More states consider legislation to let pharmacists prescribe emergency contraception.
Emergency contraception (EC) may be coming to a pharmacy near you. Four states have already OK'd pharmacist prescribing for EC. Another 21 states are considering it. EC could even go over the counter at some point. "The change in attitude is working to increase access, which is crucial because of timing for EC," said Susan Winckler, VP of policy and advocacy for the American Pharmacists Association. EC must be taken within 72 hours of intercourse, she noted.
"EC is happening in a lot of states without fanfare" Winckler noted. "All you need is a collaborative protocol in place." Currently, 40 states plus Guam allow for collaborative protocols, according to APhA.
"The moves you're seeing today reflect a lot of groundwork that began with Washington State," said Kristen Moore, president of the Reproductive Health Technologies Project. "It's an issue of access and information," she said, adding that most women still don't know EC exists or that it is safe, effective, and approved by the Food & Drug Administration.
Washington was the first state to involve pharmacists in EC. In 1998, pharmacy regulation was changed to allow collaborative protocols between pharmacists and physicians in order to give R.Ph.s EC prescribing authority. Similar programs have been established in Alaska, California, and New Mexico.
"We created one protocol to cover all pharmacists who receive EC training," said New Mexico Pharmaceutical Association executive director Dale Tinker. "That gives our pharmacists more flexibility than in states that require protocols between a specific pharmacist and a specific physician."
In Hawaii, collaborative protocol legislation that died in 2002 was reintroduced this year. The bill has passed the House and Senate and awaits the governor's signature. "We did a lot of footwork over the summer," said Barbara Kishiwabara, chair of the Hawaii Pharmacists Association's government affairs committee. "We made sure legislators were familiar with the issues and familiar with contraception versus abortion arguments. You have to get the facts out early and acknowledge the strong emotion in this issue as well as the science."
Similar legislation died in Arizona. Kathy Boyle, executive director of the Arizona Pharmacy Association, blamed local politics. "Personal issues between House leadership and members killed the bill," she said. "But there is the strong possibility that it would have died anyway. Our House is very conservative, and many members see EC as abortion. We are going to have to do a lot of educating in the legislature if [the bill] is going to pass next year."
Abortion has also become an issue in Wisconsin. Legislators are considering a bill to require hospitals that offer services to sexual assault victims to also offer EC. The state is also wrestling with a conscience clause that would allow individual pharmacists to decline to provide contraception services, including EC. Opponents charge that EC is a form of abortion, saying that conception begins at fertilization. Supporters point to the National Institutes of Health, the American Medical Association, and other groups that define implantation as the point of conception.
Politics is also roiling the scene in California, which already allows pharmacists to initiate EC under protocol with a physician. State senator Dottie Alpert (D) wants to broaden access by establishing a single EC protocol covering all pharmacists statewide.
Sen. Jackie Speier (D) also wants to broaden access. Her measure would require all pharmacies that participate in Medi-Cal, the state Medicaid program, to dispense EC. The bill would also eliminate current requirements for pharmacists training in EC and prohibit pharmacists from charging additional patient assessment fees. Most California pharmacists charge $15 to $25 per assessment.
"This bill would effectively kill access to EC," said Michael Negretti, CPhA associate VP for clinical affairs. "I have received e-mails from pharmacists who say they will reevaluate their participation in Medi-Cal. It's a money-losing proposition." CPhA is urging pharmacists to oppose the Speier bill. Physician groups are backing Speier.
"These state programs are quite hard to do," said Sharon Camp, president of Women's Capital Corp. (WCC), which distributes Plan B (levonorgestrel), one of two EC products approved by the FDA. "You get entangled in local politics and turf battles between physicians and pharmacists." WCC recently petitioned the FDA to take Plan B over the counter in order to sidestep state regulation. Camp said a decision could come by November or December.
Over-the-counter EC also has major medical allies. The California Medical Association supports OTC status, as do state affiliates of the American Medical Association, the AMA itself, and the American College of Obstetricians & Gynecologists. Former ACOG president Thomas Purdon, M.D., said every woman of childbearing age should have EC in her medicine cabinet in case of contraceptive failure.
"I hope EC goes OTC," Moore said.
Fred Gebhart. Emergency contraception expanding in pharmacies. Drug Topics May 19, 2003;147:32.