Oregon Law for Pharmacy Prescription of Birth Control: What it Does & Does Not Do for Consumers
While pharmacist-prescribed birth control seems straightforward, it’s important to understand the nuances of this policy and how it fits into the landscape of reproductive health access in Oregon. As this bill is rolled-out, it is imperative that Oregonians know what this new policy does, and does not, do, including considering background context and the implementation process.
Passed in 2015, HB 2879[1] permits Oregon-licensed pharmacists to prescribe hormonal contraceptive patches and self-administered oral hormonal contraceptives (i.e. the pill). In 2017, the Legislature passed HB 2527, which expands on the previous bill and permits pharmacists to prescribe additional forms of contraception: injectable hormonal contraceptives (i.e. DEPO) and a broader term of ‘self-administered hormonal contraceptives’.
Some additional provisions in these laws are key to how it has been implemented across the State. It is voluntary for pharmacists to opt-in to provide this service; they must complete a required $250 online training developed in collaboration with the Oregon Health Authority and the Oregon Board of Pharmacy in order to write prescriptions. Some rules for how pharmacists’ can provide this service were also included:
- Requiring an appointment is prohibited, so ‘walk-in’ consultations should be available when a trained pharmacist is onsite.
- After the initial prescription, they cannot renew the prescription for a patient who does not have evidence of a clinical visit within the three years following.
- An age limit was set for this service; people who are under 18 years of age can only receive pharmacist-prescribed contraception if they have evidence of a previous prescription for a contraceptive method from a primary care practitioner or women’s health care practitioner. To note, this age restriction does not align with any other precedent for age when accessing contraception: emergency contraception is over-the-counter with no age restrictions and Oregon is one of 21 states, and the District of Columbia, which explicitly allow minors to consent to contraceptive services.[2]
Because a prescription is being written (i.e. it is not over-the-counter), there are a few steps that need to be completed between the patient and the pharmacist, such as filling out a health history form, having blood pressure checked, and counseling to determine which method is the right choice, with instructions for use. These consultations take time; therefore, pharmacies are charging an out-of-pocket fee, ranging from $40-$60. Even people who have health care coverage are required to pay. Although HB 2527 attempted to address the out-of-pocket cost, the implementation of this has not been delivered and it is not under the purview of OHA or DCBS to regulate. The Affordable Care Act, and now Oregon law HB 3391, require private health plans to cover the cost of all FDA-approved contraceptive methods, with no cost-sharing to the consumer. Although a stop into the pharmacy might be more convenient or accessible than the local health
In January 2018, NARAL Pro-Choice Oregon Foundation coordinated volunteers to gather more data about the information consumers received when they called about obtaining a prescription directly from the pharmacist for contraception. Calls were made to randomly selected pharmacies in five counties (Deschutes, Jefferson, Crook, Lane, Jackson). Callers started the conversation with “I have some questions about getting my birth control with you. Is there someone I can talk with?” and then went on to ask follow-up questions. Fifty complete calls were made to twenty-seven unique pharmacy stores (multiple sites within chain pharmacies were contacted).
Of the fifty pharmacies called, the majority of pharmacists (70%) in the five-county area were not able to directly prescribe contraception for consumers. The most common reason for not being able to write a prescription was lack of training or no trained pharmacist on site (64.5%). More contraceptive options, including the Ring and the Shot (injectable/depo), are being offered on-site by those pharmacists that are participating. Although some large chain stores are participating, there are also some that are not and it varies by location, and independent pharmacies are more likely to not offer this service. Consumers are being charged an out-of-pocket cost for the required consultation. Many of the pharmacists were able to recommend a local health center or other pharmacy where the caller could receive the care.
With an ever-evolving landscape of rules and regulations on contraception, it is essential for consumers and health care providers to stay up-to-date on laws and coverage policies to maintain exemplary access for women. Pharmacies are a critical point of information and education for women seeking medication, and pharmacists can make the difference in ensuring women have access to their preferred contraception in a timely, affordable way.
Comprehensive research should be conducted to understand how incorporating pharmacy prescriptive authority for contraception impacts the overall reproductive health outcomes in the state. Future research to determine the effects would include learning information not only on consumer demographics of who are opting to use this service (income, race/ethnicity, age, insurance status) and total number of participation across the state, but also information on geographic proximity to health centers, consumer satisfaction/experience, and an analysis of rates of contraception uptake in total population.
Recently, Representative Knute Buehler tried to connect the decreasing abortion rate in Oregon with a pharmacists’ ability to now prescribe contraception on his campaign trail, which is not an accurate reflection on the impact of this new policy. While pharmacists play a key role in reproductive healthcare, it is misleading to connect this law with declining abortion rates without meaningful research and within the short time frame of implementation. In fact, the abortion rate has been on the steady decline since 2000, 15 years prior to the passage of this bill. There was a 15% decline in the abortion rate in Oregon between 2011 and 2014 [3], a time when the Affordable Care Act (ACA) was supporting no-cost coverage of contraception, before Buehler was even in elected office in Oregon.
In 2015, there were efforts made nationally by Republicans to not only repeal the Affordable Care Act, but also offering up legislation that would skirt comprehensive reproductive health coverage including no-cost contraception, such as over-the-counter birth control and pharmacy prescriptions. Particular pieces of Oregon’s pharmacy access bill tell us that Rep. Buehler was falling in-line with these national efforts as he is now holding it up as action he took for women’s health.
[1] Full text of HB 2871 and HB 2527 can be found at www.prochoiceoregon.org/issues/birth-control-access-pharmacies/
[2]https://www.guttmacher.org/state-policy/explore/minors-access-contraceptive-services
[3] https://www.guttmacher.org/fact-sheet/state-facts-about-abortion-oregon
