NCPA 2024: Incorporating Hormonal Contraceptive Prescribing Benefits Patients, Pharmacies

Not only is hormonal contraceptive prescribing incredibly valuable for patients in the community, but it can also be greatly valuable for pharmacies, said Brittany Sanders, PharmD, owner of The Pharmacy at Wellington, in a presentation at the National Community Pharmacists Association 2024 Annual Convention & Expo.

The Pharmacy at Wellington is located in Little Rock, Arkansas, a state which Sanders said has many challenges in women’s health. Arkansas ranks no.1 in teen pregnancies, third in infant mortality, and fourth in maternal mortality, highlighting the crucial role pharmacists can play.

“These aren’t just statistics,” Sanders said.

“These are real women, real people who live in Arkansas who could benefit from our services. We have a real chance to impact these people’s lives.”

Nationally, Sanders said 7 million women live in maternal health deserts, defined as counties with limited or no available obstetric care.

“Pharmacists are uniquely positioned in those counties,” Sanders said. “Most counties have access to a pharmacist, most counties have access to that immediate care. So we are uniquely positioned to help fill this gap and fill this voice in women’s health care.”

Currently, 23 states have active legislation allowing pharmacists to prescribe birth control, 6 states have collaborative practice agreements for pharmacist prescribing, and 6 states have policies in progress. Eleven states require patients to be 18 years of age or older in order to receive contraception. The types of contraceptives pharmacists can prescribe depends on the state, ranging from oral contraceptives, the patch, vaginal ring, injectable contraceptive, and non-hormonal methods. In Arkansas, Sanders said they can only prescribe hormonal oral contraception.

Sanders briefly reviewed the types of available contraception. The implant, hormonal intrauterine device (IUD), copper IUD, and sterilization are the most effective methods, with a less than 1 in 100 chance of pregnancy in a given year. The pill, patch, ring, and shot are also quite effective, with between 6 to 9 in 100 women getting pregnant in a given year. Finally, methods such as fertility awareness and condoms are the least effective, with between 12 and 24 in 100 women getting pregnant in a given year. Without any contraception, however, Sanders said around 85 in 100 women would become pregnant over the course of a year.

Woman holding a birth control pill | Image credit: Krakenimages.com | stock.adobe.com

The journey to pharmacist contraceptive prescribing has taken quite a while and, in many states, is ongoing. State legislatures have been significant drivers of this progress, and Sanders said gaining support from lawmakers is crucial. She urged pharmacists who are advocating in their states to look for legislators who may have been affected by teen pregnancy, or pharmacists and physicians who have become legislators.

Once state legislation and policies allow pharmacist contraceptive prescribing, Sanders said the question then becomes how can pharmacies integrate this service? Firstly, pharmacists and pharmacy staff must assess and address their own hesitations, identifying gaps in knowledge or challenges around prescribing.

Creating an approachable environment is also key and can in some ways be the greatest challenge. In addition to finding a private space within the pharmacy to counsel patients, this also extends to developing comfortable ways for patients to make appointments. Rather than calling and speaking to a technician, who they may know socially, consider an online appointment model.

Finally, identify potential patients, such as those who are recently out of contraceptive refills, have no current primary care provider or women’s health provider, or women of childbearing age who are taking glucagon-like peptide-1 agonist medications.

“These patients, because of decreased insulin resistance and decreased inflammation, may be ovulating more frequently, so pregnancy is an area of concern,” Sanders explained. “Have that conversation, make sure they understand the needs that are there.”

Last but certainly not least, Sanders addressed reimbursement, which she described as the no.1 barrier to pharmacist contraceptive prescribing. Programs for reimbursement will vary from state to state; in Arkansas, there is a private grant and support from Blue Cross Blue Shield of Arkansas. Cash pay is always an option, as well. Sanders said her pharmacy charges $75 for the pharmacist counseling appointment, which seems to be somewhat standard and has been acceptable in their community.

Once the program is established, she said it will organically take off through word of mouth, as well as any marketing efforts via social media, a pharmacy website, or community events.

“Patients appreciate that service and they tell their friends, they tell their neighbors about it,” Sanders said. “It’s not every patient who you’ll be able to help, but the patients you can help, it’s really meaningful for them.”

REFERENCE

Sanders B. A Step-by-Step Guide for Incorporating Hormonal Contraceptive Prescribing in Your Pharmacy Practice. Presented at: National Community Pharmacists Association 2024 Annual Convention & Expo. October 26, 2024.