Few California pharmacists prescribing birth control

(Reuters Health) - A California law allowing pharmacists to prescribe birth control sought to make it easier for women to obtain contraception, but few drug stores provide the service, a new study finds.

Only 11 percent of retailers in the state offered pharmacist-prescribed contraception one year after the law went into effect, the research shows.

“Our findings strongly suggest that more pharmacies need to offer this service to live up to the promise of widespread, easier access to birth control,” said study author Anu Manchikanti Gomez, professor of public health at the University of California, Berkeley.

Four states - California, Oregon, Colorado and New Mexico - allow pharmacists to prescribe contraceptive pills, patches, rings and injections after training about how to assess health risks and counsel women on contraceptive choices.

Supporters of pharmacist-prescribed birth control, which California first allowed in April 2016, believe it should improve access to birth control and curb unintended pregnancies, particularly among low-income women in rural areas without medical care and among girls who may feel uncomfortable asking a family doctor to prescribe contraceptives.

As reported in JAMA, researchers posed as patients, calling more than 1,000 pharmacies and asking if they could obtain birth control without a doctor’s prescription. Pharmacist-prescribed contraception was available in just 112, or 11 percent, of the stores.

Cost posed another barrier. Most stores that offered the service charged a fee, in most cases $45, Gomez said.

“It’s wonderful that California has legislation that aims to improve contraceptive access,” she said in a phone interview. “Whether it results in more access depends upon the availability and affordability of it.”

Under the Affordable Care Act, insurance carriers must pay for family planning consultations with healthcare providers. But the law does not cover pharmacists.

Dr. Maria I. Rodriguez, a professor of obstetrics and gynecology at Oregon Health & Science University in Portland who was not involved with the study, sees extending insurance coverage to pharmacists as “essential to ensuring equitable access to care for women.”

Oregon requires Medicaid to pay pharmacists for the service. California’s law has a similar provision, but it doesn’t take effect until 2021, a delay Rodriguez believes likely slowed availability of pharmacist-prescribed contraceptives in California, she said by email.

If financial hurdles can be overcome, and women know they can get birth control at their local drug store, “pharmacy prescribing of contraception has the potential to really expand access,” said Sarah Christopherson, policy advocacy director for National Women’s Health Network, a nonprofit in Washington, D.C.

“Pharmacies are often more conveniently located than clinics, with longer hours and more flexible consultation times,” Christopherson, who was not involved with the study, said by email. “That can be critical for women trying to juggle the demands of work, transportation, child care and more.”

Farm workers in California have told Gomez they cannot afford to leave work to seek medical care for birth control.

“A pharmacy can be a great backup, if you’re a farm worker, and you don’t have sick leave,” she said.

Rodriguez warns it will take time to train pharmacists and figure out how to bill for their services.

“Half of all pregnancies in the U.S. are unintended. This is a public health epidemic, with far reaching consequences for our generation and the next,” she said.

“Pharmacist prescription of contraception has the potential to improve access to care and reduce unintended pregnancy,” she said. “To improve public health, we need to see the policy fully implemented, and this requires community outreach, pharmacist training and equitable reimbursement.”

SOURCE: JAMA, online December 12, 2017.