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APhA 2025: Pharmacists Can Prescribe Contraceptives in 30 States and the District of Columbia
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Contraceptive options have expanded since 1960, with pharmacists today playing a growing role as prescribers of contraception and studies showing the benefit of pharmacist-driven contraception clinics.
Contraception has evolved significantly since the first FDA-approved oral contraceptive noretynodrel (Enovid; Searle and Company), which was a combination of norethynodrel (a synthetic progesterone) and mestranol (a synthetic estrogen), became available in 1960. Over the years, refinements have led to safer alternatives, including modifications in estrogen components to reduce adverse effects (AEs), explained Jasmine Cutler, PharmD, during a presentation at the 2025 American Pharmacists Association (APhA) Annual Meeting & Exposition in Nashville, Tennessee. In 2025, the landscape of contraceptive options has expanded remarkably, encompassing various forms of hormonal and non-hormonal methods tailored to individual preferences and medical needs.
Different contraceptive options. Image Credit: © Pixel-Shot - stock.adobe.com
“We still have the combined hormonal, although they ended up substituting ethylene estradiols and replaced the original component because it was a little bit safer,” said Cutler, an assistant professor at University of South Florida Taneja College of Pharmacy, during the APhA presentation. “They're even still looking at making them even more safe by using more natural estrogens to decrease some of those side effects that we see with the use of the estrogen component. We also have progesterone-only contraceptives, which includes the implant that goes in the arm, as well as the pill. We also have the injectable medroxyprogesterone acetate [Depo-Provera; Pfizer].”
Intrauterine devices have also gained traction, offering long-term reversible contraception, according to Cutler. However, despite these advancements, barrier methods such as male and female condoms remain the only contraceptive methods that protect against sexually transmitted infections (STIs), emphasizing the importance of patient education on the potential of STIs while using non-condom contraception.
Fertility awareness-based methods provide another non-hormonal option, relying on monitoring ovulation through temperature tracking and cervical secretions. Additionally, lactational amenorrhea, a natural contraceptive method, remains effective for postpartum individuals who exclusively breastfeed, maintaining a 98% effectiveness rate within the first 6 months post-delivery. Other methods, including withdrawal, permanent sterilization, and emergency contraceptives, contribute to the diverse array of choices available to patients.
Despite the multitude of contraceptive options available, barriers to contraception access continue. Approximately 19 million women in the US face challenges in obtaining contraception due to provider biases, geographic constraints, and socioeconomic disparities, Cutler explained.
Decisions around contraception should revolve around patient choice. Image Credit: © (JLco) Julia Amaral - stock.adobe.com
“A lot of this issue can be based on providers’ preferences or biases. It's very important that we come to the patient, ask them what they want, and not what we think they should have or what we think is best for them,” Cutler said.
Furthermore, studies have shown that delayed contraceptive use is more common among Black, Hispanic, and low-income women, often due to limited access to comprehensive contraceptive counseling. Pharmacists have emerged as crucial providers in addressing these gaps, as evidence suggests that individuals who receive contraceptive services from pharmacists are more likely to secure long-term supplies, particularly among younger and low-income populations.
“Among Black, Hispanic, and low income women, their access is a lot lower, and they don't actually get all the information that they need to make really good, informed decisions,” Cutler said.
Recent legislation has significantly expanded the role of pharmacists in contraceptive access. Depending on state regulations, pharmacists can now prescribe contraceptives both in-person and via telehealth services. Telehealth, which gained prominence during the COVID-19 pandemic, continues to offer a valuable solution for individuals facing logistical challenges in accessing health care facilities. Additionally, some states permit pharmacists to dispense up to a 12-month supply of contraceptives, reducing the risk of missed doses due to prescription lapses. Collaborative practice agreements further empower pharmacists to provide contraceptive care, though state-specific restrictions vary. As of 2025, 30 states and the District of Columbia allow pharmacists to prescribe contraceptives, with some imposing age-related restrictions or requiring parental consent for minors.
Insurance coverage plays a critical role in contraceptive accessibility. Federal law mandates coverage of contraceptives through most private health plans, yet network limitations can create barriers. Emergency contraceptives are generally covered when prescribed, but accessibility remains an issue for those without immediate provider access, Cutler explained. Additionally, some insurers still impose religious or moral exemptions, potentially restricting coverage without transparent disclosure to patients.
Pharmacists rely on the US Medical Eligibility Criteria for Contraceptive Use (MEC) and the Selected Practice Recommendations for Contraceptive Use (SPR) to guide their prescribing practices, Cutler explained. MEC categorizes contraceptive safety based on medical conditions, while SPR addresses management of AEs, bleeding irregularities, and other concerns. Recent updates include recommendations for patients with chronic kidney disease, considerations for antiretroviral therapy interactions, and guidance for transgender individuals taking testosterone, emphasizing the need for pregnancy prevention education in this population.
The integration of pharmacist-driven contraceptive services has been effective in various health care settings, according to Cutler. A review of implementation strategies across 5 pharmacy settings highlighted key factors influencing program effectiveness. These included financial considerations, time constraints, and the necessity of staff training and community outreach. Some pharmacies leveraged existing immunization scheduling software to facilitate appointments, while others eliminated consultation fees to enhance affordability. Pharmacist-led initiatives in college campuses also underscored the need for increased public awareness, as many students remained unaware of pharmacists’ prescribing authority.
“This one was actually done in North Carolina, in which they basically set this up at a college campus where they had a lot of individuals who may need hormonal contraceptives,” Cutler said. “It's also important that it was at 2 campuses that require you to have insurance, so these individuals already had insurance in order to register with the school. So, 72% of the participants were unaware that pharmacists could even prescribe—they weren't even aware of that.”
According to Cutler, privacy concerns were also present in this study. At these college campuses, concerns about others overhearing a conversation about contraception posed a significant barrier to seeking contraceptive care and counseling from a pharmacist.
“In a pharmacy with a lot of people around, you want to make sure you have a private area where you can talk to patients,” Cutler said.
In health system settings, collaborative practice agreements have facilitated pharmacist-led contraceptive services, improving patient access. However, operational limitations, such as restricted clinic hours, have hindered widespread adoption. Effective implementation strategies require comprehensive training, structured protocols, and active engagement with community stakeholders.
“One study looked at the implementation of a pharmacist-driven contraceptive service at a health system. It was designed and launched by a pharmacist, and it improved patients’ access to contraceptive options with the development of a collaborative practice agreement within the health system,” Cutler said. “The only issue was… they only had individuals go there for half days to the clinic. Because of that, it only really served people who came that particular day, so it was a limited study. But the protocols and how it was established within the health care system are something that I think will be good for the future.”
Cutler recommended that pharmacists use MEC and SPR if they are looking to establish a pharmacist-driven contraception clinic and to seek continuing education (CE) on the most up-to-date contraception guidelines available.
“APhA does have really good CE and information on how to approach the newer guidelines and conduct birth control screenings,” Cutler said.
