Birth control and med adherence are connected how?

David StanleyIt finally seems as if the pharmacy birth control wars are behind us, which I hope will prove that medication adherence isn't the type of rocket-science problem requiring academic studies by professors pondering how to get people to take their medicine. No, that wasn't an accidental grafting of two different sentences you just read. Stick with me, and by the end of the column you'll understand.

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First, anyone involved in the profession over the last 15 years or so can recall the small group of pharmacists who got their 15 minutes of fame by refusing to dispense birth control pills to patients with legitimate prescriptions. Back in 2010, I wrote about a short-lived attempt to launch a pharmacy that categorically refused to dispense contraceptives because it was against the moral beliefs of the owners.

I remember that another pharmacist made the disingenuous - and to anyone in the profession - laughable claim that it wasn't his morals that kept him from giving out hormonal contraception, but that they were “the most dangerous chemicals on the market.”

A good thing

In the nation's largest state, though, access to contraception is about to get a whole lot easier. California is in the process of crafting a protocol that will allow any pharmacist in the state to prescribe contraceptives - along with travel medicines and smoking-cessation products - without a doctor's involvement.

See also: God, pharmacy, and the American way

No longer will single rogue practitioners behind the counter be able to block birth control prescriptions; soon they will be greatly outnumbered by colleagues who can prescribe what's needed at any corner drugstore.

When that protocol is published, I plan to be among the first in line to take this opportunity to expand my practice. But that's not what I’m most excited about. I'm hoping this is the beginning of the end of the pointless fax.

It gets better

Everyone reading this knows exactly what I mean. I’m talking about the requests to doctor's offices not only for routine birth control refills, but also the losartan, levothyroxine, metformin, and all the other maintenance meds that everybody knows will be okayed just as soon as Dr. Dillydally gets around to sending a reply. 

I once worked at a chain that filled these soon-to-be-authorized refills in advance and kept them segregated from the other prescriptions until they were authorized. Very, very, rarely did we ever put anything back that went into that pile.

“As a pharmacist, it's hard to send my patient elsewhere for care when I know I have the knowledge and skills to help her with her birth control,” one pharmacist was quoted as saying when the California law was changed. I can add to that any number of chronic conditions that you or I could easily manage, once the diagnosis is made.

Is there anyone with a pharmacy degree who really doesn’t feel equal to bringing someone's blood pressure under control, or at least to managing the drug therapy once a plan has been initiated?

Imagine how many faxes we just eliminated by taking charge of these two Rx categories. Now add in diabetes meds. The authority to order a lab test and adjust levothyroxine doses accordingly. INR testing and warfarin. Imagine how many of the customers who who leave your counter empty-handed and frustrated every day would instead leave satisfied, with their medications in hand.

And how about this?

Now imagine this. One of the big three chains trumpets its new partnership with Brigham and Women’s Hospital of Massachusetts to “improve medication adherence through research.” Really?

Every day at every store in the chain, customers ready to fill their maintenance prescriptions walk away with nothing, yet it takes a research project to illustrate how to increase the numbers of people who take their medications?

I'll bet next month's store proceeds that eliminating Dr. Dillydally's pointless authorization to continue a lifetime med will have a far greater impact on adherence than anything those researchers are going to come up with. I can’t wait for the new law to kick in.

Right now, though, I have a pile of refill requests to resend.  I'm sure you do too.