Pharmacist-prescribed contraception is just as safe, and more accessible, than clinician-prescribed birth control, according to a new study published Wednesday in the Journal of the American Medical Association’s JAMA Network Open.
The study was led by Maria Rodriguez, M.D., M.P.H., an associate professor of obstetrics and gynecology at the OHSU School of Medicine, and funded in part by Arnold Ventures. Rodriguez’s team found that pharmacists are reaching younger, less educated, and uninsured patients and providing women with longer prescriptions.
According to Power to Decide, a campaign to prevent teen and unplanned pregnancies, more than 19 million women of reproductive age in the U.S. live in contraceptive deserts — areas without a health center that offers a full range of contraceptive options. When women do not have autonomy over their reproductive health, it contributes to a cycle of disadvantage in the lives of individuals and their communities, according to the National Institutes of Health.
In 2015, Oregon became the first of 11 states to allow pharmacists to independently prescribe hormonal birth control — the pill, patch, or ring — without a doctor’s visit. They offer women private, in-pharmacy screenings then prescribe and dispense the appropriate medication onsite.
“When we designed this study,” Rodriguez said, “we wanted to really understand: What are the reasons why women are getting their care from the pharmacy? What is their experience with it? Are they receiving the same quality of care? Do they have the same choices?” She also wanted to know if pharmacists are reaching women who cannot afford to go to a clinic or those who would have a lapse in their birth control before being able to schedule their next doctor’s visit.
She found that they were.
The study shows that pharmacists who prescribe birth control reach more people at highest risk for unintended pregnancies, especially those who are younger (aged 18 to 24), uninsured, and have less education. Avoiding pregnancy was “extremely important” to more than 70% of those surveyed. Pharmacists are providing a convenient, safe, low-cost, and accessible way for women to have more control over when, or if, they have a child.
Pharmacies can also be more affordable than clinic or doctor visits. Pharmacies can bill insurance companies for their time and most chains charge a fee between $20 and $50 to those who are uninsured. One woman who was part of Rodriguez’s study explained in a survey, “I don’t have health insurance, and this is a lot cheaper than going to a clinic. Doctor’s visit is $300 out of pocket, pharmacist filling prescriptions is $35.”
Another participant appreciated the ease with which she could obtain birth control. “So much easier than an appointment with my doctor, and Medicaid pays for it.”
According to Katy Bacon, Director of Contraceptive Choice and Access at Arnold Ventures, “If someone is uninsured and living in a contraceptive desert, they might be more likely to have a pharmacy nearby than a doctor.” Pharmacies also have longer hours and don’t require appointments.
Rodriguez’s study also shows that this practice is safe. Pharmacists were no more likely than clinicians to prescribe medicines incorrectly to women with medical contraindications. Pharmacists were, however, found more likely than clinicians to dispense contraception for six months or longer, limiting lapses in care. A 2019 study published in JAMA Internal Medicine found that providing 12 months of birth control is key in both cutting costs for patients and preventing unintended pregnancies.
Rodriguez’s team collected data from 410 women and nearly 140 pharmacies in California, Hawaii, Colorado, and Oregon, and through Oregon’s statewide health database. In 2015, Oregon became the first of 11 states to pass legislation allowing pharmacists to independently prescribe hormonal birth control, and Rodriguez’s study provides necessary information to strengthen the practice and guide care as more states pass similar bills.
Support to expand access to birth control through pharmacies comes from both sides of the political aisle. Andrea Kane, Vice President for Policy and Strategic Partnerships at Power to Decide, called allowing pharmacists to directly prescribe contraception a “common-sense policy,” noting that it has gained support on both sides of the aisle in states as politically varied as California, Maryland, Tennessee, Utah, and West Virginia.
The novel coronavirus (COVID-19) pandemic has highlighted disparities in health care access in the United States, showing the importance of providing additional avenues for distribution of medications like birth control. Pharmacies can offer an invaluable alternative during this time with telehealth visits, drive-through pick-up, and medication delivery services.
One day, I would like people to go to the pharmacy for their birth control like they go to the pharmacy for their flu shots.Sally Rafie pharmacist
Pharmacist Sally Rafie called being prescribed birth control at a pharmacy a “one-stop process.”
She regularly sees a diverse group of patients at the San Diego, Calif., pharmacy where she works. She prescribes birth control pills and provides information on reproductive health to nervous teenage girls and reliable contraception for women who work on fishing ships for weeks at a time. One time, a supportive mother brought her 18-year-old daughter in for a birth control prescription — they both left with a supply.
Rafie is also a doctor of pharmacy, a researcher, and founder of the advocacy and educational project, Birth Control Pharmacist. “One day,” she said, “I would like people to go to the pharmacy for their birth control like they go to the pharmacy for their flu shots.”
Rafie explained why she believes it’s safe for pharmacists to prescribe birth control. “Contraception is a service that doesn’t require a diagnosis. People are able to determine if they would like to use contraception.” In addition, she said teaching patients about their medications is part of the job description: “Patient education is core to what we do.”
Visiting a pharmacist for a birth control prescription isn’t, however, a replacement for a wellness visit, during which a patient is screened for sexually transmitted infections and breast and gynecologic cancers. Rather, it is part of a larger suite of options to make contraception more accessible to more people. “This isn’t, ‘Don’t go to the doctor, go to the pharmacist.’ This is, ‘There are a lot of potential channels out there and we want to create options,’” Bacon said.
“Removing barriers to getting a refill or to getting more coverage seems like a very simple thing to do,” Rodriguez said. “Pharmacists are closing that gap.”