By Rachel Crumpler
A 31-year-old Asian-American woman hopped into an Uber with a mission to a New Bern pharmacy to pick up birth control pills.
Because of her family’s cultural and religious beliefs, she was not allowed to see a doctor alone or seek contraception.
But when pharmacists in North Carolina began to prescribe hormonal contraceptives, she had her first exposure to pregnancy prevention.
That day, pharmacist Anna Baird, who was working at Realo Drugs, a community pharmacy with 18 locations in eastern North Carolina, helped counsel a patient about contraceptive options and explained that she didn’t understand STDs and condoms. educated about the content. Communicate openly with her family and health care providers.
The patient came out of the pharmacy with contraceptives. For Baird, who recently spoke about it in an interview with North Carolina Health News, it was a rare opportunity to reach out to patients.
“She’s my ‘why,'” Baird said, telling the story to other pharmacists. “We need to be able to provide care to unsupported people.”
Under House Bill 96, a new law that went into effect on February 1, 2022, North Carolina pharmacists are required to provide hormonal contraceptives (pills or patches) to people 18 and younger who have a parent. have become available. or legal guardian consent.
Baird was one of the first pharmacists to offer this service in the state.
“If you think of access to reproductive health as a pie, we are just another slice of that pie,” said Molly Scott, regional associate dean at UNC Eschelman College of Medicine. Hormonal contraception is practiced statewide. She said there are many ways people get care, including family physicians, obstetricians and gynecologists, and county health departments. “It’s another door that we want to open.”
According to the Guttmacher Institute, 28 states and the District of Columbia allow pharmacists to provide contraceptive care, but the legal language governing this practice varies from state to state.
Scott said that as of March, 564 North Carolina pharmacists had completed the required training and were approved as pharmacists by the state pharmacy board. About 47 pharmacies offer the service.
As access to post-Roe reproductive health care changes dramatically, Scott said pharmacists have entered a new realm of offering hormonal contraceptives, and he expects their numbers to grow in the coming years. .
That’s why on August 11, dozens of stakeholders, including pharmacists, state health officials, and physicians, gathered at the Contraceptive Summit in Chapel Hill to discuss ways to improve pharmacist participation in the provision of hormonal contraceptives statewide. We talked.
Fighting the contraceptive desert
With restrictions on abortion tightening, contraception has become a more important topic for many women.
“As the reproductive health landscape evolves, it is more important than ever to ensure that people are in control of their reproductive health and have access to the full spectrum of reproductive life planning,” said State Health Director Betsy. Tilson said in his speech. summit.
More than a quarter of American pregnancies in 2020 were unwanted, according to America’s Health Rankings. Ninety-five percent of unwanted pregnancies occur in women who do not use contraception or whose contraceptive methods are inconsistent or incorrect.
In North Carolina, 637,960 low-income women live in areas classified as “contraceptive deserts,” according to data from Power to Disside, a national pregnancy prevention advocacy group. A contraceptive desert is a county or area lacking reasonable access to a health center that offers any type of contraceptive method.
Additionally, one of the state’s top health officials, Tilson, said accessing the health care system can be difficult, even for those with the resources.
“Even I tried to access my daughter’s health care system for contraceptive care, but there was one wall after another,” Tilson said.
Pharmacies now serve as additional points of access for hormonal contraceptives. Scott said this puts pharmacists in a position to help combat access issues and the contraceptive desert at a critical time.
“One of the things that I really like about this model is whether you can see a doctor today, or, especially if you live in a small rural community, how much you can afford to see a doctor. It means that sometimes you have to drive a long way.Everyone lives near a pharmacy,” Scott said.
Nearly 90 percent of the U.S. population lives within eight miles of a local pharmacy, according to a 2022 study. Research shows that people may choose to buy contraceptives at a pharmacy because it’s nearby, has extended hours, and doesn’t require an appointment.
“Empowering pharmacists and pharmacies as part of the care team and providing the resources to reduce barriers to care is absolutely incredible,” said Tilson, celebrating the policy progress. Ta.
I need a payment method
North Carolina is still in the early stages of introducing pharmacist-prescription contraceptives, working toward its original goal of having at least one pharmacist in every 100 counties in the state provide this service.
Baird, a New Bern pharmacist who was trained at Realo Drugs, jumped at the opportunity to implement the service, but many pharmacists have been slow to act.
North Carolina has approximately 12,000 pharmacists, of whom 4,723 work in the community. So far, as of March, about a year after the law took effect, 1,785 pharmacists have registered for the training required to prescribe hormonal contraceptives.
The North Carolina State Pharmacy Commission is paying the first 6,000 pharmacists to enroll for five hours of hormonal contraceptive training to promote the use of this service.
Scott said the biggest barrier preventing pharmacists from prescribing hormonal contraceptives is the lack of regular reimbursement for services other than drug dispensing, such as time spent in counseling.
“We need to establish a sustainable reimbursement model because at the moment we have models that pay for products but not for services,” Scott said. “Pharmacists told us they needed help creating this new service within their community pharmacies.”
Baird said that when Realo Drugs offers this service, pharmacists charge a $40 consultation fee, the same as the doctor’s out-of-pocket expense. She wants the reimbursement model to change so that the $40 fee is covered by insurance rather than the consumer. Until then, the $40 fee may deter some from going to pharmacies for this service.
Baird said Realo Drugs has been providing hormonal contraceptives to about two patients a month since the service launched last July. He said most patients seeking the service are between the ages of 18 and 22 and will be sterilized for the first time. Some people seek a pharmacist to continue their current birth control method in a more convenient way.
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“Convenience is really the biggest factor for patients,” Baird said. “We can meet online and then they come in to finish the appointment with a blood pressure check. Usually he arrives within 30 minutes.”
Baird expects demand for the service to grow as more people become aware of its existence. But even just helping two people a month shows there’s a gap for pharmacists to address, she said.
Results from Oregon, the first state to introduce pharmacist-prescribed contraceptives in 2016
- Research shows that two years after the policy was implemented, it prevented more than 50 unwanted pregnancies and saved the state approximately $1.6 million in public costs, including medical costs associated with poor maternal and child outcomes, according to the study. is shown.
- Among Oregon Medicaid enrollees in the first two years of the program, 10% of new oral and transdermal contraceptive prescriptions were written by pharmacists.
- The observed safety profile for pharmacists was comparable to clinicians prescribing contraceptives.
Ashley Leggett, a pharmacist who provides contraceptive services at McDowell Pharmacy in Neck, Scotland, feels confident about introducing new services with a hormonal contraceptive toolkit from the North Carolina Pharmacists Association. said.
Now, she plans to open her own pharmacy in Martin County in September and bring the service to Martin County. She expects her pharmacy to become a particularly important access point for the community, following the recent closure of the county hospital and women’s health center.
“My presence in the community will probably push this effort a little further because their access to medical care, and reproductive health in general, is very limited,” Leggett said. said at the summit.
Pharmacists still expect other facilities to remain the main prescribers of contraceptives, but they are working to equip themselves to fill the gap.
“This is how we become part of the larger reproductive health community to increase access, reduce unwanted pregnancies and ultimately reduce maternal mortality,” Scott said. .
Over-the-counter contraceptives to arrive in 2024
- On July 13, 2023, the U.S. Food and Drug Administration approved Opill, the first commercially available daily oral contraceptive to be approved for use in the United States.
- Opil is expected to be available without a prescription in drugstores, convenience stores and grocery stores as well as online in early 2024.
- Details such as cost have not yet been announced.