Refusal to Fill Prescriptions Under Conscience Clauses

If a pharmacist is convinced that filling a prescription is not in the best interest of the patient, due to an allergy or contraindication, the pharmacist may be under a professional duty to refuse to fill, at least until he or she contacts the prescriber to resolve the question.

Similarly, if the pharmacist believes the prescription is illegal, the purported prescription is not legal and not a valid order. It may not be filled, at least until questions are resolved.

A more difficult question is raised if a pharmacist refuses to fill based upon his or her religious beliefs. In July 2002, a University of Wisconsin student requested a refill on her birth control prescription at her local pharmacy. The pharmacist on duty, Neil Noesen, RPh, refused to fill it, citing his religious beliefs. He also would not transfer the prescription or tell her where she could get it filled.

The student filed a complaint with the Wisconsin Board of Pharmacy. The board’s administrative law judge restricted Noesen’s license, finding that a pharmacist with a conscientious objection to dispensing a prescription must ensure there is an alternative mechanism for the patient to receive the medication, including informing the patient of their options to obtain their prescription.”

Noesen appealed the decision. The Court on appeal ruled, “Noesen had a right to refuse to provide birth control pills but not to refuse to transfer a valid prescription to another pharmacy.”¹

Related article: When valid prescriptions are refused

In 2012, the Washington State Pharmacy Quality Assurance Commission passed a regulation stating that all pharmacies “must stock and dispense emergency contraceptive drugs” regardless of religious or moral reasons. A federal court judge originally ruled the regulation violated the religious freedom of pharmacy owners, however a unanimous federal appeals court panel overruled this in 2015.² The Court of Appeals decision was appealed to the United States Supreme Court. The Supreme Court refused to hear the case, leaving the appeals panel’s ruling as the final decision on the case.

Reports of pharmacies refusing to fill prescription for birth control or provide emergency contraceptives have arisen in 26 states, according to the National Women’s Law Center. Regulations allowing pharmacists to refuse to fill are in effect in at least seven states, while a similar number require pharmacists to fill the prescriptions.³ Pharmacy law is primarily a product of state law and Board of Pharmacy rules.

The Atlantic published an article in January 2018 noting, “The Trump administration is making it easier for medical providers to object to procedures on religious grounds.” The author noted an HHS proposed rule that would require hospitals and doctor’s offices to post notices of protections against religious discrimination on their job applications and employee manuals, and it would allow HHS to enforce protections for religious medical providers.⁴

The article noted, “The initiative doesn’t change the law. Rather, it strongly signals a change in the focus of the department’s Office of Civil Rights, which is responsible for investigating civil-rights violations in healthcare contexts.”  The head of the Office of Civil Rights has stated he hopes to increase enforcement of laws that protect workers from being forced to violate their consciences, according to the article.⁴

Pharmacists must be familiar with their state regulations and new federal guidelines. 

References:

1. McLean MR. A pharmacist refuses to fill a prescription for birth control: An ethics case study. Podcast. Accessed on May 15, 2018.

2. Stormans Inc v Wiesman. Supreme Court of the United States. 579 U. S.  (2016). Accessed on May 15, 2018.

3. Pharmacy Refusals 101. National Women’s Law Center. Accessed on May 15, 2018.

4. Khazan  O:  When the religious doctor refuses to treat you.  Atlantic. Jan. 25, 2018. Accessed on May 15, 2018.