Pharmacist administration of depot medroxyprogesterone acetate (DMPA), both intramuscular (DMPA-IM, 150 mg) and subcutaneous (DMPA-SQ, 104 mg), is an emerging practice that may significantly improve access to this contraceptive method.
Clinical Context
Progestin-only injectable contraceptives, both IM and SQ formulations, are available in the U.S. and can be initiated at any time as long as the provider can be reasonably certain that the patient is not pregnant. For most patients, no examinations or tests are needed prior to initiating DMPA.
The appeal of injectable contraception, including self administration, has increased in recent years, particularly during the COVID-19 pandemic, due to its convenience and adherence advantages. As trained medication experts with competency in injection techniques, pharmacists possess the necessary skills to offer contraceptive administration, and such a service would fall under their scope of practice. Pharmacist-administered injectable contraceptives represent a promising public health intervention to address contraceptive access gaps, particularly in rural communities and contraceptive deserts, where traditional clinic access may be limited.
Expanding Pharmacist Contraception Services to Improve Access
Since 2016, some states have expanded contraceptive access through pharmacist prescription or provision of contraception programs. Legislation varies, with some states permitting pharmacist-administered injectable contraception directly, while others limit pharmacist services to self-administered methods. In some states, legislation permits individuals to obtain contraceptive care at pharmacies regardless of age, although some restrict access for those under the age of 18. Currently 30 states and the District of Columbia permit pharmacists to provide hormonal contraceptives via a variety of mechanisms and 11 of these explicitly include injectable contraceptive methods. Notably, this expansion also encompasses DMPA-SQ. The U.S. Selected Practice Recommendations for Contraceptive Use, 2024 support self-administered DMPA-SC as an additional approach to deliver injectable contraception.
Patient Perspectives on Receiving DMPA at the Pharmacy
Patients report high levels of satisfaction with pharmacist-administered DMPA. However, some patients prefer receiving their DMPA at a provider’s office, especially when it can be coordinated with other preventative care services. Reported concerns about pharmacist-administered DMPA include cost of service, pharmacist availability and knowledge, and a preference for a different type of healthcare professional.
Pharmacist Perspectives on Providing DMPA
Pharmacists have expressed interest and confidence in expanding their role through the implementation of these types of services. Many view it as an opportunity to improve access to care and strengthen relationships with patients and other healthcare professionals. Common barriers include lack of time, reimbursement challenges, confidence in providing the injection, and administrative support.
Other Healthcare Professional Perspectives on DMPA
Other healthcare professionals largely support pharmacist-prescribed and administered injectable contraceptives, viewing it as a strategy to reduce access barriers and promote patient autonomy.
Bottom Line on Pharmacist Administration of DMPA
Community pharmacists can play a vital role in expanding access to DMPA, especially in underserved or rural areas. Ongoing advocacy is essential to ensure legislation continues to support pharmacists’ scope of practice to include both prescribing and administering injectable contraception.
