Pharmacists Authorized to Prescribe Self-Administered Hormonal Contraceptives

Pharmacists Authorized to Prescribe Self-Administered Hormonal Contraceptives
Katherine Anderson, Pharm.D., Cash Wise Clinic Pharmacy / Affiliated Community Medical Center

Background: Pharmacists can prescribe contraceptives in the District of Columbia and 11 states. The 2020 Minnesota legislative session amended 151.37 to state that pharmacists have the authority to prescribe self-administered hormonal oral contraceptives (OC) for the intended use as contraception. This amendment went into effect August 1st, 2020. The Board of Pharmacy will establish a standardized protocol by January 1st, 2021. Pharmacists who choose to utilize these prescribing privileges must successfully complete a training program on OC and maintain continuing education requirements.  

Pharmacists are one of the most accessible healthcare providers. A study published in the Journal of Women's Health in 2016 followed 1385 women, 68% of whom have tried to get a OC, 29% of these women reported problems accessing an initial prescription or refills. Over 19 million women in America lack access to contraceptive methods. Worldwide there are at least 120 million couples in need of contraceptives, 80 million pregnancies are unintended and 45 million resulted in abortions.There is no guidance available regarding how to implement the new amendment into community-based pharmacies.

Evidence and discussion: A study completed in San Francisco, CA in April 2020 evaluated the number of community pharmacies that have effectively and efficiently prescribed OC. Only 11% of community pharmacies in California are prescribing OC due to barriers such as reimbursement, liability, time available and lack of knowledge. A cross-sectional study was conducted by calling 113 community pharmacies in San Francisco and asking a series of interview questions. The questions involved if pharmacies are prescribing OC, description of the prescribing process, pharmacists perception of the effectiveness, advantages, disadvantages and barriers, any recommendations and how COVID-19 has affected the demand for pharmacist prescribing.

CVS, Walgreens, Safeway, Costco and independent pharmacies were called and 21 out of 113 (19%) stated that they prescribed OC. 12 of those 21 agreed to complete the interview. Factors the pharmacies could control that gave success in prescribing OC in the pharmacies preception included a company protocol, advertising, and pharmacist engagement. Large corporations provided payment for training that the pharmacists were required to complete. Factors outside the control of the pharmacies that gave success were collaborations with local clinics or pharmacy location. Lack of time was a barrier identified, 8 of the 12 pharmacists stating if the process was streamlined it would improve workflow. Two of the 12 pharmacists suggested scheduling appointments. 9 of the 12 pharmacies interviewed did not have a private consultation room, which is a barrier. As part of the prescribing process, an accurate blood pressure reading is required. Lastly, some pharmacies saw an increase in need, however others saw a decrease in need due to COVID-19.

The study limitations included a small sample size and geographical location of only one city. Statistical significance was not tested due to sample size but the reports given by these 12 pharmacies can be a model on how to successfully implement prescribing OC in pharmacies.

Clinical Impact: This new legislation allows pharmacists the ability to intervene, with roughly 50% of all pregnancies being unintended. The study completed on the successful implementation of hormonal contraceptives prescribing in San Francisco community pharmacies gives Minnesota and other community pharmacies a model to implement pharmacists prescribing self-administered hormonal contraceptives. 

References: 

  1. Minnesota Board of Pharmacy. Summary of 2020 Legislation. https://mn.gov/boards/assets/2020_Minnesota_Legislation_Affecting_Pharmacy_tcm21-440503.pdf

  2. Grindlay K, Grossman D. Prescription birth control access among U.S. women at risk of unintended pregnancy. Journal of Women's Health. 2016;25(3):249-254. doi:10.1089/jwh.2015.5312

  3. Chen L, Lim J, Jeong A, Apollonio DE. Implementation of hormonal contraceptive furnishing in San Francisco community pharmacies. JAPhA. Published online July 21,2020. doi:10.1016/j.japh.2020.07.019