Editor’s Note: In a new playbook, supported by Arnold Ventures, Manatt Health provides state policymakers and other stakeholders with legislative, regulatory, reimbursement and operational strategies to increase access to contraception by effectuating pharmacist prescribing. Key points are summarized below. Click here to access a free copy of the full report.
More than 19 million individuals in the United States lack meaningful access to birth control within their communities.1 Low-income women, women of color and individuals from other historically marginalized communities have been shown to have greater difficulty in accessing reproductive healthcare generally and contraception in particular.2 Authorizing pharmacists to prescribe and dispense contraceptives is one strategy states can deploy to increase contraceptive choice and access and at the same time address health disparities.4
The early experience of states that have implemented pharmacist prescribing policies demonstrates that such policies increase contraceptive access and choice. In a 2019 study of four states with contraceptive prescribing laws, women who chose to get contraception prescribed by a pharmacist as opposed to a clinician were younger, had less education and were more likely to be uninsured.4 Pharmacist prescribing may help address access disparities particularly for Black women6 and people living in rural communities7 because both of these populations are likely to live closer to a pharmacy than a physician’s office.
In addition, the pharmacy counter may be a preferred access point for some consumers. Individuals who have obtained pharmacist-prescribed contraceptives report high levels of satisfaction and note, in particular, the convenience of obtaining care at the pharmacy.8
Recognizing these benefits, nearly a dozen states have passed legislation to allow pharmacists to prescribe contraceptives. These states’ experiences show that successful pharmacist contraceptive prescribing initiatives require thoughtful design and implementation and realistic execution timelines.
In a new playbook for states and stakeholders, Manatt Health reviews different types of laws that authorize pharmacist prescribing and outlines strategies to assure effective implementation. State boards of pharmacy are most commonly charged with leading implementation and ongoing oversight of policies, but the strategies listed below and described in more detail in Manatt’s playbook could be implemented by any state regulators charged with leading implementation.
Strategies to Assure Effective Implementation
Stakeholder and Community Engagement
1. Engage Providers, Pharmacists, and Community-Based Organizations Early and Often
2. Design Consumer Outreach Plans to Ensure Awareness of Pharmacist Prescribing
3. Establish a Centralized Registry of Pharmacists Certified to Prescribe Contraceptives
4. Ensure Pharmacists Are Paid for Contraceptive Prescribing Services
5. Develop a Cross-Payer Toolkit for Pharmacist Credentialing, Enrollment and Billing as Providers
6. Increase Pharmacy Dispensing Fees
7. Offer a Range of Pharmacist Training Programs
8. Partner With Local Schools of Pharmacy to Incorporate Contraceptive Prescribing Certification Programs
9. Provide Pharmacist Prescribers With Family Planning Referral Resources
Promoting and Supporting Pharmacist Uptake
10. Collaborate With Multi-Location Pharmacies
11. Assess Family Planning Provider Availability to Craft Pharmacist and Consumer Engagement Initiatives
12. Assess Contraceptive Access
Medicaid and Medicaid Managed Care Strategies
13. Clarify Balance Billing Restrictions for Pharmacists
14. Clarify Freedom of Choice of Provider Protections
15. Incorporate Pharmacist and Member Engagement and Billing Requirements in MCO Contracts
1 Birth Control Access 2020 | Power to Decide. Accessed December 16, 2020. https://powertodecide.org/what-we-do/access/birth-control-access
2 Dehlendorf C, Rodriguez MI, Levy K, Borrero S, Steinauer J. Disparities in Family Planning. Am J Obstet Gynecol. 2010;202(3):214-220. doi:10.1016/j.ajog.2009.08.022
3 Grindlay K, Grossman D. Prescription Birth Control Access Among U.S. Women at Risk of Unintended Pregnancy. J Womens Health. 2016;25(3):249-254. doi:10.1089/jwh.2015.5312
4 Rodriguez MI, Hersh A, Anderson LB, Hartung DM, Edelman AB. Association of Pharmacist Prescription of Hormonal Contraception With Unintended Pregnancies and Medicaid Costs. Obstet Gynecol. 2019;133(6):1238–1246. doi:10.1097/AOG.0000000000003265
5 Anderson L, Hartung DM, Middleton L, Rodriguez MI. Pharmacist Provision of Hormonal Contraception in the Oregon Medicaid Population. Obstet Gynecol. 2019;133(6):1231–1237. doi:10.1097/AOG.0000000000003286
6 Barber JS, Ela E, Gatny H, et al. Contraceptive Desert? Black-White Differences in Characteristics of Nearby Pharmacies. J Racial Ethn Health Disparities. 2019;6(4):719-732. doi:10.1007/s40615-019-00570-3
7 Kelling SE. Exploring Accessibility of Community Pharmacy Services. Innov Pharm. 2015;6(3). doi:10.24926/iip.v6i3.392
8 Rodriguez MI, Edelman AB, Skye M, Darney BG. Reasons for and experience in obtaining pharmacist prescribed contraception. Contraception. 2020;102(4):259-261. doi:10.1016/j.contraception.2020.05.016