As Access to Contraception Expands, Pharmacists Can Play a Key Role

In an interview with Pharmacy Times, experts Lauren Lakdawala, PharmD, BCACP, and Veronica Vernon, PharmD, BCPS, BCACP, NCMP, discussed their presentation at the 2024 American Pharmacists Association (APhA) Annual Meeting and Exposition. Lakdawala and Vernon’s session discusses the changing landscape of hormonal contraception and pharmacists’ roles within it.

Q: Contraception has been a major topic of conversation recently. What updates or events have spurred this renewed interest?

Lauren Lakdawala, PharmD, BCACP: Yeah, I think I can, you know, kick it off. Of course, the biggest update that's forthcoming is that the FDA did approve the first OTC contraception. It is a progestin-only contraception that has the medication norgestrel, and it will be known by the brand name Opill. That was approved back in July of 2023 and we're expecting it to be available on pharmacy shelves in just a couple of months, so very soon after the conference. So that's one big update. Veronica, did you have anything else you wanted to add?

Veronica Vernon, PharmD, BCPS, BCACP, NCMP: Theother big update in addition to Opill becoming available—which is very exciting, I think both of us are thrilled about this; this has been a long time coming—is we're seeing more and more states pass legislation to permit pharmacists to prescribe contraception. After immunizations and Naloxone prescribing by pharmacists, this would be our next biggest category that pharmacists can do, which is very exciting from a public health standpoint, providing just another tool in the toolkit to get individuals access to reproductive health care.

Q: How does the addition of an OTC option change the hormonal contraception landscape?

Veronica Vernon, PharmD, BCPS, BCACP, NCMP: I think that's a great question—Lauren can jump in here too—but I think this provides an option that previously didn't exist. You would have had to go to a provider, and even going to the pharmacist in states where pharmacists can prescribe that can sometimes be a barrier, but this will be over the counter. This will be out on the shelves very soon; it's available for preorder right now. And the price point is attractive for some people. For some folks, it still may be too expensive, so the manufacturer is coming out with an assistance program to help with the cost. But I think it's exciting that we finally have a daily contraceptive option over the counter now, in addition to levonorgestrel, also known as Plan B.

Lauren Lakdawala, PharmD, BCACP: I 100% agree with Veronica. I think the only other thing that makes this unique now is that patients do have more of an active role in their health care. So, having contraception available over the counter allows them to make a decision if that would be right for them and being just more active, as far as what they're doing for their reproductive health.

Q: How could this option improve access challenges? Are there any lingering barriers for Opill?

Veronica Vernon, PharmD, BCPS, BCACP, NCMP: It provides access because individuals can read the label, use self-screening questions that are on the box, determine if they're an appropriate candidate, and then purchase it. They don't need to make an appointment. They don't need to talk to anyone else. They can always ask their pharmacists questions, which we do encourage folks to always speak to your pharmacist if you have questions about any over the counter medications. But this is really exciting. Studies have shown that patients can self-screen themselves or consumers can self-screens safely for contraception, and it's why they're going to be widely available. One of the biggest issues that I'm concerned about is still the cost aspect. It's still going to be around $20 for one pack, which for some people that might be too much of a stretch. Also, we have to figure out the insurance component—is insurance going to cover over the counter contraception? In some states, yes, there are laws that have been passed so OTC coverage is mandated, but what is that going to look like? How are we going to make that to scale where it's easy for consumers and health care providers to learn more about and access?

Lauren Lakdawala, PharmD, BCACP: Absolutely. And certainly, you know, with some states being able to cover medication over the counter, of course, that clause is there. But it's not necessarily a clear and easy approach for a patient to receive a medication when it's supposed to be covered as an over-the-counter product under insurance. So, currently, a lot of states require a prescription for that OTC product to then be covered by the insurance and dispensed to the pharmacy. And that would also just be another unique way that, you know, if the state had contraceptive prescribing available, that that would be a readily available option for a patient to entertain. Should that conversation come down with the pharmacist and the patient about being the most appropriate product for them?

I think some other barriers have always been…some concern that oh, you know, having contraception more available without having to go to the doctor's office would cause the patient to not come back for their physical exams or follow up visits. And there have been some surveys and post-marketing studies that have come out to say that that's not the case. Actually, a majority of patients would understand and know that they do need to go back to their physical gynecologist to be able to have the appropriate screenings that are also needed for reproductive health care. So, we know that patients understand what they need to do. Due to the active agency, as far as reproductive health and just having that access overall, we'll be able to eliminate some of the burdens that have also been reported about patients not being able to obtain their contraception on time. And if you can't obtain your contraception on time, that means you're not going to take it, and then that could lead to an unintended pregnancy. And so reproductive rights are certainly very important to any patient, regardless of their gender.