Pharmacists Play an Essential Role in Patients’ Access to Contraception

Until recently, a pharmacist's responsibilities were almost exclusively confined to counting pills, attaching a label to the prescription bottle, and handing out the medication. At most, they would counsel patients whose prescriptions were somewhat complicated.

However, as health care in the United States has advanced, pharmacists have gained a more active role. Some of their new responsibilities include providing comprehensive medication reviews to patients, conducting research, and administering vaccinations.

Idaho is the most progressive jurisdiction in the United States in terms of the scope of a pharmacist’s practice. Practitioners in the state can prescribe lower-risk drugs like contraceptives so long as the circumstances and the agents in question fall within the parameters set by the Idaho legislature. And other states have been following suit.

In New Jersey, for instance, Assembly Bill A5810 was passed by the Senate in June of 2021 and referred to the Assembly Health Committee. This bill would permit pharmacists to dispense self-administered oral contraceptives under a standing order and in accordance with the protocols of New Jersey’s Board of Pharmacy and Board of Medical Examiners.² If enacted, the bill would require pharmacists to go through a training program provided by the boards, and women would have to take a self-screening test before receiving the contraceptives.² If, after the self-screening the pharmacist decides the medication is inappropriate for the patient, he or she would be able to refer the woman to her primary care physician.

Currently, 15 states allow pharmacists to prescribe oral contraceptives.³ The extent of their authority in this mat- ter (the type of contraceptive and the circumstances under which they can provide it) varies by state. In addition to expanding pharmacists’ roles, the passage of more such laws could improve access to birth control for a great many women, including the estimated 435,000 women aged 13 to 44 in New Jersey who are in need of publicly funded contraceptive services and supplies.⁴

Research also shows that access to birth control greatly improves women’s quality of life. Such access has significantly increased the number of women who enroll in and graduate from college.⁵ These women also have the option to delay childbirth and invest in themselves by pursuing a career.⁵ This is not only liberating for women but can also help the economy by increasing the number of employed people. In the 1970s, women began to make up a larger percentage of the workforce, especially in fields like medicine and law,⁵ and some of this increase can be attributed to the greater access to oral contraceptives they had at the time.

Unintended pregnancies are higher in the United States than in other developed countries, and this problem disproportionately affects low-income women.⁶ Although as currently written New Jersey’s A5810 bill would not decrease the cost of coverage of contraceptives, it would save patients a trip to the doctor’s and its attendant costs. It would also make it significantly easier for those in rural areas and lower socioeconomic groups to obtain contraceptives because they can visit their local pharmacy far more easily than the nearest physician’s office. Patients would also experience shorter wait times, and their health care would be more cost-effective.¹

There are numerous benefits to making contraceptives more accessible, but it does not come without risks. Primarily, easier access to birth control could increase the incidence of certain adverse effects associated with them, including blood clots and depression. Pharmacists would have to be vigilant about counseling patients regarding the risks as well as benefits. As with most prescriptions, pharmacists would also need to monitor potential interaction among all the patients’ medications. Given the heavier workload that community pharmacists have experienced since the start of the COVID-19 pandemic, some might feel overwhelmed by the prospect of yet another responsibility, and quality of care could suffer as a result.

However, legislation like A5810 could also have a pos- itive impact on pharmacy students. New positions—specifically to prescribe oral contraceptives—could become available for pharmacists at publicly funded institutions like Planned Parenthood. Pharmacists would be required
to undergo additional training, but as the practice becomes more mainstream, pharmacy schools may begin to offer this training as part of the curriculum. Overall, allowing pharmacists to prescribe these medications will be beneficial not only for women but for society as a whole, and it may also allow pharmacy students to grow in an area that had previously been confined to just one brief lecture during their academic years.

Adrienne Michelet is a P3 student at the Ernest Mario School of Pharmacy at Rutgers University.

References

1. S404 (2020-2021). Accessed October 15, 2021. https://www.njleg.state.nj.us/ bill-search/2020/S404

2. Pharmacist-prescribed contraceptives. Guttmacher Institute. Published October 6, 2021. Accessed October 26, 2021. https://www.guttmacher.org/ state-policy/explore/pharmacist-prescribed-contraceptives

3. Birth control access 2021. Power to Decide. Accessed October 26, 2021. https://powertodecide.org/what-we-do/access/birth-control-access

4. Center for the Economics of Reproductive Health at the Institute for Women’s Policy Research (IWPR). The Economic Effects of Contraceptive Access: A Review of the Evidence. 2019:1-44. https://iwpr.org/iwpr-issues/ reproductive-health/the-economic-effects-of-contraceptive-access-a-re- view-of-the-evidence Committee opinion no. 615: access to contraception.

5. Obstet Gynecol. 2015;125(1):250-255. doi:10.1097/01.aog.0000459866.14114.33