Study shows promise for hormonal contraception services in the community pharmacy setting

In recent years, pharmacists’ scope of practice has increased in many states through new legislation, allowing pharmacists to expand the range of clinical services they can provide patients, particularly in community pharmacy settings. While these changes are a welcome addition to the pharmacist’s tool belt, implementation of certain services has been slow, primarily because health insurance plans have not reimbursed pharmacists for providing them.

A 2013 California Senate Bill 493 (SB493) now allows pharmacists to provide a wider range of health care services, including the ability to “furnish,” or prescribe, hormonal contraceptives directly to patients; Oregon followed suit with a similar law in 2015. Both states use a statewide protocol that became effective in 2016.

A new study, carried out in part by Lisa Kroon, PharmD, chair of the Department of Clinical Pharmacy, UCSF School of Pharmacy, shows the potential of these new services by taking a closer look in California and Oregon at Albertsons pharmacies where pharmacists offer hormonal contraception to patients.

Sunny Lu, PharmD, of the Kaiser Permanente Santa Clara Medical Center; Sally Rafie, PharmD ’08, the founder of the family planning website The Birth Control Pharmacist; and Jeffrey Hamper, PharmD, and Rebecca Strauss, PharmD, both of whom work for Albertsons, also contributed to the study.

Because pharmacists keep longer hours than primary care physicians and are available without an appointment, the study’s authors hypothesized that a supermarket-based pharmacy chain would be an ideal place for women to both obtain and fill, on a walk-in basis, a prescription for hormonal contraception pills, patches, vaginal rings, or injections.

“The study showed [that] pharmacists who are trained can implement this model and serve as a new access point for patients to get health care,” Kroon said.

A total of 2,117 patients, ages 13 to 55, used the service at their local Albertsons pharmacies. For about 7 percent of the women, an initial screening by the pharmacist revealed a health issue requiring these patients to see their primary care physician instead of getting a prescription on the spot. The most common issue was high blood pressure.

Wider implementation of this service by pharmacists could fill a pressing need in the U.S. health system, where, as the paper notes, nearly half of all pregnancies are unintended, and where many women report challenges in obtaining a prescription or getting a refill for hormonal contraception. Since the study concluded, both California and Oregon state Medicaid programs have started to reimburse pharmacists for these clinical services.

Kroon says these services are just the start for the expanded scope of practice for pharmacists. Hamper and Strauss said that Albertsons is already looking into offering even more services.

“Where states allow, we have begun prescribing [medications] for chronic conditions, such as statins for patients with diabetes, emergency medications such as epinephrine and naloxone, and medications for self-limiting conditions such as influenza, strep throat, urinary tract infections, and cold sores,” Hamper and Strauss shared. “We are also working on implementing more smoking cessation services where pharmacists can prescribe tobacco cessation medications and also HIV pre-exposure prophylaxis.”

Just as providing immunizations is now a standard of practice for pharmacies, Kroon hopes that one day other patient care services become the norm at community pharmacies.

More

• Characterizing pharmacist-prescribed hormonal contraception services and users in California and Oregon pharmacies (Contraception)