Hormonal Contraceptive Prescribing Benefits Patients, Pharmacies | NCPA 2024
With nearly 7 million women living in a health care desert, pharmacists can provide crucial reproductive care services.
According to the CDC, 35.7% of pregnancies in the US are unintended, costing taxpayers an estimated $11 billion annually. With millions of women living in health care deserts—lacking access to primary care providers and OB/GYN services—pharmacists can step in and fill that gap.
With nearly 7 million women living in a health care desert, pharmacists can provide crucial reproductive care services. | Image credit: Pixel-Shot - stock.adobe.com
Arkansas, where Brittany Sanders, PharmD, works, ranks first in the country in teen pregnancy. “We are third in infant mortality, and fourth in maternal mortality,” Sanders said. “These aren’t just statistics. These are real women—real people—who live in Arkansas who can benefit from our services.”
At the National Community Pharmacists Association (NCPA) 2024 Annual Meeting and Expo, held October 26-29 in Columbus, Ohio, Sanders, owner of The Pharmacy at Wellington in Little Rock, Arkansas, led a session on incorporating hormonal contraceptive prescribing in pharmacy workflows.1
“We have a chance to really impact these people’s lives,” Sanders said.
Across the US, just over half of the states allow pharmacists to prescribe birth control, said Sanders. Twenty-three states have active legislation allowing pharmacist prescriptions; 6 states have collaborative practice agreements that allow pharmacists to prescribe under the guidance of another health care provider, and another 6 states have legislation pending. “We’re gaining momentum,” Sanders said. “This is not just a 1-state or 2-state program anymore; this is gaining traction across the US.”
Even in the states where pharmacist prescribing is allowed, the specific products that pharmacists can prescribe differ. Some states allow pharmacists to prescribe the patch or ring, while others allow the injection. There are also state-level age restrictions to contend with. “Arkansas is 18 [and older],” Sanders explained. “There are 11 [or so] states that are similar to that.”
Advocate for Access
Pharmacists who live in a state where they are not yet permitted to prescribe hormonal contraceptives can follow these 4 steps outlined by Sanders to get started:
Draft model legislation. “If you want to get something like this started in your state, you can draft model legislation that looks like a copy of your neighboring state’s protocol,” Sanders said. Not sure where to start? Find a pharmacist in a neighboring state and pick their brain.
Find a supportive sponsor. “Find a sponsor in the legislature who is willing to be your champion,” Sanders said. “Do you have a pharmacist in your legislature? Do you have a physician who’s friendly to pharmacy in your legislature? Is there someone who’s been impacted by a teen pregnancy, or the death of a loved one, who would be very passionate about this program?” There’s no need to go at it alone, either: connecting with other pharmacists in the state may uncover supportive connections.
Engage with community pharmacists. Engaging with fellow pharmacists can help double down on demonstrating the need for pharmacist contraceptive prescribing. Approximately 7 million women live in maternal health deserts with limited to no obstetric care; these are areas where pharmacists can step up.
Meet with state legislators. “Change begins at the state level,” Sanders explained. By meeting with state legislators, fellow pharmacists, and advocacy groups, pharmacists can help move potential legislation across the finish line.
“State advocacy is incredibly important,” Sanders said. “Get involved and be active in your state association; make connections with legislators. Talk to them, let them know what you’re seeing in the field. Let them know how your patients are suffering with a lack of access to care.”
READ MORE: Opill Marks a New Era for Birth Control Access
Getting Started
Once legislation is passed, “the first thing to do is look internally and assess what barriers you may have,” Sanders said. “Are you comfortable talking about this? Are you comfortable initiating the conversation? Are you comfortable talking about the different types of birth control that are available, and why you would choose one over another?”
The pharmacy environment should be assessed as well: Is it approachable? Is it a comfortable conversation for that young woman? “Is the only way for a patient to make an appointment to call the person who doubles as their Sunday School teacher?” Sanders asked. Consider setting up an online tool to book appointments and ensure that the pharmacy has a separate room in which these conversations can be had.
Involving the whole pharmacy team is another crucial part of success. “Helping [your team] understand what services you can provide and helping them understand what your goals are and what kind of patients to look out for, can go a long way to making these programs successful,” Sanders added.
Establishing a Workflow
The legislation has passed, the pharmacy team is on board… What’s next?
“It really doesn’t take a lot of supplies to get set up,” Sanders said. A few clipboards, a binder with copies of the state protocols and relevant paperwork, and space with a few chairs to sit down and have the conversation, and an automated or manual blood pressure cuff. “If the state requires a negative pregnancy test, you’ll need that—and make sure that’s added to your CLIA [Clinical Laboratory Improvement Amendment] waiver.”
In Sanders’ experience, an appointment-based model has been most effective. “We’re not going to turn away a walk-in patient if we have the time or ability to help them,” she explained “But we have the most success with appointment-based models.” At her pharmacy, patients can either call or use the online scheduler to make an appointment, allowing the pharmacists to prepare in advance. “We have found that is the biggest piece of this being a successful program: taking the least amount of time away from the pharmacist being at the bench.”
Preparation also eliminates the scramble when the patient shows up. “You can seamlessly check them in, make sure they’re ready to go, and collect payment,” Sanders added.
Sanders highlighted some other workflow considerations as well.
“If the patient has to be referred [to another health care provider, such as an OB/GYN], you can still have a conversation about other birth control options,” Sanders said. “If you cannot provide birth control, you can still talk to them about condoms [or other OTC] methods that they can use in the interim.”
Pharmacists can also discuss human papillomavirus (HPV) vaccination with these patients. “If they haven’t seen a women’s health provider,” Sanders said, see if the patient has been offered an HPV vaccine. Also take the opportunity to ask if the patient is a smoker and provide nicotine cessation services if applicable. “And remember, even if you cannot prescribe that day, it’s still a billable service,” Sanders said. “You’re still billing for the time that you spent with the patient, even if you cannot prescribe the prescription.”
Getting the Word Out
Like any other pharmacy service, pharmacist prescribed hormonal contraceptive services need to be advertised.
“What we found effective was to do a soft launch,” Sanders said. This involved identifying easy patients—those who, for example, had been patients at the pharmacy for years. “Start there,” she said. “Once you’re comfortable—once you’ve done 6 or 12 of these—then you can send an email.”
In that email, let your patients know this is a service the pharmacy offers. After that, Sanders said, make sure the pharmacy’s social media platforms and website are updated as well. “We’ve got a poster in the pharmacy…that says, ‘Talk to your pharmacist about birth control,’” Sanders said. “Once patients realize you can do this, it organically takes off.”
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