A contraception toolkit helps them improve women's reproductive health.
In the United States, almost half of pregnancies are unintended.1 Globally, maternal mortality has declined steadily over the past 3 decades,1 but tragically, the number of American women dying during childbirth continues to climb.1 Accessible, affordable birth control could decrease unintended pregnancies and maternal mortality by 30%.1 Family planning allows women to obtain college educations, pursue advanced professional degrees, and join the nation’s workforce.1 The American Gynecological and Obstetrical Society advocates for full unrestricted access to contraception,2 and pharmacists are poised to help.
Forty-nine states have awarded some form of prescriptive authority to pharmacists with variable prescriber oversight and restrictions.3 Pharmacists address antimicrobial stewardship, chronic conditions, immunization, and the opioid crisis (eg, naloxone) every day.4
Oral contraception’s safety is well established.5 Although combined oral contraception creates a venous thromboembolism risk, it is small com- pared with the risk during pregnancy and post partum.2 Studies show that women can self-screen and nonphysicians can safely assess contraindications to using oral contraception.5 Pharmacists can refer patients who need to use other methods.6
Fifteen states already allow pharmacists to prescribe birth control without collaborative practice agreements, and that number is increasing (Table 1).7 Successful pharmacist prescribing initiatives demonstrate its potential. Already, 46% of Oregon’s pharmacies prescribe contraception.8
All states require training and patient visit documentation.9 Typically, training involves certification or continuing education (CE) modules. Most locations use statewide protocols that identify when physician referral is required.5,9 Patient questionnaires address health history and pregnancy status, identify patient preferences, require blood pressure measurement, and screen for eligibility and interacting medications.2,10
The CDC has great contraception-prescribing resources. The evidence-based US Medical Eligibility Criteria (US MEC) for Contraceptive Use and the Selected Practice Recommendations for Contraceptive Use guide contraception choice based on medical conditions and help with managing challenges. The US MEC is updated at least every 5 years, and its components are available as mobile apps and include an easy-to-use summary chart.11 The CDC offers CE on the US MEC’s clinical application (https://www.cdc.gov/reproductivehealth/contraception/unintendedpregnancy/training.htm ).12
Women hesitant to start birth control are most concerned with potential adverse effects. Pharmacists can guide patient decisions and discuss alternatives that may alleviate undesired effects.13 Birth control is a journey for women, and Table 2 lists factors that influence their selection of methods.14
Breaking Down Barriers
Barriers affecting all health care curb access to contraception. Limited appointment availability and having to miss work cause patients to avoid office visits.15 Expanding pharmacy services is the very definition of health care convenience.8 Patients may also prefer pharmacies because of the availability of multilingual staff, pharmacy hours, and the facility’s proximity to their home.8
Might access at the pharmacy decrease regular physician visits? On the contrary, pharmacist-patient interaction could encourage regular physician visits. Contraindications to prescription birth control require physician referral, and states often require pharmacists to inform the patient about the importance of regular exams.16
Cost remains a barrier for 11.7% of women of reproductive age who are uninsured or underinsured.14 Without insurance, contraception’s average out-of-pocket cost is $240 to $900 yearly including secondary expenses (eg, lost wages and transportation).14
Pharmacist participation varies across states, and reimbursement influences participation.8 Paying pharmacists reasonable fees for patient assessment and prescribing or referral is critical.4
States often delay developing payment policies for contraception prescribing, so pharmacists may consider temporarily increasing dispensing fees for the additional services.17 For example, in 2014, Illinois established a $35 dispensing fee.17
Pharmacists ready to exercise prescriptive authority have the education and tools to successfully provide birth control to women.
Ashley Walsh, PharmD, is a pharmacist at Mohegan Pharmacy in Uncasville, Connecticut.