Should pharmacists prescribe birth control?
In its recent segment on Oregon’s new law allowing pharmacists to prescribe and dispense contraceptives, Good Morning America portrayed pharmacists as ill-equipped to fill this need without input from a physician, notably an OB/GYN.1 During the segment, medical contributor Dr. Jennifer Ashton contended that pharmacists do not have the training or expertise to care for patients using contraceptives.
Said Ashton, “Last night I spoke to the president of ACOG [American Congress of Obstetricians and Gynecologists], and they are all for more access to contraception for women, but they do not think the pharmacist is the right person there, because it in fact puts another person, another barrier in between women and the birth control.1”
Is that statement scientifically supported? Might it be revenue-driven? We see a clear conflict in this criticism of the value and expertise of pharmacist clinicians.
When Good Morning America co-anchor Robin Roberts asked Dr. Ashton, “Should pharmacists be the best person to handle this situation?” Ashton’s response was “This comes down to risk vs. benefits, and low risk does not mean no risk. The pill does have a slightly increased risk for blood clots; it in fact has an 8% failure rate in preventing pregnancy with typical use, and to state the obvious, a pharmacist is not a physician.”1
Later, Dr. Ashton tweeted, “But 2 think that ocps [oral contraceptive pills] don’t have significant medical issues attached & that PharmD can manage that is laughable.”
First things first
Let’s start by correcting the segment’s title: “Over-the-Counter Birth Control Available in Oregon, California to Follow,” with its suggestion that contraceptives will be available over the counter (OTC) in pharmacies.1
OTC medications are available without a prescription, and patients can purchase them without medical evaluation. In Oregon and California, contraceptives will be prescribed by a pharmacist and dispensed only after a health screening is completed. This is not synonymous with OTC, and clearly birth control pills will not be available like cough drops or antacids.
According to Oregon’s House Bill 2879 Section 2(B), it will be necessary to “[p]rovide a self-screening risk assessment tool that the patient must use prior to the pharmacist’s prescribing the hormonal contraceptive patch or self-administered oral hormonal contraceptive.”
The real problem: Access to care
• It is estimated that within the next 10 years, there will be a 27% shortage of primary care providers (PCPs) in the United States, approximately 90,000 less than the U.S. health system requires.3
• At present, the United States has 300,000 pharmacists, and the number continues to increase.4
• More than two-thirds of Californians live in areas with shortages of healthcare providers, according to Senator Ed Hernandez, an optometrist, who is sponsor of the birth-control-pill bill.5
• A study published in year 2011 states that in 2006, 49% of pregnancies were unintended — a slight increase from 48% in 2001. Among women aged 19 years and younger, more than four out of five pregnancies were unintended.6
According to ACOG, access and cost issues are common reasons why women do not use contraceptives.