Sally Rafie, PharmD
Sally Rafie, PharmD, BCPS, APh, NCMP is a pharmacist specialist at the University of California San Diego (UCSD) Health and an assistant clinical professor at the UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences. She started the Birth Control Pharmacist project (www.birthcontrolpharmacist.com) to help educate pharmacists and other health care professionals about family planning topics such as hormonal contraception, emergency contraception, and youth-friendly pharmacy services. Her advocacy efforts support widespread access to reproductive health services and products, particularly in pharmacies.
Why the delay? Because it took a few years to develop and approve multiple rounds of revisions to the statewide protocol.
Which birth control methods can California pharmacists prescribe?
At California pharmacies, women will have their choice of the pill, patch, ring, or injection. The only other state with a similar protocol is Oregon, where women can obtain birth control pills and patches at the pharmacy.
In California, women of any age can access this service from a participating pharmacist, so there are no age minimums and no ID checks. This service is completely confidential and no information can be shared with parents or anyone else.
What about pap smears?
A pelvic examination and pap smear aren’t necessary to initiate hormonal birth control, but they’re important for other health reasons. Women seeking birth control from a pharmacist in California will need to complete a health history questionnaire and have their blood pressure taken at the pharmacy. The pharmacist will use this information to determine which methods of birth control are safe.
If the pharmacist finds something concerning in the patient’s health history, or if the patient desires a long-acting birth control device, then the pharmacist will refer the patient to a provider who can help with that.
After the visit, the pharmacist will send a note to the woman’s primary care physician to fill them in, unless the patient doesn’t want the pharmacist to do that.
Who’s going to pay for this?
If a patient goes to the pharmacist for her birth control visit and fills her prescription, the prescription costs will be covered by her insurance just the same as if it were written by a physician.
Unfortunately, insurance companies aren't reimbursing pharmacists for these visit as they do for physicians, nurse practitioners, physician assistants, nurse midwives, and even nurses in California. However, pharmacists can charge a fee for the visit that patients would have to pay for out-of-pocket and then submit the receipt to their insurance company for potential reimbursement.
Is this a good idea?
This is an enormous step forward in increasing access to birth control. Hopefully, pharmacists will take pride in providing this important service, and women will appreciate having more choices in terms of how to obtain birth control.
Ideally, more states will pass similar laws that expand access to birth control through pharmacists. Tennessee is already moving forward with legislation, and many other states are considering it. There is also growing federal support for OTC birth control pills.