Pharmacist Prescribing of Contraception Could Improve Access

In an interview with Pharmacy Times, Veronica Vernon, PharmD, BCPS, BCACP, NCMP, and Lauren Lakdawala, PharmD, BCACP, discussed the evolving landscape of contraception. In particular, they discussed the roles pharmacists can play in counseling patients and, in some states, prescribing contraception.

Q: Several states have allowed pharmacists to prescribe hormonal contraceptives through various mechanisms. What does this mean for access to contraception?

Veronica Vernon, PharmD, BCPS, BCACP, NCMP: I think it's exciting. It's another access point and we're using pharmacists who are very knowledgeable about contraception and can help direct patients to resources. We don't have all of the necessary services that individuals need at the pharmacy, but one thing that I think is really important about pharmacists doing this service is we can direct people to resources in our communities, we can direct them to Title X clinics where they have a whole host of contraceptive options, where we can discuss IUDs and the implant. We can't do those in the pharmacy, but we can definitely educate and refer patients on. We can refer them on for STI screening, or preventative care, for primary care follow ups. And even in the pharmacy, we can make sure that they're up to date on their immunizations and take care of any other needs they may have.

Lauren Lakdawala, PharmD, BCACP: I think the other thing that would be remarkable as we expand access for contraceptive prescribing, not all states permit this, but we are starting to see some legislation where some medications for contraception, such as the long-acting injection medroxyprogesterone that does require to be administered into the muscle space—it's not something that is self-administered—and so having a pharmacist also being able to provide that service. So, providing the contraceptive prescribing and then being able to administer the medication all in one visit would be remarkable for the patient, as opposed to right now, the patient would have to pick up the medication and then take it somewhere where it could be administered. So, lots of remarkable things that could come of this.

But right now, every state does function in their own right, and I think that a lot of states are learning from some states that are doing it really well, about what they can do to improve and reduce their barriers. You know, from the state side, there's different states from year to year, when it comes to legislative sessions, wanting to introduce legislation. There's politics inherently related to that, as far as what is the right priority for the state. So, some states are successful, other states are not. So, we're excited to see what may happen at the end of this legislative session.

I think, as well, when you look at the payer side, like we talked about, [there are] barriers. So, not only could there be improvements just in the service being provided, but also looking at fiscal policies as far as how to increase access and increase the scope to be able to allow for state funds to pay for services or contraception. But ultimately, I would say that for things to really change…there does need to be some revisions made in order to allow for contraceptive access, especially OTC, to be covered. So, federally, that would be great if there could be some revisions down the road. But for right now, it's mainly relying on the states that want to help and using the state-only funds for that.

Veronica Vernon, PharmD, BCPS, BCACP, NCMP: I think there's a big interest on the federal and state levels about increasing access to reproductive health care. We've seen from the current federal administration that there have been at least 2 executive orders very recently issued about reproductive health care access and ensuring that individuals have access to contraception, and that's been a priority. APhA and the Contraceptive Access Initiative hosted a summit with contraception and reproductive health advocates from across the nation in conjunction with the White House Gender Policy Council and Department of Health and Human Services on how we can make contraceptive access more widely available using pharmacies and pharmacists, so using pharmacist prescribing and through the availability of Opill, which is great. And I think that shows there is a lot of interest. We want to work on that, we want to work with payers on how pharmacists can be credentialed and contracted with health plans to provide the service and get reimbursed, and then how we can make a pill widely accessible and affordable for individuals.

Q: What are best practices for prescribing or counseling patients about hormonal contraception?

Veronica Vernon, PharmD, BCPS, BCACP, NCMP: I think one of the best practices you can do is being open with patients—and consumers, I'll say, because not all of our individuals coming in the pharmacy are going to actually be a patient if they're seeking OTC access—but asking them what their preference is and making sure that we're not trying to push them one direction or another. We obviously have to think about medical conditions that may make them a less desirable candidate for some conditions or for some forms of contraception, but making it very patient-centered and person-centered, and helping the individual choose what works best for them. So, it may be Opill over the counter, they may want something that they can take, or you may find out that maybe they don't want anything that they have to remember to take every day. Maybe the ring would be a better option, or the patch, or even using the injection, especially the subcutaneous form if they want to self-administer it at home. So, I think the most important thing is to ask questions and help direct and provide resources and provide a space that is nonjudgmental, and you will be able to get patients to the right choice. And also, never making an assumption, I think, is the most important thing when counseling. We also don't want to assume that they're using this for one indication or another. We ask questions, we ask what their goals are, and make sure that we are getting folks to the right resources and the right medication.

Lauren Lakdawala, PharmD, BCACP: Absolutely, I think Veronica summed it up really well. You know, it's more about providing a comfortable space for the patient to be able to openly speak to the pharmacist to find out what would be the right option for them. As Veronica mentioned, not assuming that contraception is just to prevent pregnancy. There are so many other indications and benefits for contraception as to why a patient would be able to take it. The other thing, I think, is that we as pharmacists are trained to understand what we can provide for a patient in real time, but also knowing when we need to have a follow-up visit with the patient to discuss more information after maybe the patient has thought about the first consultation, or even referring in that aspect if there was something that maybe did require more of a physical exam to better understand, such as unexpected urine bleeding that might be occurring, and helping the patient know that it would be appropriate to have a follow-up, and that it's okay that you're having this health condition. It happens, you know, it's normal. And so, I think having the pharmacists being involved in this aspect really helps extend that branch for patients being comfortable talking about reproductive health care needs, because in some societies, it's still considered a little taboo. And hopefully, by pharmacists providing the service, we're extending the olive branch and making patients feel more comfortable.

Q: Is there anything you’d like to add?

Veronica Vernon, PharmD, BCPS, BCACP, NCMP: No, I think this is just a really exciting topic to discuss and there's a lot coming out. We in the reproductive health care space, outside of contraception, we do have the pending US Supreme Court case regarding the approval of mifepristone, and that will be just after APhA wraps up. So, that will have a lot of attention and a lot of focus. And I think it's important for pharmacists to stay on top of what is happening in this space and to be informed, and if they're interested in providing these services, even just making more patient education available. It's always a great idea to get your whole team involved, including your pharmacy technicians. They are wonderful to help implement the services, help with getting the patient screener forms out, helping organize workflow. I think this is a great space for pharmacists to be in and it's important that we think about how we can provide the full host of information and services to our patients and get them connected to resources in their communities.

Lauren Lakdawala, PharmD, BCACP: Yeah, I think what's wonderful is that the American Pharmacists Association is dedicated to providing the education out there, not only with our hormonal-based contraceptive training program, but also doing continuing education. You know, Veronica and I are only just one small piece of the pharmacists that are out here in our nation that are dedicated to educating our colleagues and pushing this initiative forward to be able to help the public health and reproductive health care, so I'm excited. I'm excited to see how everything goes and we can't wait for what's in store.