In the next few months, women in California and Oregon will be able to obtain hormonal contraceptives like pills, patches and rings by getting a prescription directly from the pharmacist, a more convenient and potentially less expensive option than going to the doctor.
Groundbreaking laws in two Western states — California and Oregon — will soon make access to birth control easier for millions of women by allowing them to obtain contraceptives from pharmacists without a doctor’s prescription.
Even as the Supreme Court prepares to consider yet another divisive case involving access to contraception, public-health advocates hope these arrangements could spread across the country, as states grappling with persistently high rates of unintended pregnancy seek to increase access to birth control with measures that, so far, have been unavailable under federal law.
Most Western countries require a doctor’s prescription for hormonal contraceptives like pills, patches and rings, but starting sometime in the next few months, women in California and Oregon will be able to obtain these types of birth control by getting a prescription directly from the pharmacist who dispenses them, a more convenient and potentially less expensive option than going to the doctor.
Pharmacists will be authorized to prescribe contraceptives after a quick screening process in which women fill out a questionnaire about their health and medical histories. The contraceptives will be covered by insurance, as they are now.
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The laws are the latest effort to make birth control more accessible, a long-standing goal of medical professionals and policymakers. But unlike other recent debates over contraception — including the firestorm over the Obama administration’s requirement under the Affordable Care Act that all health plans pay for contraceptives — these legislative efforts have been largely free of political rancor.
“I feel strongly that this is what’s best for women’s health in the 21st century, and I also feel it will have repercussions for decreasing poverty because one of the key things for women in poverty is unintended pregnancy,” said state Rep. Knute Buehler, a Republican who sponsored Oregon’s law.
About half of the 6.6 million pregnancies annually in the United States are unintended, a higher proportion than in Europe.
Reproductive-health groups and medical associations increasingly say the ultimate goal should be to make contraceptives available without a prescription, and some worry that the push for pharmacist-prescribed contraceptives could thwart that. The American Congress of Obstetricians and Gynecologists is one of the few groups to express opposition to these laws, arguing that hormonal contraceptives should be available solely over the counter.
“My basic tenet is there should be nobody between the patient and the pill,” said Dr. Mark DeFrancesco, the president of the organization. “I’m afraid we’re going to create a new model that becomes a barrier between that and over the counter. I worry that it’s going to derail the over-the-counter movement.”
But supporters of over-the-counter contraceptives acknowledge that getting Food and Drug Administration approval could take a long time because the agency often requires additional studies.
Cost is another possible drawback of over-the-counter sales. The Affordable Care Act does not explicitly require plans to cover over-the-counter medications, so women might wind up paying hundreds of dollars a year for over-the-counter birth control instead of obtaining it free with a prescription.
A bill introduced in Congress in May by Republican senators would help expedite the process in which contraceptive manufacturers apply to the FDA for over-the-counter approval, but some Democrats and women’s groups say it might ultimately reduce birth-control use because it does not specify insurance coverage for over-the-counter methods. In response, Democrats have introduced a bill stipulating that contraceptives would remain covered if they were to become available without a prescription.
In the absence of federal action, states are stepping in.
Jill Vincik, a high-school teacher who recently moved to Bend, Ore., said that being able to get her birth-control pills without a doctor’s appointment would make her life easier.
“I would certainly take advantage of it,” said Vincik, 37, a single mother, who noted that she had a gynecological exam before moving and had not yet found a gynecologist in Oregon. “I shouldn’t be in a position to have to go to a doctor when my pills run out. I’m not going to do another Pap smear; I just did one.”
Advocates of this approach, including pharmacists’ organizations, plan to lobby for it across the country. “We are actively going to come up with a statute to spread to other states, and I think it can spread pretty quickly,” said Buehler, the Oregon legislator, who is also an orthopedist. Pharmacy-board representatives from states including Arizona and Idaho observed a recent meeting in Oregon about the new rules.
A New Mexico proposal that failed in 2012 is expected to be revised to reflect the Oregon and California measures, said Dale Tinker, executive director of the New Mexico Pharmacists Association. Raley’s, a grocery store and pharmacy chain with 80 stores in Northern California and 16 in Nevada, is urging Nevada to follow California’s lead, said Lee Worthy, the chain’s vice president for pharmacy and wellness.
“It’s going to take a lot of the barriers away from that underserved community that we see surrounding every store,” Worthy said.
Many reproductive-health experts have come to support pharmacist-prescribed contraceptives, convinced that pharmacists can safely dispense contraception without a doctor’s prescription and that women can assess their health risks on questionnaires.
“There’s a growing body of evidence that there isn’t a safety concern,” said Dr. Daniel Grossman, vice president for research at Ibis Reproductive Health and a professor of obstetrics and gynecology at the University of California, San Francisco. “There are studies showing that women can really accurately identify the conditions that make it appropriate to use certain contraceptives, using a simple checklist.”
Some people have argued that a need for contraception brings women to the doctor, ensuring that they get other important screening tests, like Pap smears to detect cervical cancer. But Dr. Nancy Stanwood, an obstetrician and chairwoman of the board of Physicians for Reproductive Health, said a study of Texas women who received over-the-counter contraceptives in Mexico had found that many still visited doctors for Pap smears. And she noted that Pap smears were now recommended every three years, not annually, and not until women turn 21.
“We were holding pregnancy prevention hostage to cancer screening,” Stanwood said. “They’re both worthwhile goals, but one should not be held hostage to the other.”
The new laws are extensions of arrangements now found in almost every state: collaborative practice laws that allow pharmacists to administer vaccines or prescribe certain medications if they have agreements with physicians or other health providers. The laws vary widely, and some include only specific diseases or drugs. But in some places, like Washington state and Washington, D.C., collaborative practice laws are broad enough for pharmacists to prescribe birth control if their physician agreements permit it.
In Seattle, Beverly Schaefer, a co-owner of Katterman’s Sand Point Pharmacy, has a physician’s permission to prescribe various medications, including antibiotics and antihistamines. She charges a $35 fee, and will prescribe hormonal contraceptives for women who say they have previously been prescribed them.
So far, those customers have typically been college students who “haven’t planned ahead and are like, ‘Oh, my God, I don’t have any contraceptives,’ ” she said. “I also see it in some ways as being more comfortable for women because it is a less clinical environment.”
One unanswered question, however, is whether insurers will pay for the time pharmacists spend reviewing women’s questionnaires or helping evaluate options. To cover that cost, some pharmacists may charge fees of $25 or more, which could be an obstacle for some women.
The laws in Oregon and California differ in some ways. California’s has no age restriction; the Oregon law requires that teenagers under 18 obtain their first contraceptive prescription from a doctor. In California, pharmacists will also most likely have to take women’s blood pressure for contraceptives containing estrogen.