HEALTH POLITICS--Within the next few months, SB-493, a California law passed in 2013, will go into effect across the state, allowing the state’s licensed pharmacists to prescribe birth control pills and other hormonal contraception directly to patients without a doctor visit.
While access to birth control through the Affordable Care Act has been a heated topic, pharmacist-prescribed birth control seems to be less controversial, except for some resistance from the Congress of Obstetricians and Gynecologists -- but not for the reasons you might suspect.
The ACOG supports over-the-counter hormonal birth control. “My basic tenet is there should be nobody between the patient and the pill,” says Dr. Mark DeFrancesco, president of the organization. “I’m afraid we’re going to create a new model that becomes a barrier between that and over-the-counter. I worry that it’s going to derail the over-the-counter movement.”
Certainly, there’s a pressing need to provide easier access to birth control; statistics cited in the New York Times and other sources indicate the rate of unplanned pregnancies in the U.S. and Canada is higher than the rate in most European countries.
An ill-timed pregnancy can present lifetime economic and educational consequences. According to the Centers for Disease Prevention and Control, the live birth rate for teens aged 15-19 is substantially higher in the U.S. than in other western industrialized countries. Though teen pregnancy rates have been dropping, just five years ago, teen pregnancies cost U.S. taxpayers at least $9.4 million, including increased health care and foster care, increased incarceration among teen parents, and lost tax revenue due to lack of educational attainment and income.
Only fifty percent of teenaged mothers go on to earn a high school diploma by 19 years old, compared to ninety percent of women who did not give birth during their teen years. The long-term impact on earnings remains, even after adjusting for poverty, high school dropout rate of the teen’s parents and poor school performance.
Regardless of a woman’s age, an unplanned pregnancy can result in economic, professional, and other challenges. Easing the path to effective birth control seems prudent, but what about prescription by pharmacist as compared to the over-the-counter option?
All licensed pharmacists in California hold a doctorate degree, which confers expert knowledge of prescription medications as well as the ability to counsel patients on the proper use of drugs. Pharmacists will undergo additional training before being able to prescribe hormonal birth control.
The FDA “OTC Switch List” includes a number of previously prescribed medications that are now available over-the-counter, most of which treat allergy or acid reflux/heartburn symptoms. However, many of these OTC variations are in lower dosages than their prescribed counterparts and the labels still advise consulting a physician.
Warning labels are not a substitute for medical advice and pharmacists are often the first line of defense against potential drug interactions. Hormonal birth control pills become less effective when taken with antibiotics and some other medications, or even some herbal supplements. Purchasing birth control pills or rings without any professional oversight seems to be a risky proposition.
Women with certain medical conditions, including high blood pressure and certain cancers, or behaviors such as smoking, are advised against using hormonal contraception. In order to receive a prescription from the pharmacist, the patient must first complete a questionnaire about her health and medical history in order for the pharmacist to be authorized. This step would not be required with OTC hormonal birth control.
In addition, pharmacist-prescribed contraceptives will be covered by insurance, unlike OTC medications -- a slippery loophole that provides a free pass to insurers. The Affordable Care Act does not require plans to cover OTC medication so a switch would likely hit women in the pocketbook, costing hundreds per year instead of obtaining the pill or ring for free with a prescription.
A bill introduced in Congress last May by Republican senators would fast-track the process by which contraceptive manufacturers apply to the FDA for OTC approval. House Democrats responded with a bill of their own that would stipulate coverage of OTC contraceptives, should the Republican-sponsored bill pass.
CA Senate Bill 493 and a similar bill in Oregon are extensions of collaborative practice laws in most states that allow pharmacists to administer vaccines like flu shots or to prescribe certain medications. One issue at stake is how insurers will handle charges for pharmacists to review questionnaires or to evaluate options, as well as blood-pressure screening usually required for estrogen-containing medications.
Allowing trained and licensed pharmacists to prescribe birth control pills and rings after evaluating health and medical history seems to be an effective way to ease access to women who might not otherwise see a physician.
Placing hormonal medications on the shelves in the “family planning” aisle of your local CVS or Rite-Aid seems to be a costly and risky measure.
(Beth Cone Kramer is a Los Angeles-based writer and CityWatch contributor.) Prepped for CityWatch by Linda Abrams.
-cw
CityWatch
Vol 13 Issue 96
Pub: Nov 26, 2015
