When Denicia Cadena started looking into increasing access to contraceptives for women in her home state of New Mexico, she knew the problem was urgent: Some counties in the state didn’t have a single primary care provider, leaving many women without access to prescription birth control.
“We knew that this was a really important issue in our community,” said Cadena, who is the policy director at Bold Futures, an advocacy organization and think tank based in Las Cruces and Albuquerque, N.M. “New Mexico is a very rural state with many low income people, a majority of them people of color,” she said. “Our state was facing extreme provider shortages.”
One way policymakers have been trying to solve this problem is by advocating for laws that would allow pharmacists to prescribe contraceptives at pharmacies. In June of 2017, Bold Futures, along with the help of lawyers at the ACLU of New Mexico, community advocates, and the New Mexico Pharmacists Association, worked to pass a law that allowed pharmacists to provide both contraceptive counseling and prescribe contraception at pharmacies. The law stipulates that pharmacists must be trained in areas such as counseling, interviewing, and informed consent. About 12 states have similar laws in place.
Nationally, about 19 million women live in “contraceptive deserts,” lacking “reasonable access” to a health center that offers a range of contraception, according to Power to Decide, a think tank based in Washington, DC. And about 1.5 million of those women live in counties without a single center.
Number of U.S. women who live in “contraceptive deserts.”
Pharmacies and prescribing laws help close some of that gap, says Gayle Mauser, policy analyst and senior manager at Manatt Health, a legal consulting firm based in Washington, DC. “It's one of the few [policies] that helps to address contraceptive desert issues and this notion of like, ‘OK, how do we get contraceptives in the hands of people that want them and ensure that they have contraceptive choice when they just don't have access to what would normally be entry points, whether that's Title X clinics, or a primary care provider that provides contraceptive care, or a gynecologist.”
The new law has been crucial to improving access in New Mexico where there are more pharmacies than clinics, and pharmacies are open longer hours.
Cadena, who grew up in a small town of 2,500 residents, said the new law reduced privacy concerns as well. If someone doesn’t feel their local clinic is understanding of their situation, identity, or beliefs, she says they can now drive to a pharmacy that feels right to them — away from their own community, or local clinic, where everybody might know them.
“As a queer woman, for me, it can often be challenging seeking reproductive health care, because I feel like I have to explain my identity, my relationship status,” said Cadena. “[If I needed contraceptive care,] to know that I could access a pharmacy at whatever time of day or night that suited my needs; to know that I could go to a different community [to protect my privacy or serve other needs], to know that I could find a provider that was actively LGBTQ-friendly, meant everything to me. And I hope it does to other New Mexicans.”
The Path Toward Success
The road to authorizing pharmacist prescriptions wasn’t easy. In California, where policy makers passed a similar law in 2016, only about 15 percent of pharmacies participated, according to CaliforniaHealth Report, a nonprofit news organization reporting on health care.
Among the barriers cited for the low participation were low levels of awareness among consumers, low pharmacist training levels, staffing (not every pharmacy has enough people available to not only dispense, but also assess clients’ needs and prescribe contraception), and liability concerns. If consumers don’t know about the option and at the same time most pharmacists aren’t trained, a new law doesn’t change the reality. In addition, insurance companies also weren’t obligated to reimburse participating pharmacies, which as a result would often default to charging a fee to their customers for their services rather than to insurers. In New Mexico, Bold Futures was determined to learn from these implementation shortfalls.
The successful implementation of the first law in June of 2017 led to additional legislation, thanks to the help of a coalition of health professionals, lawyers, and pharmacists who worked together on passing more measures in the NM legislature. “It's one thing to legally say, ‘OK, pharmacists now have this scope of practice and they can do this,'” Mauser said. “And it's another thing to fix all of those issues that can be a problem in other areas as well [such as reimbursement].”
In 2019, as a result of the continued work of Bold Futures, the ACLU of New Mexico and Planned Parenthood, New Mexico expanded on the Affordable Care Act’s contraception coverage requirements. The new stipulations required insurers to cover contraceptive methods regardless of a person’s gender, provide coverage of those methods during a minimum of six months, and include over-the-counter contraceptive products. The new measure made sure more women from all backgrounds could receive the contraceptive care of their choice.
In 2020, another law was passed that expanded access to contraceptives and made coverage more widely available, removing an important barrier toward implementation of the 2017 pharmacy prescribing law. The New Mexico House Bill 42, providing reimbursement parity, made sure that pharmacies could be compensated for their services at a level similar to other health care professionals such as physicians and nurses.
The new measure helps to keep pharmacies in business, Cadena said, and provides an incentive for them to commit the resources to prescribe contraception.
“If they worked at a chain, their chain would say, ‘No, you can't take a spare 30 minutes to accomplish that. We're not going to get paid for it.’ And if they worked at an independent pharmacy,” Cadena added, “[they’re] just really trying to work on very thin margins and keeping up with the chains.”
Alleviating Pressure on ‘Overwhelmed’ Clinics
Since the pandemic hit, many clinics have not been able to keep up with the high volume of patients. Some do not have the extra space to care for COVID patients and others seeking care, or lost nursing staff who fell ill with the disease themselves. In an attempt to alleviate some of these pressures, clinics have switched to servicing patients online, offering appointments through telemedicine. But not everyone has access to online resources, exacerbating disparities in care.
Pharmacies have remained accessible through the pandemic and are on the front lines of distributing medications and vaccines. “It's very important that we have this option available to people in New Mexico. It means they can still access their birth control throughout this emergency,” Cadena said.