THE PHARMACIST-PRESCRIBED SOLUTION TO A HORMONAL CONTRACEPTION PROBLEM

BY THOMAS BURNS, Pharm.D., PGY1

Apharmacist’s ability to provide efficient and effective clinical services continues to solidify their role as a member of the healthcare team. Moreover, the continued expansion of clinical services in the community pharmacy space has many asking what is next. At least 20 states have already answered that question by adopting legislation allowing pharmacistprescribed hormonal contraception.(1) With approximately half of all pregnancies in the United States being unplanned, the need for expanded access to hormonal contraception is a problem that pharmacists can offer a solution to.(2)

It is estimated that 1 in 4 women in the U.S. have trouble with access to hormonal contraception.(3) However, in a survey of U.S. women ages 18 to 44, 41 percent stated they would begin using a contraceptive if available through a pharmacy. Among women already using contraception, 66 percent said they would like to receive a prescription from a pharmacy.(4) With community pharmacies readily accessible and already integrating clinical services (for example, pharmacybased immunizations) into their current workflow, hormonal contraception prescribing presents an enormous opportunity to increase healthcare access for many.(5-7) Further supporting this need, early adopter states that have extended prescriptive authority to pharmacists have also shown the adoption of pharmacist reimbursement mechanisms, strong patient satisfaction and support from physicians.(5-7) Better yet, it has been demonstrated that pharmacists can prescribe and dispense hormonal contraception in a timely manner with no increase in error when compared to other clinicians.8

The training and workflow process in community pharmacies is similar to other clinical services provided. Summarizing from excellent continuing education sessions at the 2023 Michigan Pharmacists Association (MPA) Annual Convention and Exposition, the following have been discussed when pharmacist-prescribed hormonal contraception has been implemented:

Location

• A private, quiet pharmacy space compatible with Health Insurance Portability and Accountability Act (HIPAA) requirements is preferred.

Training and education

• Consider using existing clinical training resources from local or national sources, Accreditation Council for Pharmacy Education (ACPE) courses and/or requiring continuing education annually or per renewal cycle to ensure competency.

• Practice! Utilize mock patient consultations to gain comfort.

Staff support

• Identify and/or assign a “champion” for your pharmacy-based clinical services.

• Utilize all pharmacy staff, including pharmacy clerks and pharmacy technicians.

• Utilizing your pharmacy team and working with them to incorporate into the workflow, either as scheduled appointments or walk-ins.

Documentation

• Consider an informed patient consent form to promote patient autonomy and instill confidence and trust in your team!

• Consider a standardized process that includes questionnaires and workflow based on the U.S. Medical Eligibility Criteria (U.S. MEC) and U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR).

 The U.S. MEC guides the pharmacist to determine if a patient is eligible for therapy at the pharmacy or if they will need to be referred to a provider.

• Effectiveness chart/selection chart

 Consider other resources that may be helpful to pharmacists and patients, such as an effectiveness and product selection chart provided in the U.S. MEC.

• Reminder: Document everything!

Reimbursement:

• For clinical services:

 Identify pricing and business model for cash-pay patients.

 Work towards government-funded and commercial insurance coverage.

• For product and dispensing:

 For patients with insurance, adjudicate per standard practice.

 Consider identifying affordable options for cash-pay patients.

• Pharmacists must be reimbursed for services rendered!

While pharmacists' rapid advancement in hormonal contraception prescribing has been seen in the last eight years, more than half of states have yet to grant the right for pharmacists to prescribe. For Michigan, the time is now. Pharmacist-prescribed hormonal contraception is coming. As we move forward, please give sincere thought to how MPA, its practice sections and local organizations can support you in this advancement of the profession of pharmacy.

References:

1. Pharmacist Prescribing: Hormonal Contraceptives. NASPA. https://naspa.us/resource/contraceptives/

2. Prevent Unintended Pregnancy | 6|18 Initiative | CDC. Published March 10, 2022. https://www.cdc.gov/ sixeighteen/pregnancy/index.htm

3. Lesson: Prescribing Oral Contraceptives: A New Pharmacist Role. https://journalce.powerpak.com/ce/ prescribing-oral-contraceptives-a-new

4. Landau SC, Tapias MP, McGhee BT. Birth control within reach: a national survey on women’s attitudes toward and interest in pharmacy access to hormonal contraception. Contraception. 2006;74(6):463-470. doi:10.1016/j.contraception.2006.07.006

5. Over-the-Counter Access to Hormonal Contraception. https://www.acog.org/en/clinical/clinical-guidance/ committee-opinion/articles/2019/10/over-thecounter-access-to-hormonal-contraception

6. Eckhaus LM, Ti AJ, Curtis KM, Stewart-Lynch AL, Whiteman MK. Patient and pharmacist perspectives on pharmacist-prescribed contraception: A systematic review. Contraception. 2021;103(2):66-74. doi:10.1016/j. contraception.2020.10.012

7. Gardner JS, Downing DF, Blough D, Miller L, Le S, Shotorbani S. Pharmacist prescribing of hormonal contraceptives: Results of the Direct Access study. Journal of the American Pharmacists Association 2008;48(2):212-226. doi:10.1331/JAPhA.2008.07138

8. 19-1392 Dobbs v. Jackson Women’s Health Organization (06/24/2022). Published online 2022:213.