Pharmacists Aren’t Using Contraceptive Powers

A new law expands pharmacists' abilities to include prescribing birth control methods, but few do so, research shows.

Anu Manchikanti Gomez found that only 11 percent of California pharmacies offer contraception prescription. Credits: Photo courtesy of Anu Manchikanti Gomez

Run out of birth control pills? Have a new honey, but medical appointments for contraception are weeks away? No doctor and no time to track one down?

Life intervenes, and this is one of the reasons California passed landmark legislation several years ago allowing pharmacists to prescribe contraception. The hope behind Senate Bill 493, adopted in 2013 and implemented last spring, was to safely improve access to contraception for the millions of California women and couples wanting to prevent pregnancy, according to public health leaders behind the move. Birth control would be as easy as stopping by your local pharmacy for a simple screening process. California joined Oregon, New Mexico, and Colorado in expanding the family planning services of pharmacists, after a required training.

But so far, the new ability of your corner drugstore isn’t translating to much difference on the ground, according to recent study by a UC Berkeley researcher. The service is optional, not mandatory.

Only 11 percent of California’s more than 5,000 pharmacies offer contraception prescription, according to research by Anu Manchikanti Gomez, a UC Berkeley assistant professor of social welfare and director of the campus’ Sexual Health and Reproductive Equity Program.

The study, the first of its kind to look at service changes under the new law, was published in the Dec. 12 issue of Journal of the American Medical Association. “Our findings strongly suggest that more pharmacies need to offer this service to live up to the promise of widespread, easier access to birth control,” Manchikanti Gomez said. “Most women in the U.S. use birth control at least at one point in their lives, so this is a pretty critical medication to a huge part of our population. If women can more seamlessly access the birth control they want, then they can have more autonomy over their reproduction.”

The new law also gives pharmacists the ability to prescribe travel medication, immunizations, and the opioid overdose drug, Naloxone, all in the interest of easing service challenges especially in areas with limited health care access.

In her study, Manchikanti Gomez’s team conducted phone interviews of a representative sample of 1,000 licensed pharmacies throughout California asking if the pharmacies offered birth control without a doctor’s prescription. Those who answered yes were asked follow-up questions on types of contraception and costs. The names of pharmacies weren’t included in the results.

The law allows trained pharmacists to prescribe contraceptive pills, patches, rings, and injections. Survey results found most of the pharmacies offering the service prescribe birth control pills (77 percent), compared to vaginal rings (40 percent), patches (38 percent), and injectable contraception (9 percent).

Women wanting birth control must complete a medical history questionnaire, meet with the pharmacist in person to discuss risks and dosage, and in some cases have a blood pressure check. It’s up to the pharmacy whether to require an appointment or serve drop-ins.

The UC Berkeley study didn’t analyze why pharmacies are deciding to prescribe contraception or not. But Manchikanti Gomez said she has conducted other research indicating that costs and time related to cost are issues.

“[The law] didn’t have any provisions for pharmacies to be reimbursed by insurers, and I think that’s the main reason. For the clinical services to be paid, the only option is directly charging a fee to the consumer,” she said. And these fees are an obstacle for some women.

The survey found that most of the pharmacies offering the service (68 percent) charge a service or consult fee of $40 to $45.

While the Affordable Care Act requires health insurers to cover the costs of contraception, there is no requirement to reimburse pharmacists who prescribe birth control. The cost of the actual medication or device is covered by insurance, but not the time pharmacists spent providing the service. Those without insurance must pay all costs.

This will change for at least some patients in 2021, when a new law, Assembly Bill 1114, goes into effect, requiring Medi-Cal to reimburse pharmacists providing contraceptive services to its enrollees. Medi-Cal is the government health plan for low-income residents.

An informal check-in with a variety of East Bay pharmacies showed a mix of responses to the law. Independent Oakland pharmacies High Street, Dolphin, and Wellspring all said they don’t offer the service. But pharmacist Hilton Wong at High Street said he thinks it’s a good idea “to expand the scope of a pharmacist.” Wong said he thought the new law wasn’t publicized well enough, and if more people were aware of it, demand might increase and more pharmacies would jump on board.

Pharmaca, an upscale pharmacy chain with locations in Oakland and Berkeley, does provide contraceptive services – a corporate requirement. But “honestly, we haven’t had much demand for it here,” said Jill Dean, a pharmacist at Pharmaca’s Solano Avenue store.

Dean said she thinks one reason she doesn’t get many requests is because women in the East Bay have many options for getting birth control. But she also thinks giving pharmacists the ability is a great idea. “I think providing expanded health care options for people is an important function.”

Safeway embraced the new law, offering birth control service at all of its pharmacies for a $45 consultation fee. When asked how it was going, Wendy Gutshall, a Safeway spokesperson, wrote: “We’ve received positive feedback from our patients who take advantage of the service and the pharmacists providing the service. Patients appreciate dealing directly with the pharmacist and consulting with the pharmacist about the medication outside of the hours that most physician offices are open.”

Gutshall went on to say that Safeway supports the expanded role of pharmacists in health care, “as we are able.”

Rite Aid is piloting the service at 20 California locations for a $45 fee “to get a sense of customer interest,” said spokesperson Ashley Flower.

Walgreens is also giving the service the try at a “small number” of Bay Area stores, said Jim Graham, senior manager of media relations. “We appreciate the California law’s recognition of the valuable role that pharmacists can play as health care providers. We are continuing with a pilot offering of hormonal contraceptives at a small number of our stores in the state to gather key learnings and insights to help determine any future steps.” CVS, which also operates all Target pharmacies, is also piloting the service at 120 locations mostly in Southern California but at two San Francisco stores, for an annual fee of $29.

“As we measure the demand for this service and determine how to best integrate the process with our existing pharmacy workflow, we will to determine how and when to expand the service to additional pharmacies in California in 2018,” said Amy Lanctot, a senior public relations manager.

It took years for Senate Bill 493 to be written, enacted, and implemented. The survey shows there’s still work to do, Manchikanti Gomez said.

“I hope this really becomes a feasible option for women to be able to use these methods and continue using them more easily, without breaks in birth control use. To be able to just go straight to the pharmacy and get that renewal could help women use that method that they like.”

This report was originally published by our sister publication, Oakland Magazine.