Pharmacist-Prescribed Hormonal Contraception: A Review of the Current Landscape

Abstract

Objective: The objective of this article is to review the current supply-side, demand-side, and regulatory landscape of pharmacist-prescribed hormonal contraception (HC) in the United States.

Summary: At least ten states have authorized pharmacists to prescribe HC. Several others are considering legislation to promote or advance pharmacist-prescribed HC models. From the perspective of the supply-side, pharmacists appear to be supportive of pharmacist-prescribed HC. This is especially pronounced in female pharmacists or pharmacists who have no religious objections. However, support does not necessarily indicate likelihood of implementing the practice, as a significant number of pharmacists report that they have little expertise with HC. The likelihood of implementation can be increased with education and training of HC prescribing by pharmacy schools and colleges. The federal government and many states have passed legislation allowing pharmacists and other health care professionals to refuse to provide certain services on the grounds of moral opposition, religious or otherwise. As a result of these conscientious objector laws, it is possible that refusal to prescribe will present a major obstacle to successful implementation of pharmacist-prescribed HC, especially in areas where pharmacies are less available, such as rural regions and some inner-city areas. Investigations of the demand for pharmacist-prescribed HC suggest that women broadly support accessing contraception within a pharmacy. Expanded access, where available, could improve rates of use and adherence. Women at higher risk for unintended pregnancy, such as younger women and women without health insurance, are likely to utilize the pharmacy to procure HC given increased privacy and convenience. However, research suggests that despite a willingness to pay for HC consultations with pharmacists, costs remain as a significant barrier for many women.

Conclusions: Expanding access to HC through pharmacist-prescriptive authority could help curb the rates of unintended pregnancy in the United States. Pharmacists are well positioned for such a role; however, significant barriers for pharmacists and patients remain. Examination of current implementation methods will assist policy makers in overcoming these barriers.

Keywords: contraception, contraceptives, reproductive rights, family law, abortion, women, conscience clause, religious freedom, Religious Freedom Restoration Act, RFRA, pregnancy, unintended pregnancy, health law, Roe v. Wade

JEL Classification: I12, I14, I18, Z12, Z18, I1, I10