Pharmacist Personal Beliefs in the News Again

A visit to a pharmacy in 2016 in Albuquerque, NM, left one woman saying she felt humiliated and frustrated because the pharmacist refused to fill her daughter’s prescription based on his personal beliefs. The American Civil Liberties Union (ACLU) filed discrimination complaints on her behalf, and the case made national news.

The woman’s teenaged daughter had difficult menstrual cycles. The teenager’s gynecologist recommended an intrauterine device, and prescribed medications for pain and anxiety, and misoprostol to soften her cervix in preparation for insertion of an intrauterine device. After filling prescriptions for the pain and anxiety medications, the Walgreens pharmacist told the woman to fill her daughter’s misoprostol prescription at another pharmacy, even though his store stocked it. When she asked why he declined to fill the prescription, the pharmacist cited “personal beliefs,” and said he had “some idea” why it might be used. Although misoprostol can be used to induce an abortion, it is also prescribed for nonreproductive health problems such as prevention of ulcers.

The woman complained to Walgreens officials and then contacted the Southern Women’s Law Center, which connected her with the ACLU of New Mexico. On June 3, 2017, the ACLU filed complaints against the pharmacy chain, noting the New Mexico Human Rights Act, which bars discrimination based on sex. The complaint stated that “refusing to fill prescriptions that are directly tied to the attributes that make women different from men-i.e. the ability to become pregnant-constitutes sex discrimination.”

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“The ACLU is deeply committed to ensuring that businesses do not discriminate against customers,” said Erin Armstrong, a reproductive rights attorney with ACLU of New Mexico, told Drug Topics. “Pharmacies are no exception. They are subject to New Mexico law that prohibits discrimination against women who seek reproductive-health medication. Open for business means open for everyone.”

The New Mexico incident is the latest in a series of reported cases in which pharmacists refused to fill prescriptions because of religious or moral beliefs. Many pharmacy chains now have policies to address this issue.

Walgreens already had a policy in place, prompted by a 2013 incident in which a pharmacist refused to fill a birth control prescription. The company’s guidelines ask pharmacists to refer a prescription they find objectionable to another employee or a manager on duty, which the pharmacist in the New Mexico incident did not do. Walgreens is currently working with the ACLU to prevent future incidents, which includes retraining pharmacists and store leadership about acceptable options.

“The policy’s objective is to ensure that in these rare instances, patients-both male and female -are offered reasonable alternatives to access legally prescribed medications,” said Phil Caruso, a Walgreens spokesperson.

Up next: What should be done? 

While policies that balance a pharmacist’s religious rights and a woman’s right to access are good, they need to be explained and enforced, said Mara Gandal-Powers, JD, Counsel for Health and Reproductive Rights at the National Women’s Law Center (NWLC). “They need to make sure the pharmacist knows about them, and that they need to refer to another pharmacist. They need to make sure the pharmacist can do that so women don’t end up like this woman did-in her car, frustrated at having to go to other pharmacies,” she told Drug Topics.

According to the NLWC, cases of pharmacists refusing to fill prescriptions were reported in 25 states between 2004 and 2012, but the organization does not have more recent data. At least eight states have laws making it illegal for a pharmacist to refuse to fill prescriptions, while six states have laws that allow pharmacists to object. Objecting, however, does not mean a woman should have to travel far or wait an unnecessary amount of time to fill a time-sensitive prescription, said Gandal-Powers.

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APhA supports a balanced approach that recognizes both the individual pharmacist’s right to exercise conscientious refusal, but at the same time ensures a patient’s access to legally prescribed therapy.

According to an APhA policy statement, “When this policy is implemented correctly, and proactively, it is seamless to the patient, and the patient is not aware that the pharmacist is stepping away from the situation.” The policy does not support “lecturing a patient or taking any action to obstruct patient access to clinically appropriate legally prescribed therapy.”

Drug Topics reached out to Planned Parenthood and the Guttmacher Institute for this article, but they declined to comment.