Q&A: Pharmacist Prescribed Contraception Can Mitigate Barriers to Care

In the United States, access to reproductive health care has continued to decrease over the past several years, leaving the 66 million women aged 15 to 44 in the country with far fewer options.¹ With an increasing provider shortage putting strain on the US health care system, pharmacists are well positioned to help provide reproductive care.

Q&A: How Pharmacist Prescribed Contraception Can Mitigate Barriers to Care / Towfiqu Barbhuiya - stock.adobe.com

In an effort to gauge support for pharmacist prescribed contraceptives, researchers from the University of Rhode Island conducted surveys among students, patients, pharmacists and clinicians.^2,3 The studies found that the majority of all survey respondents supported pharmacist prescribed hormonal contraceptives.

Drug topics sat down with 3 authors from the studies, Ginger Lemay, PharmD, clinical professor of Pharmacy Practice and Clinical Research and residency program director at the University of Rhode Island College of Pharmacy, Jeffrey Bratberg, PharmD, clinical professor of Pharmacy Practice and Clinical Research at the University of Rhode Island College of Pharmacy and academic collaborations officer at the Rhode Island Department of Health, and Audrey Whalen, PharmD, clinical pharmacist specialist at Rhode Island Hospital, to discuss common barriers patients face in accessing hormonal contraception and key challenges pharmacists face when prescribing them.

READ MORE: Majority of People Support Pharmacist Prescribed Hormonal Contraceptives

Drug Topics: What are the most common barriers patients face in accessing hormonal contraception, and how could pharmacist-prescribed contraception help address these challenges?

Audrey Whalen, PharmD: This was one of the biggest questions that we asked in our survey, and we had a lot of various barriers that were possible for these 4 cohorts of people. Ultimately, we nailed it down to the top 3 most common barriers for each of those 4 groups, and then looked overall and determined what was that main barrier. Across all 4 cohorts, the biggest barrier that we saw was having some sort of time constraint or delay in getting an appointment, causing difficulty obtaining a prescription. That was the biggest barrier that our participants voted for. Some of the other ones that we saw were along the same lines; not having refills, which could be kind of grouped into that same sort of delay in appointment. If you're having a delay in appointment, you're not getting a refill, and there you are without a prescription. Also, cost barriers, like copay and insurance, and not having a clinician, whether that be a primary care provider or a gynecologist.

How can pharmacists help address these barriers? We know right now that there's a significant provider shortage in the country. This is a space where pharmacists are trained and are able to step up and fill that role and help provide prescriptions for these drugs that patients need. I would say that having pharmacists step up and provide this service can help free up some of the time that doctors are searching for. Pharmacists are trained to do it, we have a lot of education in school about it and it's just something that we're able to do with our training, so why not put it to good use?

Ginger Lemay, PharmD: One thing Audrey and I were talking about when we were reflecting on the data and where we are now almost a year and a half after we did the study, is when we look at those four cohorts and the disparity between the barriers that they faced, you see the highest percent of barriers among the average patient. These are patients who came into a community pharmacy in the state of Rhode Island, and took the survey. When you look at clinicians, their barriers were far less. We know that we need to be supporting our patients as they're seeking care. Our clinicians and pharmacists, they're in the business, so to speak—they know how to access care—although they did face barriers, it wasn't as difficult for them to obtain hormonal contraception.

Jeffrey Bratberg, PharmD: I think I would add to build on what ginger said is that the pharmacy has to exist. Convenience is important to some in terms of barriers and facilitators, either being inconvenient as a barrier, or convenience as a facilitator. But if the pharmacy isn't there, there's pharmacy deserts or contraceptive deserts—those typically overlap. One of the biggest barriers for pharmacists is that they're not paid to provide that service. You can go to the pharmacy and get contraceptives. But we have a whole different set of issues with pharmacy benefit managers and other types of reimbursement for the product. These pharmacies will exist, only probably breaking even, by being able to be paid for the services that go along with the product. Not only for contraceptives, for all the other medications patients need, so the patients don't have to travel even farther just to get their medications.

Drug Topics: What are the key challenges pharmacists face when prescribing hormonal contraception?

Whalen: I think the biggest challenge by far is the reimbursement for the service. Pharmacists can be reimbursed for the physical drug that they're dispensing, but in order for pharmacists to carry out this service, we need to be reimbursed for it. It takes time. If we were to do this service, there's a whole protocol that we would go through. There's regulations that need to be written. There's steps that we need to go through, assessing the patient's medical history, their medication history, and looking at their chronic conditions and taking that all into consideration. Then choosing the best contraceptive that's best for them. That's what we're providing. If we're not able to be reimbursed for it, then it doesn't really put us in the best position to provide that service. We have limited time as pharmacists, and especially community pharmacists. If we're offering this, then we need to be reimbursed for our services. If we can't, then that's just going to create more out of pocket costs for the patient. At that point, it kind of negates the purpose of it, because we're trying to decrease costs and limit barriers. We don't want to do this if it's going to be making another barrier.

Bratberg: I think the other thing about reimbursement is that we are seeking reimbursement for all services. Reimbursement was something that we really fought hard to keep in this, we had to explain to the policymakers. Anyone who's hearing this and wants to advocate for this or other pharmacist services, you have to explain, yes, the pharmacist is getting a salary, but when your doctor is getting a salary at their office, they're also billing for their service that is paying for their salary. We're trying to shift billing for the services, not only contraceptives, but we're trying to pass payment for services, like I know Audrey's in collaborative practice agreements, so all the things that she does, she should be paid for equitably. Also, going beyond the ability to bill but to be able to confirm reimbursement.

There's lots of states that have and very recently passed these laws we introduced this last year, and so we reintroduced that in our Rhode Island legislature to try for anything that's in our scope of practice, because, as we learned with the contraceptive bill, to overcome the barrier of reimbursement, to make sure that this is a widespread, widely adopted service, we know that we had to have reimbursement, but we had to explain it to the legislators. We just don't want to fight that battle every single bill. We want to say we're going to get paid for scope of practice, and then expand scope. We know that those services will be provided because we're reimbursed for them.

Lemay: And freeing up the pharmacist. Obviously, most of these services will take place in a more traditional community pharmacy, and so being able to allow the pharmacist more time. These are the services that pharmacists want to be participating in. However, without the reimbursement, it's hard to say whether these services are sustainable, because we haven't had the opportunity to make them a reality. At this point, we are the number one destination for immunizations, medication therapy management and a variety of other services, point of care testing, test to treat, etc. However, this, along with pharmacist initiated tobacco cessation products and a variety of other disease states—PrEP and PEP—these are the future of community pharmacy. Until we have that ability to bill for those cognitive services, we can't gain traction to make them happen.

READ MORE: Women's Health Resource Center

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References

1. Population. Report. March of Dime. February 24, 2024. Accessed January 27, 2025. https://www.marchofdimes.org/peristats/data?reg=99&top=14&stop=125&slev=1&obj=3

2. Lemay V, Whalen A, Cohen L, et al. Assessing Student and Patient Perspectives on Pharmacist Prescribed Hormonal Contraceptives. J Am Pharm Assoc (2003). 2024 Oct 3:102259. doi: 10.1016/j.japh.2024.102259. Epub ahead of print. PMID: 39368549.

3. Whalen A, Bratberg J, Cohen L, et al. Assessing pharmacist and clinician perspectives on pharmacist-prescribed hormonal contraceptives. J Am Pharm Assoc (2003). 2024 Jan-Feb;64(1):314-320.e3. doi: 10.1016/j.japh.2023.11.013. Epub 2023 Nov 13. PMID: 37967721.