More than 19 million women in the United States live in contraceptive deserts1—areas with insufficient access to the full range of birth control methods. This burden disproportionately affects women of color,2 who also tend to report more negative health care experiences overall.3 To help address this crisis, one promising policy reform is to expand pharmacists’ prescriptive authority to allow them to both prescribe and dispense select contraceptives. However, there are common challenges to implementation that policymakers must be aware of and work to address.
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Challenge: Awareness and transparency
A common barrier to widely implementing pharmacist prescribing is a lack of awareness due to the absence of a robust outreach and communications strategy for disseminating new policy information. To address this, policymakers may want to consider taking the following actions:
- Create a robust alert and notification system to increase awareness of new policies and laws, such as email alerts and notifications that contain a printable, informational flier and copy of the new policy.
- Develop a public and readily accessible list of all pharmacists and pharmacies certified to prescribe and dispense hormonal birth control.
Challenge: Training and continuing education
Training programs and continuing education initiatives are imperative for a well-implemented policy that is responsive to people’s needs. Trainings may help pharmacists learn or broaden their knowledge of hormonal birth control, including how to assess a person’s eligibility, communicate and conduct contraceptive counseling, and assess what operational changes and practices need to be in place to meet state standards. While not an exhaustive list, these components are crucial for implementing pharmacist prescribing of contraceptives. As pharmacists’ authority and roles are expanded, another often overlooked component is ensuring that they are incentivized to complete the trainings through continuing education credits and other means that compensate them for their time.
States can implement training programs effectively by:
- Creating an implementation work group or other multidisciplinary taskforce to oversee and help with implementation and to issue training guidance.
- Developing certification standards and incentivizing pharmacists to complete continuing education around the statewide protocol. States may wish to look at other training models to inform the development of their pharmacist prescription training.
Challenge: Billing and reimbursement
Another concern is that pharmacists will not be able to receive reimbursement from insurers and health benefit plans for the additional labor and protocol required to prescribe contraceptives. Similar concerns have arisen in states that have increased access to contraception through one-year prescribing laws, covered in the first installment of this series. To combat these concerns, states must:
- Develop billing guidance for pharmacists, as they are increasingly providing important care services, and train pharmacists on this billing guidance.
- Ensure that policies clearly require reimbursement for time spent and services provided, including contraceptive counseling.
- Develop and implement billing codes for pharmacists, where applicable.
Read more on advancing contraception access in the previous report in this series
Challenge: Patient privacy and confidentiality
Another concern is whether pharmacies have the space and capacity to provide patients the confidentiality necessary to adhere to state and federal privacy standards. This is crucial to ensuring that sensitive patient health information is protected and that patients have consented to treatment and are comfortable. States should:
- Configure pharmacy spaces to create private areas in which patients can receive counseling and discuss other protected matters with the pharmacist.
Challenge: Safety and pharmacist liability
Last are concerns about patient safety and pharmacist liability. Certain medical conditions make some hormonal contraceptives inappropriate or unsafe for some people to use, a condition known as contraindication. Without a proper and thorough health screening by a pharmacist or a complete disclosure of medical history from a patient, there is concern that a person may be inappropriately prescribed hormonal birth control. To mitigate risks to patient safety, pharmacists, just like other health care providers, must:
- Perform the required patient screening and assessment, including a blood pressure screening, prior to prescribing hormonal contraceptives.
Conclusion
Expanding pharmacists’ prescriptive authority is a crucial policy option that could mitigate barriers to contraceptive access. When implemented effectively and to scale, pharmacist prescribing of contraceptives could help ensure a women’s right to decide when or when not to have children and promote bodily and reproductive autonomy. Policymakers can look to some of the states mentioned in the full report4 as models on how to initiate and design a program that is tailored properly to their respective state’s needs.