Expert Discusses Pharmacist's Role in Contraception, What Reversal of Roe v. Wade Could Mean

Ashley Gallagher: Hi, I'm Ashley Gallagher from Pharmacy Times® and today I'm speaking with Elizabeth Ruzzo, founder and CEO of Adyn, about the impact of the reversal of Roe v Wade and how it will affect pharmacies. So, before the Roe v Wade reversal, what was the pharmacist’s role in contraception and abortion access?

Elizabeth Ruzzo: My understanding is that pharmacists play a really important role in reproductive health care, including prescribing hormonal contraception and emergency contraception in some states, but pharmacists have had a limited role and involvement in abortion care, primarily due to FDA’s regulations around dispensing abortion pills specifically. My understanding is, that even prior to Roe, pharmacists in most states weren't able to dispense this directly. Usually, it was done in clinics themselves.

Ashley Gallagher: How will the reverse impact pharmacies?

Elizabeth Ruzzo: I think for now, because of that, there aren't going to be big implications for pharmacies, specifically, because they weren't yet dispensing. I think, hopefully, they will see an increase in volume for helping provide highly effective methods of contraception.

Ashley Gallagher: What are the long-term ramifications of this ruling on women's health care and women's health care access?

Elizabeth Ruzzo: I mean that is a loaded question, right? I think that women are not going to stop getting abortions, they're going to stop getting legal abortions, and abortion is health care. It's also really important if someone has, for example, an ectopic pregnancy, if there's a problem with the fetus, sometimes if a woman has severe preeclampsia. It is a lifelifesaving technique used to save the living mother. Part of the problem here is that also doctors in these states are not going to be trained even in how to do these procedures. So the real truth is that the impact is that women are going to die. Estimates are that there'll be a 21% increase in pregnancy related deaths, and that number rises to 33% in non-Hispanic Blacks, so it just has devastating implications.

I think the other implication is that women are going to need to rely more than ever on highly effective methods of birth control, and potentially Plan B.

Ashley Gallagher: How might the reverse will impact the right to privacy? And what does our right to privacy have to do with birth control?

Elizabeth Ruzzo: This ruling basically was based on a right to privacy. That is the same underpinning of several other rulings like Griswold, which gave us the constitutional right to privacy. Specifically, that a married couple was free to choose their own contraception. There was another case after that in 1973 that also extended that right to unmarried women, and so by taking down this right to privacy-related rule with Roe, it opens the door for not just those to specific to contraception, but a number of other rulings related to gay marriage, interracial marriage, and more.

Ashley Gallagher: What are the economic benefits of birth control?

Elizabeth Ruzzo: I really think that birth control is freedom, right? It gives individuals the freedom to pursue higher education, and as a result, careers that are higher paying. There's also a big economic burden of unintended pregnancy to the country at large. In 2019, there was an estimate that annual direct medical costs from unintended pregnancy in the US were at least $5.5 billion. It's a really massive strain on the economy, and even when we've seen declines in pregnancy rates, the annual costs of unintended pregnancies have continued to climb.

The other thing I like to point out about potential economic benefits is what an economic benefit an individual would get from finding the best method for them more quickly. What I mean by that is a lot of times people experience unwanted side effects on birth control, and frequently, what this means is that they have to go to a different specialist. Let's say you have acne, maybe then you go to your dermatologist, you have to pay that copay. Maybe you get a prescription for a topical drug to treat that, and so on. So part that's a big part of what we're doing at Adyn, we're trying to help people skip that trial and error and instead use precision medicine to find the right birth control more quickly and get a personalized contraceptive counseling visit for that same reason and save people the burden of both time and money associated with not being on the right birth control.

Ashley Gallagher: What are the implications of this decision on future birth control access? Elizabeth Ruzzo: I think hopefully right now, the answer is, it's not having an impact. But the reality that we spoke about before with regard to Griswold, and the right to privacy means that potentially access to birth control is very much next on the chopping block. That is just a devastating reality. I think it's really important for us to make sure that we're out there educating about what all of the reasons birth control is really used. It is a hormonal medicine that is used to do all kinds of things and treat reproductive health disorders of all kinds. It's not just about preventing pregnancy.

Ashley Gallagher: Are there states where legislators are attempting to interpret IUDs as abortion and what are the implications of this?

Elizabeth Ruzzo: I've heard of at least 1 anti-abortion bill in Louisiana that luckily did not pass that was trying to include the IUD. So the copper IUD can be used as emergency contraception. It's 99% effective and present preventing pregnancy if it's used within 120 hours.

However, there is no evidence whatsoever that the copper IUD is an abort efficient. The World Health Organization talks about the effect of copper being pre-fertilization. So what that means is, it's having an effect on the sperm or the ovum. It is not in any way hurting a fertilized embryo.

Ashley Gallagher: What might the role of the pharmacy be if contraceptive access were impacted by future decisions at the state level?

Elizabeth Ruzzo: I think if contraceptive access were to be taken away, the pharmacist’s role would really be to help provide unbiased and factually accurate information and resources to patients, in particular, if there were still ways for them to legally obtain birth control. Unfortunately, maybe start having to rely on less highly effective methods like barrier methods. Ashley GallagherL What is the importance of contraceptive access for health for both men and women?

Elizabeth Ruzzo: I think it's really important to remember that reproductive health and contraception affect both men and women. It means freedom for both of them. Men also experienced benefits, including economic benefits, from not having unintended pregnancy happened in their life that lets them continue to pursue education and reach different career goals and earning potential as a result.

The other thing is just that birth control, like we talked about a little bit here already, it is medicine. It's really important for the health of women to be able to have access to that it can do things from alleviate PMS symptoms, to manage really serious medical conditions like endometriosis and PCOS. The men in our lives should be supportive of us living our healthiest and most pain free life possible.

Ashley Gallagher: And lastly, how can pharmacists help patients during this time?

Elizabeth Ruzzo: I think they can help provide unbiased and factually accurate information and really just act as a resource as much as they can to patients. I think that I would encourage pharmacists to spend extra time with patients fulfilling a highly effective method of contraception to make sure they don't have questions about its use, its safety, that they understand how to quickly recognize any potential side effects, so that they can switch if needed and make sure that they're not suffering unnecessarily because birth control isn't one size fits all. It's really a matter of finding one that that works for you, and with nearly 200 options, there will be 1 out there that should work for you.

I think pharmacists can also remind patients to keep Plan B on hand for instances if they miss several pills or even just to have to share with a friend.