Q&A: Challenges, Opportunities in Pharmacist-Administered Contraception
Nicole Cieri-Hutcherson, PharmD, BCPS, MSCP, FCCP, clinical associate professor at University at Buffalo, discusses how pharmacists can implement an injectable contraception program.
A study in the Journal of the American Pharmacists Association recently explored pharmacist-administered injectable contraception, highlighting its potential to improve access, especially in rural areas.1 Pharmacists expressed confidence in providing the service but noted the need for additional training and resources, reimbursement issues, and regulatory challenges. Despite these obstacles, the study suggests that expanding pharmacists’ roles in contraceptive care could enhance patient convenience and accessibility.
Q&A: Challenges, Opportunities in Pharmacist-Administered Contraception / adragan - stock.adobe.com
Drug Topics® sat down with Nicole Cieri-Hutcherson, PharmD, BCPS, MSCP, FCCP, clinical associate professor at University at Buffalo and an author on the study, to discuss how community pharmacists can effectively implement an injectable contraception program into their practice, what kinds of barriers they should be aware of, and how the barriers can be addressed.
READ MORE: Q&A: Community Pharmacists Well-Positioned to Provide Injectable Contraception
Drug Topics: How can community pharmacists effectively implement an injectable contraception program into their practice?
Nicole Cieri-Hutcherson, PharmD, BCPS, MSCP, FCCP: The ability to implement the injectable contraceptive service in your practice really varies from state to state. If you can administer injectable contraception in your state underneath a broader mechanism, such as a standing order that would allow pharmacists to administer multiple different injection types, then this can really simply be added to that armamentarium of services that you provide. It's important that if you start to offer this service that you definitely want to advertise about the reproductive health services that you're offering in the pharmacy setting. That could include both physically in the store with signage or even on your website. This reduces reproductive health care stigma and advertises the broad range of reproductive services that could be obtained at the pharmacy setting.
The other option of delivery includes pharmacist provision, sometimes called pharmacist prescription of contraceptive forms. In 2016, some states began expanding contraceptive access through pharmacist prescription or provision contraceptive programs. The legislation varies from state to state. Some allow pharmacists simply to administer it and some allow pharmacists to prescribe a self-administered hormonal contraceptive. Typically, this usually only includes the contraceptive pill, the patch and the vaginal ring, although in some states, this also includes injectable contraception or subcutaneous injectable contraception for self-administration, although that is not FDA approved for that. The selected practice recommendations for contraceptive use state that subcutaneous injectable contraception should be made available as an additional approach to deliver injectable contraception regardless of that.
There's other state to state variations that allow pharmacists to either administer it but not prescribe it. Legislation can permit individuals to obtain contraceptive care regardless of age. In some states, there are age restrictions associated with that, so it really depends. Over recent years, the desirability for injectable contraception has definitely been increasing, especially with factors such as the COVID 19 pandemic, which increased demand for a long acting effective contraceptive without delays to obtaining it. With the inherent adherence advantages associated with this formulation, because it's administered every 11 to 13 weeks, that, coupled with long wait times for insurance coverage of other long acting effective contraceptives, such as IUDs, means that this might be the only option that a patient has in a timely manner to obtain injectable contraception.
Drug Topics: What kinds of barriers should pharmacists be aware of and how can these barriers be addressed?
Cieri-Hutcherson: As with anything, a lot of different barriers that can be identified. In our systematic review that the research team conducted, there were 6 major areas where pharmacists identified potential barriers that would need to be addressed in order for this to be successfully implemented. [There was] a need for more education and training. In some instances, this is tied to legislation in the state. To provide injectable contraceptive services, pharmacists have to take a certain amount of continuing education. Improved infrastructure was the second, so workflow, how would patients obtain that staffing comfort just with administering injectable contraception? Since it is something different, although they're trained in that technique, they might have never administered an injectable contraceptive before. This does expand the scope of practice a little bit, so some pharmacists expressed that they were less comfortable with that pressure. Sometimes language barriers with patients, if they're seeking contraceptive care and you aren't able to adequately counsel them about this new option. Also, securing reimbursement for both the product and the service.
These insights underscore a lot of ways that we can target strategies to address both the benefits and the challenges that pharmacists identified with successful implementation. That's what pharmacists might need to be aware of. But there's also a couple of patient perceived disadvantages about obtaining injectable contraceptives in the pharmacy setting, and they're also linked with the pharmacist identified barriers. So, cost of the service. How much is it going to cost compared to a clinic visit or a provider visit? Preference of different healthcare professionals might play a role. Pharmacy staff, knowledge about the service and competency and how. Ax well as more about accessibility at the pharmacy level. What are their hours, availability of appointments, those types of barriers. Most of the time, other health care professionals think that this is also a great option to increase access to injectable contraception. Sometimes a barrier that's brought up is a potential decrease in patient compliance with other health maintenance services. But most research does not support that patients aren't obtaining that health maintenance as often as they would have if they weren't receiving their injectable contraception at the pharmacy setting.
READ MORE: Women's Health Resource Center
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