Pharmacists’ services continue to expand as pharmacists are getting involved in prescribing and/or furnishing certain medications, such as hormonal contraceptives, in several states.  Listed below is the latest information on initiatives underway in Oregon and California.

Oregon

Pharmacists in Oregon can now prescribe and dispense hormonal contraceptives, both oral and transdermal.  While the Oregon Board of Pharmacy is expected to establish permanent rules based on public input and will consider adoption of the Permanent Rules at their April 7, 2016 Board meeting, they have established temporary rules to enable pharmacists and pharmacies to prepare for implementation of the law.  For each patient, pharmacists are required to obtain a completed Oregon Self-Screening Risk Assessment Questionnaire and to follow the Oregon Standard Procedures Algorithm to perform the patient assessment before prescribing a contraceptive.  If the pharmacist determines that it is not clinically appropriate to prescribe the contraceptive, he or she is required to refer the patient to a healthcare practitioner.  Patients under 18 can only receive a pharmacist prescribed contraceptive if the patient has evidence of a prior prescription from a primary care practitioner or women’s health care practitioner for an oral contraceptive or contraceptive patch.  Additional Board approved training is required for pharmacists who want to participate in prescribing contraceptives.  It is a five credit hour course available online for $250, available at https://pace.oregonstate.edu/catalog/comprehensive-contraceptive-education-and-training-prescribing-pharmacist.

Oregon law requires insurance coverage for prescription contraceptives.  Only religious employers are exempt from the requirement.  A new law extends that requirement to “apply to hormonal contraceptive patches and self-administered oral hormonal contraceptives prescribed by a pharmacist.”  Individual insurers may still have formulary limitations on the specific brands of contraceptives that are covered.  PHSI has heard that Oregon Medicaid is already providing coverage, but it’s unclear if commercial payers have begun providing this specific coverage in the middle of a benefit year.

California

A similar law in California is expected to be enacted on April 1, 2016.  The law permits pharmacists to furnish contraceptives (which can include contraceptives that are administered vaginally and by depot injection), and to “order and interpret tests to monitor drug safety.”  California’s law only permits furnishing by pharmacists who the Board of Pharmacy recognizes as advanced practice pharmacists (APP), which can be gained in as little as a one hour Continuing Education program.  Accredited California schools of pharmacy may also offer an “equivalent curriculum-based training program completed on or after the year 2014” which would also count as sufficient training to participate.

Missing from the discussion has been reimbursement for the pharmacist’s services.  California’s law specifically calls out that, for furnishing emergency contraception drug therapy (ECDT) the “pharmacist, pharmacist’s employer, or pharmacist’s agent may charge a patient an administrative fee of up to $10 above the retail cost of the drug but may not charge a patient a separate consultation fee for ECDT services.”

Colorado, Hawaii, and Washington state legislatures have introduced bills that would allow pharmacists to effectively prescribe contraceptives.

Future Opportunities

PHSI envisions state-by-state growth similar to the now nationwide availability of pharmacist administered immunizations and the growing number of states allowing pharmacists to provide emergency contraception to patients under certain requirements.  Certain states have begun to allow pharmacists to dispense naloxone to patients and/or caregivers without a doctor’s prescription.  As we’ve seen with other clinical initiatives, some pharmacies will evaluate the most effective (profitable) use of their time – be it dispensing other prescriptions or initiating prescriptions for products such as contraceptives.  As pharmacy practice continues to evolve, PHSI envisions a future where pharmacists are compensated for the clinical services they are providing to patients.

Pharmacist prescriptive authority for contraceptives was recently discussed in the PHSI Winter 2016 Newsletter.  The updates above were initiated by feedback from you.  For your reference, the initial article can be found here.