinars, and we're always interested in learning how we did, how we can do better.

So feel free to scan the QR code on the screen, or also there's the, link in the chat.

But thank you, everyone, for your time and your energy. It's been a joy to be with all of you today, and have a good rest of your Wednesday, folks. Thank you!

HORTON:
Thank you. Bye, folks.