As their ever-growing role in healthcare causes pharmacists to concentrate more on medication management and patient consulting, some are specializing in healthcare issues and needs specific to women.

In 2006, the Food and Drug Administration (FDA) made Plan B, an emergency contraceptive used to prevent pregnancy after intercourse, available over the counter to consumers 18 and older, and in April 2009 a subsequent bill decreased that age to 17. These decisions have spurred some pharmacists to learn more about women's health.

Impetus for an expanded role for pharmacists also stems from the medication therapy management (MTM) mandate in Medicare Part D and from initiatives by employers such as the City of Asheville, North Carolina, and Pitney Bowes; both entities have put pharmacists front and center in successful value-based benefit designs that combine lower drug copayments with pharmacist-directed disease management.

"Pharmacists are becoming interested in providing and advocating for more direct services to women, but don't feel they have sufficient skills or are empowered enough," said Sharon Cohen Landau, director of Pharmacy Access Partnership.

Kathy Besinque, associate professor of clinical pharmacy, University of Southern California School of Pharmacy in Los Angeles, and a Partnership mentor, believes that emergency contraception has opened the door for pharmacists to become more involved in women's issues, including menopause management, osteoporosis, hormone therapy, and use of contraceptives. Her curriculum includes an elective course on women's health.

"Unfortunately, the media have created the perception that many pharmacists are not interested in involving themselves in women's issues, which is just not true," she said, adding that pharmacists are not always reimbursed for these extra services.

Adding responsibility

Don Downing, another program mentor and clinical professor, University of Washington School of Pharmacy in Seattle, considers the pharmacy to be a convenient and safe place to provide public health services, including "urgent prevention."

Licensed Washington pharmacists, who have collaborative agreements with physicians granting them authority, are allowed to prescribe emergency contraception to improve access and are reimbursed for the medication and for an office visit.

On the basis of more than 600 collaborative contracts with providers, pharmacists in Washington State also can prescribe medroxyprogesterone (Provera, Pfizer), a derivative of progesterone; conduct screenings for gonorrhea and chlamydia; and prescribe a variety of medications.

Downing, who was instrumental in starting the first community pharmacist-administered immunization-services program, believes that offering vaccines has given pharmacists more credibility in other areas of healthcare. "They are not just pill vendors, but also caregivers who take personal responsibility for patient outcomes," he says. "We don't diagnose conditions, but we do assess them."

A haven for youth

Liseli Mulala-Simpson, who serves as pharmacy manager for a San Francisco-based Walgreens, is the professional at her retail store behind the creation of a pharmacy program that trains pharmacists to develop and deliver youth-friendly pharmacy services and provide information to youths about reproductive health. "We are sensitive to the needs of teenagers and young women who might otherwise be embarrassed to talk to their primary-care doctors about sexual health," she said. "We provide more access, more affordable medications, convenience, privacy, and confidentiality."

She and her fellow pharmacists can prescribe emergency contraceptives; provide Gardasil, the human papillomavirus vaccine, after customers sign a release form; and conduct consultations on all types of medications by phone or in person, as they have been doing since 1993. The store, however, is compensated for offering consultations only by the San Francisco Health Plan, which caters to low-income residents.

MARI EDLIN is a freelance writer based in Mill Valley, California.