How Oregon Pharmacists Are Prescribing Birth Control

Pharmacists in Oregon rang in the New Year with permission to prescribe birth control.

A state law effective January 1, 2016, authorizes Oregon pharmacists to prescribe and dispense transdermal and oral contraceptives to women aged 18 years or older and also those younger than 18 who have received a previous prescription for contraceptive patches or oral contraceptives from a physician.

Women in Oregon seeking birth control from a pharmacist must fill out a health questionnaire at the pharmacy and get their blood pressure checked. If there are no problems, then they can get a contraceptive prescription.

Some of the questions on the hormonal contraceptive self-screening questionnaire include inquiries into chronic diseases, smoking habits, current and past use of different types of contraceptives, and blood clot history.

Fiona Karbowicz, RPh, a pharmacy consultant for the Oregon State Board of Pharmacy, explained to Pharmacy Times that this questionnaire was derived from an algorithm in a birth control direct access study that was conducted more than 10 years ago.

The study, which was conducted by researchers from the University of Washington and published in the Journal of the American Pharmacist Association, sought to establish a collaborative drug therapy protocol to screen and counsel women for safe use of hormonal contraceptives prescribed by community pharmacists.

The effectiveness of pharmacists’ intervention was measured by the continuation of hormonal methods by women who participated in counseling and interview processes.

A year after this intervention, 70% of women reported continuing use of their prescribed birth control. Both women and pharmacists reported satisfaction with the experience, and nearly all study respondents said they’d be willing to continue seeing pharmacist prescribers for contraception and other services.

“The study showed that the pharmacist is clearly capable of doing this process,” Karbowicz exclusively told Pharmacy Times. “The algorithm helps to ensure consistency in pharmacist conversations with patients, [and] consistent care leads to safer care.”

The law also mandates that pharmacists attend a training course to help them prepare for prescribing birth control.

Lorinda Anderson, PharmD, BCPS, a professor at Oregon State University who helped design the requisite 5-hour training course for pharmacists, told Pharmacy Times that the program fills a continuing education (CE) gap regarding birth control therapeutics and prescribing.

“There are a lot of CE programs available that talk about therapeutics, and maybe even some about prescribing that are geared toward doctors, but none that are geared toward pharmacists prescribing,” she explained. “How a pharmacist could incorporate [birth control prescribing] services like this into their pharmacy…has never been taught before.”

Oregon State Board of Pharmacy executive director Marcus Watt, RPh, told Pharmacy Times that the law will greatly benefit women who live in the more rural areas of Oregon and sometimes “wait up to 18 weeks to see a provider.”

“The big word is ‘access.’ Access to birth control is a major public health issue because of the risk of unwanted pregnancies,” he explained.

Dr. Watt expressed optimism about the potential for Oregon pharmacists to use this opportunity and potentially expand their scope of practice even further. He said pharmacists are signing up for the training course at a much faster rate than when immunization provider training became available.

“There was a sort of trepidation with the idea of providing immunizations—the great unknown,” he told Pharmacy Times. “Pharmacists seem to be much more confident about prescribing contraception.”

About 150 of the 4000 licensed pharmacists in Oregon have completed the training since it was introduced in November, according to Dr. Watt. He expects about 800 pharmacists to complete the training by the end of February.

Oregon now joins California as the only states with laws in place that permit pharmacists to prescribe birth control. Although California’s Senate Bill 493 was signed into law in 2013, the measure has still not been implemented.

Meanwhile, a federal bill that would allow OTC dispensing of oral contraceptives has been introduced in the US Senate.