Contraception debate spreads to Capitol Hill and courts

The debate over contraceptives in pharmacy has spread to Capitol Hill. Last week, lawmakers introduced a bill that would prevent pharmacists from refusing to fill valid prescriptions because of their moral objections to their use.

Supporters in Congress, mostly liberal Democrats, put the bill forward as a defense against growing reports of pharmacists who deny birth control to women with doctors' orders to buy it. But conservative pharmacists ridiculed the proposal as unenforceable and branded it an attempt to force them to become complicit in abortion. Several R.Ph.s have filed lawsuits challenging state rules that ban pharmacists from withholding Rxs because of their beliefs.

The federal bill does not require pharmacies to stock any particular drug, including birth control pills or emergency contraceptives (EC). But it does oblige pharmacists who refuse to dispense a prescription because of "personal beliefs"-and not medical safety-to find a colleague willing to fill it.

The bill follows increasing reports from several states where pharmacists have declined to dispense either oral contraceptives or the emergency morning-after pill known as Plan B (levonorgestrel, Duramed). Included is a case in Denton, Texas, where in 2004 three Eckerd pharmacists allegedly refused to dispense EC for a rape victim. "A handful of pharmacists are saying they have a right not to fill legal prescriptions written by doctors," said bill sponsor Sen. Frank Lautenberg (D, N.J.), who unveiled the proposal at a Capitol Hill briefing while flanked by supporters from abortion rights and women's groups. "We just want a bill that says, 'Pharmacists, do your job, period,' " he said.

Pharmacists could be fined up to $5,000 per day of violation and up to $500,000 in total for refusing to fill legal prescriptions under Lautenberg's bill, sponsored in the House by Rep. Carolyn Maloney (D, N.Y.).

Karen Brauer, R.Ph., who heads the 1,600-member Pharmacists for Life International, said in an interview that EC is tantamount to abortion and that the bill seeks "to force pharmacists to kill." She also argued that the bill would be indefensible in court because many conservative pharmacists who object to birth control on moral grounds also consider it medically unsafe. "First they'll have to prove that the denial is due to beliefs. I think we could make the government go broke trying to enforce that law," she said.

And Brauer's members are by no means the only ones supporting pharmacists' right to refuse legal prescriptions. Also last week, two Illinois pharmacists sued Gov. Rod Blagojevich over a new state rule enacting restrictions similar to the ones in the Congressional bill. Blagojevich approved the rule on April 1 after two Chicago pharmacists refused to fill Rxs for emergency contraceptives.

But in Washington, Congress-watchers from the American Pharmacists Association said they have "grave concerns" about Lautenberg's bill. The group's policy defends pharmacists' right not to participate in dispensing drugs they find objectionable-such as EC or drugs used in executions. But it also clearly states that pharmacists should never obstruct patients from receiving medically appropriate drugs from other sources.

"Bottom line, pharmacy practice is regulated at the state level, not the federal level," said Susan Winckler, R.Ph., APhA's VP for policy and communications. Five states have actually expanded access to EC through collaborative doctor-pharmacist practice agreements that let qualified women obtain the drug directly from the pharmacy without a doctor's prescription, she pointed out.

Meanwhile, Capitol Hill remained deadlocked on President Bush's pick to head the Food & Drug Administration also because of a controversy involving EC. Two Senate Democrats, Patty Murray (Wash.) and Hillary Rodham Clinton (N.Y.), said that they had placed a hold on Lester Crawford's nomination until the FDA delivered a long-awaited ruling on whether to clear Plan B for over-the-counter sale to women 16 and older.

"I certainly will not lift the hold until the FDA issues a decision," Murray said in an interview.