The ability to access the method of birth control you need when you need it is impacted by a variety of complex and intersecting factors. Reported barriers include cost, lack of insurance, challenges obtaining an appointment or going to a clinic, unnecessary examination before prescription such as a Pap smear, not having a regular health care provider, and difficulty accessing the pharmacy. In the past decade, pharmacist prescribing of birth control has become increasingly available across the country. Pharmacist prescribing can increase access and reduce barriers and costs associated with a trip to a health center as nine out of 10 Americans live within five miles of a pharmacy. Here’s what you need to know:
Where is pharmacist prescribing of birth control available?
The availability of pharmacist prescribing varies from state to state as both federal and state laws and regulations apply to the practice of pharmacy. Currently, 12 states allow for pharmacist provision of birth control with a statewide protocol, standing order, or contraceptive-specific collaborative practice agreement, and an additional seven states offer pharmacist provision with a general collaborative practice agreement. Excitingly, nine additional states have statewide protocols or standing orders in progress. That means pharmacists will soon provide access to birth control in more than half of states.
States like California and Oregon allow pharmacists to prescribe birth control with a statewide protocol, which means that getting birth control is as simple as taking a trip to the pharmacy, filling out a screening questionnaire, and meeting with the pharmacist for a consultation. However, in some states patients must be 18 years or older and the type of birth control that the pharmacist can prescribe varies. For example, New Mexico allows pharmacists to prescribe the pill, patch, ring, shot, and non-hormonal methods, like condoms, while in Colorado and North Carolina, pharmacists are limited to prescribing the pill and patch. To find out if pharmacist prescribing is available in your state and to learn about any state-level restrictions check out these interactive maps from Power to Decide. If pharmacist prescribing is available in your state, you can find out who is offering it in your community from Birth Control Pharmacies.
What about EC?
In 2009, the FDA approved the use of the emergency contraceptive (EC), levonorgestrel 1.5 mg (PlanB One-Step and generics), as an over-the-counter, non-prescription product for women ages 17 and older. And in 2013, this approval expanded access without a prescription to everyone regardless of age or gender. Other forms of EC, such as ulipristal acetate (ella), the copper IUD (Paragard), or levonorgestrel IUDs, require either a prescription or a clinician visit. Pharmacists in some states, such as California and Hawaii, can prescribe ulipristal acetate EC pills due to a collaborative practice agreement or state-wide protocol.
Do people want to get birth control from a pharmacist?
Yes. Research shows that individuals reported seeking a birth control prescription from the pharmacy because it was faster than a doctor’s appointment, the location and hours of a pharmacy were more convenient, it offered cost savings, and they lacked a primary or regular doctor. While pharmacist-prescribed birth control is often underutilized, patients visiting a pharmacy to get their contraception prescription report high levels of satisfaction with the pharmacy services and that they would return to the pharmacy to get their birth control prescription in the future.
Pharmacists are ready
Pharmacists already possess general knowledge of birth control and have advanced patient education skills. But additional training on prescribing contraception may be required as part of the state-specific protocols. Not all schools of pharmacy provide this additional training in their curriculum. Supplementary certifications after graduation may be needed depending on the state you were trained in compared to the one you practice in. Advanced training may also improve comfort levels for pharmacy graduates who feel less comfortable prescribing contraception.
Certain states, like Maryland or California require a two-to-three-hour training session before prescribing birth control. Trainings such as these are approved by the state’s Board of Pharmacy and are usually a requirement of the statewide protocol, standing order, or contraceptive-specific collaborative practice agreement to ensure knowledge, service implementation, and awareness of protocol procedures.
Are there other ways pharmacists can increase access to birth control?
Absolutely. In states where pharmacist-prescribed birth control isn't yet an option, pharmacists can take a few steps right away to increase access to birth control. Pharmacists can:
- Recommend generic versions to lower costs.
- Recommend 3-months or 1-year supplies to reduce the need for return visits.
- Recommend prescription savings cards and coupon programs for patients with commercial health insurance.
- Become aware of local resources and refer to Title X health centers offering contraceptive services on a sliding-fee scale.
- Recommend available OTC options to bridge until another method can be started.
- Counsel on ways to use fertility awareness methods, including the FDA-approved contraceptive app NaturalCycles.
- Review options for when birth control isn’t covered.
While pharmacist prescribing won’t solve all of the barriers for people to access birth control, it is an innovative and expanding strategy for increasing access to birth control.