Even though legislation SB493 was
passed in January of 2013, a law that allows pharmacists to deal out hormonal
birth control without a prescription from a doctor, it is still a struggle for
women to find pharmacists who will distribute the medicine in California. It was
supposed to be in effect in April 2016, but it took an additional 18 months for
some pharmacy chains to establish regulations. And even then, there are still
some pharmacies who have not rolled out the law yet. The law itself allows
pharmacists to prescribe pills, patches, injections, and vaginal rings; if the
device has to be inserted (like IUDs), it has to be done by a doctor.
So why the long wait time?
Politics. Just kidding, not really. Most pharmacy chains said that they weren’t
ready, some pharmacists said they still needed to undergo the state-mandated
training and their stores were still trying to figure out how they want to
implement the services. There’s also confusion among the pharmacies as well. It
is estimated that of the approximately 7,000 pharmacies in California, fewer
than 100 are actually distributing these types of nonprescription birth control
to patients. Walgreens and Rite Aid both confirmed that they are not yet
providing birth control pills or a contraceptive patch without a prescription. Walgreens operates about 629 pharmacies in
California, and their spokesperson said they are ‘currently assessing" the
law's requirements and plan to test the service in a small number of
pharmacies. While CVS said they’re testing this service in some locations in LA
to feel customer demand.
In addition to California, states
like Oregon, Washington, and most recently, New Jersey have their own legislation
with varying modifications that allow pharmacists to prescribe birth control. States
such as New Mexico, South Carolina, Hawaii, Missouri, and Tennessee are in the
middle of discussion about this type of law. Some of the variations lie in age requirements
and the level of birth products being able to be prescribed, but what is universal is that pharmacists must get
the patients’ relevant medical history, pregnancy status, perform a blood
pressure screening via a 1 page questionnaire, similar to those used in
immunizations. After a birth control product is chosen, the pharmacist will
counsel the patient, explain things such as how the medication works, side
effects, warnings on limitations of its protection against STDs, remind them
of the importance of health screenings such as cervical cancer, and then
finally end with a fact sheet on birth control.
“Pharmacists who wish to
participate in these practices must first complete the necessary training
seminars mandated by their state” The Board of Pharmacy have developed
a protocol for pharmacists; they first have to be trained to do a short
consultation with patients, to help them select the appropriate birth control
option and identify red flags in
a patient’s medical history such as a history of blood clots or uncontrolled
high blood pressure. Currently, there are online classes available for
practicing pharmacist and pharmacy students in CA now get this training as part
of their curriculum.
There are still concerns about
this topic. Some, like the CA medical association, think that if pharmacists
are able to prescribe birth control, there will be less visits to the doctor
for necessary checkups, i.e. pap smears (something to be checked for every 3-5
years for women at certain ages). But pharmacists will check to see if the
patient has had a checkup with their doctor and if their birth control
prescription was prescribed within the last 2 years; this ensures women are
doing recommended screenings.
Pharmacists can perform this
service that was once reserved for the doctor’s office, but it might not be
celebrated by all. Not only do they have a checklist of duties in a fast-paced
work environment they have to get through, but they also have this new hormonal
contraceptive service, something, they won’t get sufficiently reimbursed for
their time and counseling if their respective states don’t have provider status.
The law does not compel insurance companies or Medi-Cal to reimburse
pharmacists for these services. Currently
pharmacists in California gets reimbursed up to $10 per prescription. The only hope is that they will be able to bill
insurance in the future, just as a physician would. In the long run, the law
could ultimate decrease health care spending, because reimbursement
rates for pharmacists will most likely be lower than what doctors charge.
The prescribing of contraceptives
is just the beginning of this movement of pharmacists prescribing power. Pharmacists
have long been an underutilized resource in our health care system. With
increased prescribing authority, they can improve an individual’s access to
care, patient adherence, and ultimately, be the solution to the shortage of
primary care physicians.
http://www.npr.org/sections/health-shots/2015/06/05/412226430/california-women-can-soon-go-right-to-the-pharmacist-for-birth-control
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