ASHP Studies Find Patients Welcome Hormonal Birth Control Access from Pharmacists

Two studies presented at the American Society of Health-System Pharmacists (ASHP) 2022 Midyear Clinical Meeting are confirming patients’ desire to have hormonal birth control access from pharmacies.

Pharmacists can now prescribe hormonal birth control in 20 states, according to a press release. In 2013, California became the first state to pass such legislation and South Carolina was the most recent state to enact this legislation in May 2022. Ten more states have similar legislation in process.¹

“Pharmacists are an underutilized and essential resource for so many Americans, especially for people who live far from other health care providers or have limited access for other reasons,” said Tom Kraus, JD, vice president of government relations for ASHP, in the press release.¹

One study presented at ASHP conducted a review of the various state regulations for pharmacist provision of hormonal contraceptives. Due the rapid growth of these services, there is a lack of consensus around the regulations for pharmacist prescribing, and the study was intended to clarify the state of pharmacist prescribing rights.²

Researchers conducted a systematic search of publicly available information and assessed relevant state legislation concerning pharmacist-prescribed contraceptives. States were categorized as red, yellow, or green based on legislation status or lack of current legislation.

States categorized as red states had either no evidence of pending legislation, legislation preventing pharmacists from prescribing contraceptives, a required collaborative practice agreement without evidence of pending legislation, or legislation that failed to progress. Yellow states had legislation proposed with or without a defined protocol, and green states had legislation or a standing order permitting pharmacists to prescribe contraceptives with or without state board of pharmacy-defined protocols.²

A literature search on PubMed yielded 66 results, including evaluations of legislation, research into perceptions of such legislation, training protocols, and laws and regulations. The state with the most robust literature was California, with 21 articles, whereas 24 states had zero results in the PubMed search.²

According to the study results, 40% of states were categorized as red, 20% were yellow, and 40% were green. Among the 20 green states, pharmacists were able to prescribe hormonal contraceptives through statewide protocols (n=11, 55%), standing orders (n=8, 40%), or other means (n=1, 5%).²

Investigators also established a timeline for relevant legislation in the green states. The first 2 states with legislation passed were California and Oregon, and the most recent state was South Carolina.²

Based on these findings, the assessment identified some legislative discrepancies and provided a straightforward chronological path of states allowing pharmacists to prescribe hormonal contraceptives. Despite the progression of pharmacy practice since the first legislation passed in 2013, laws, regulations, and training are lacking, according to the investigators. Current findings suggest a potential unmet need for further study of state-specific protocols, pharmacist educational requirements, implementation in community or ambulatory settings, and variations between states allowing pharmacists to prescribe hormonal contraceptives.²

“Pharmacists have taken on more responsibility in providing health care the past few years due to the COVID-19 pandemic,” said Soumya Jairam, PharmD candidate at the Rutgers University Ernest Mario School of Pharmacy and lead author of the analysis, in the press release. “The scope of our practice is expanding, and it’s important to be aware of what the rules look like in other states.”¹

A separate study, also reported at ASHP, surveyed 500 women in New York state and established their perceptions of pharmacist prescribing authority for hormonal contraceptives. Pharmacists in New York do not have prescribing authority, but the survey found that nearly three-quarters of respondents would be comfortable getting a contraceptive prescription from a pharmacist. Nearly as many women noted that they live closer to a pharmacy than to their health care provider, but only 1 in 4 respondents were aware that pharmacists in many states can prescribe hormonal contraceptives.¹

Most respondents said that pharmacists have the knowledge and skills to prescribe birth control in the pharmacy setting, according to the study results. Women indicated that distance to a health care provider, long wait times, and difficulty making appointments were the primary barriers to getting birth control in physicians’ offices, particularly because visits are required once or twice a year to renew prescriptions.¹

“Access to contraceptives could be even more important with the Supreme Court decision striking down Roe vs. Wade,” said Jennifer Fiscus, a PharmD candidate at the Binghamton University School of Pharmacy and lead author of the survey, in the press release. “That decision is causing family planning clinics to close down in many areas, and birth control prescribing stands out as a perfect opportunity for pharmacists to be able to step in and take on a health care role. This is especially true in emergencies where people are running out of refills on the weekends or can’t get into their provider for a few weeks or even several months.”¹

REFERENCES

1. Pharmacists Can Now Prescribe Hormonal Birth Control in 20 States. News release. ASHP; December 5, 2022. Accessed December 6, 2022. https://www.ashp.org/news/2022/12/05/pharmacists-can-now-prescribe-hormonal-birth-control-in-20-states
2. Jairam, S. Review of state regulations for pharmacists prescribing of hormonal contraceptives. Presented at: ASHP 2022 Midyear Clinical Meeting.