Pharmacists Can't Refuse to Fill Based on Religion in Washington State

Pharmacists in Washington State can no longer cite religion to refuse to fill a prescription.

A federal appeals court recently delivered this ruling on a case filed by a pharmacy owner and 2 pharmacists who had religious objections to dispensing emergency contraceptives.

Pharmacists have traditionally been able to refuse to fill for certain reasons, such as suspecting a prescription is fake or finding that a customer does not have the money to pay for the medication. In the past, Washington pharmacists have also been able to use religious objections to refuse to sell a product if another pharmacist in the store could provide the medication in their place.

For further context, the Washington State Pharmacy Quality Assurance Commission adopted 2 related rules in 2007.

The first, which is known as the Pharmacist Responsibility Rule, maintained that pharmacists may refuse to dispense medication if they have religious, moral, philosophical, or personal objections to its delivery. Pharmacies could “accommodate” the objecting pharmacist by having another pharmacist fill in via telephone or in person.

The second rule dealt with delivery of services in a timely manner and did not contain an exemption for objecting pharmacists.

In 2012, US District Court Judge Ronald B. Leighton ruled that these 2007 policies violated the religious freedom of pharmacy owners by requiring pharmacies to stock and dispense emergency contraceptives.

However, the unanimous 3-judge federal appeals court panel overruled Leighton’s 2012 ruling on July 23, 2015.

Several professional pharmacy organizations, including the Washington State Pharmacy Association, did not respond to requests for comment on this ruling. Meanwhile, Pharmacy Times fans on Facebook expressed mixed opinions on the subject.

The most popular comment from a reader stated, “If your religious beliefs are detrimental to providing quality evidence-based care, maybe it’s time to reevaluate them.”

Some readers referenced the pharmacist oath, which emphasizes serving the public and their needs, as one reason why pharmacists should not be allowed to refuse to provide certain products.

Others said pharmacists should be able to decide which products to stock, just as customers are allowed to choose which pharmacy to patronize.

The plaintiffs involved in the case in Washington State objected to the use of emergency contraception, so they did not want to stock Plan B and Ella for religious reasons. The pharmacy involved in the matter is Ralph’s Thriftway in Olympia, Washington. According to the court opinion, many complaints had been made against Ralph’s for not stocking emergency contraception.

The other 2 plaintiffs were Rhonda Mesler and Margo Thelen, who objected to the Washington State Pharmacy Quality Assurance Commission’s 2007 rules and did not want to work for a pharmacy that stocks emergency contraception. Mesler said she would have to move out of state if the regulations are upheld, and Thelen said she had to move to a different pharmacy because her employer could not accommodate her requests.

Defendants included the commission, the Secretary of the Washington State Department of Health, and interveners—or individuals who had negative experiences because of being denied Plan B.

Judge Susan Graber, who authored the court opinion, maintained that pharmacies must stock and dispense products such as Plan B because of the time-sensitive needs of patients who want to buy emergency contraception.

“Speed is particularly important considering the time-sensitive nature of emergency contraception and of many other medications,” Graber wrote. “The time taken to travel to another pharmacy, especially in rural areas where pharmacies are sparse, may reduce the efficacy of those drugs.”

The opinion also stated that facilitated referrals to other pharmacies may result in feelings of shame by the patient and could discourage her from getting the contraception elsewhere.

The judges also showed concern for patients who reported not having access through a pharmacy to oral contraceptives, AIDS medications, and a variety of other medicines and devices, such as syringes and prenatal vitamins. Since 1997, there were at least 9 cases of a pharmacy refusing or failing to dispense drugs other than Plan B, according to the opinion.

“Accordingly, the commission was ‘motivated by concerns about the potential deleterious effect on public health that would result from allowing pharmacists to refuse to dispense lawfully prescribed medications based on personal, moral objections (of which religious objections are a subset),’” it read.

Washington Attorney General Bob Ferguson applauded the decision and called it a “major victory” for Washington residents.

“Decisions regarding medical care—including reproductive rights—are appropriately between a patient and his or her medical professionals,” Ferguson said in a statement.

However, the Becket Fund for Religious Liberty disagreed, calling the ruling “unfortunate.”

“The government has no business punishing citizens solely because of their religious beliefs,” said Luke Goodrich, deputy general counsel of the Becket Fund for Religious Liberty, in a statement. “The pharmacists in this case willingly refer patients to over 30 pharmacies that stock the morning-after pill within a 5-mile radius, and no patient has ever been denied timely access to any drug.”

The ruling followed on the heels of California’s law that now requires all schoolchildren to receive vaccinations regardless of their parents’ personal or religious beliefs.