Q&A: Reproductive Health Training Equips Pharmacists to Close Care Gaps

In this Q&A, Sally Rafie, PharmD, BCPS, APh, FCCP, FCPhA, founder of the Birth Control Pharmacist, discusses how pharmacists are increasingly stepping into frontline roles in contraception and broader reproductive care, even as many pharmacies struggle with survival-mode pressures and limited reimbursement. She explains that even though pharmacists are trained to assess patients, make clinical decisions, and counsel on medications, traditional pharmacy education often overlooks critical skills like patient assessment and implementation for services such as contraception.

To address these gaps, she helped develop a comprehensive reproductive health certificate program that prepares pharmacists to practice at the top of their license now and as scope-of-practice laws evolve. The program covers a continuum of services, from contraception and HIV prevention to pregnancy, postpartum care, and menopause, with practical modules on billing, implementation, and advocacy to make these services sustainable in real-world community settings.

Drug Topics®: What are the main barriers being encountered—regulatory, social, logistical—when trying to expand pharmacy-based reproductive health services?

Sally Rafie, PharmD, BCPS, APh, FCCP, FCPhA: Pharmacists are encountering a lot of different barriers, but they are super motivated to help with reproductive health services, which is really important, because pharmacists do feel like it's within their scope of practice, and they also feel like this is something that they want to help their community with. So I think that's a great starting place, and then despite the barriers, we can tackle those together and really get to a place where pharmacists are able to do more. I believe pharmacists have the skills. We learn everything we need to know in pharmacy school about how to assess patients, make clinical decisions, counsel, and really help provide the continuum of care around these services. It might just be a matter of learning about specific clinical topics or getting up to date on certain things, but we've got the baseline skills there, which is a great starting place. One of the biggest barriers, I think, right now for pharmacies is that they're simply in survival mode, and we know that it's hard to expand services when you're just trying to stay afloat, doing the basic services that our communities need from us, especially when there isn't reimbursement for services. We know that in a lot of cases that reimbursement is not available. There aren't payments available from health plans, but that's expanding. So all the time, we were hearing about more states and more plans that are choosing or being mandated to cover pharmacist services, so that's going to really help a lot. The other big barrier is scope of practice limitations. So depending on the state that the pharmacist is practicing in, there might be different scope of practice limitations on specific services or within the service, how much of that service we're able to provide. But again, over time, this is changing, and it's changing pretty rapidly, with already a handful of states having passed standards of care and giving pharmacists independent prescribing authority. People have really become aware of the value that pharmacists bring in the community setting, and that's starting to be reflected in the regulation. So I think it's just a matter of time before a lot of these services are standard of care.

Drug Topics: What gaps in current pharmacy education or patient care does the certificate aim to fill?

Rafie: A lot of these topics are not really covered in traditional pharmacy curriculum or in continuing education programs. Contraception, of course, is. According to the latest ACCP [American College of Clinical Pharmacy] recommendations, contraception is considered tier 1, so that is to be included in all the pharmacy school curriculum, but sometimes that curriculum covers the pharmacotherapy aspect of it and not necessarily some of the skills around that, so the patient assessment piece or the counseling piece that comes with actually providing the service rather than just being the dispenser of the medications. There's still room and the educational opportunities, even with contraception and beyond that. This certificate program includes a lot of other topics that are pertinent. Our goal was to create a comprehensive certificate program, because there is no such thing out there now, and we know that patients may go from wanting to prevent pregnancy to being pregnant to being postpartum to then needing to prevent pregnancy again. That's an example of how patients are on a continuum, and their needs are constantly changing, and we want to be able to help them through all of those different stages and not just with 1 particular sliver of the care. So that's some of the gaps that are out there and some of our goals.

Drug Topics: Tell us more about the Pharmacists CARE Initiative. What motivated you to create the Reproductive Health Certificate Program?

Rafie: The pharmacist care initiative—our goal actually was focused here in California initially—was to really make sure that we are providing comprehensive reproductive health services and that patients are able to access those services, and similarly, providers of all types are able to provide them and be protected in doing so as well. We partnered up with the California Pharmacist Association and doing lots of different initiatives within this larger initiative to really expand access to care and get our pharmacists all the education and training that they need to do this work. With this reproductive health certificate program, we really want pharmacists to feel prepared and encouraged to practice at the top of their license with today's current scope of practice wherever they are but also for what's coming in the future. What are the scope of practice expansions that they're anticipating in the next 3 years or 5 years? Because it's going to be here before they know it, and there were no other reproductive health training programs out there for pharmacists. So we made it. We think it's a really important topic, and hopefully this meets everyone's educational needs when it comes to this and encourages them to get involved, specifically with the planning portion of the certificate program. We started with a Delphi panel of experts, and we did several rounds of figuring out which topics need to be included, the best format for the certificate program, and then once all of that was finalized, we invited expert faculty and peer reviewers to create the content for us.

Drug Topics: How do you envision pharmacists’ roles evolving over the next 5 to 10 years in reproductive health care, and how does this program support that shift?

Rafie: Contraception has pretty much already become a standard part of pharmacist rules. We've got about 2 or 3 states already that have granted pharmacists the authority to directly provide contraception care, and there are other services that are following closely behind that, so HIV pre- and post-exposure prophylaxis and testing, and then hopefully after that, as part of sort of the test and treat suite of services that we're able to provide, we can do STI [sexually transmitted infections] pre-exposure prophylaxis, testing, treatment of STIs, [and] expedited partner therapy for folks who might have other partners who need treatment as well. I also see an evolving role for pharmacists in pregnancy and postpartum care. Maternal morbidity and mortality continue to be an issue here in the United States. We're struggling still to identify folks who are having complications early on or make sure that they're getting sort of the preventative care along the way, and community pharmacies and pharmacists in general, I think, are really well positioned to provide some of that care. I think that's going to become a bigger and bigger role for pharmacists in really ensuring that Americans, if they start out with a healthy start, a healthy pregnancy, that's really going to be the best way to set them up for a healthy life. It's going to be really important for pharmacists to get more involved in that space. Another hot topic that has been really growing in the health care community is menopause, and pharmacists can really help with that. That's a big life transition; many people are going through that. And so far, I think the awareness and consideration that's been given to menopause has not been adequate, and there's a lot of room to do better when it comes to menopause, and pharmacists can really help with that.

Drug Topics: You’ve had a diverse career—clinical practice, community pharmacy, teaching, advocacy, and research. How has your journey informed the design and priorities of this certificate program?

Rafie: In lots of different ways. I think, first off, myself being a reproductive health expert. I don't feel like every pharmacist out there needs to be a reproductive health expert. I know that reproductive health is a small part of what our pharmacists are doing every day, right? So, they are generalists. They need to be able to take care of a wide variety of patient needs, and my goal is to get them the amount of knowledge and skills that they need to be able to provide this care for 95% of patients who walk through their doors. There may be an occasional, very rarely, a patient who's maybe too complex or outside of the scope of that generalist pharmacist's comfort level, and that's okay. We can still care for so many people, provide so many services, and still provide those referrals as needed. In the rare case that someone comes through our doors that's a little too complicated for us at the community pharmacy. The other major way I think that my experiences have helped inform this certificate program is that I've been there myself as a community pharmacist, trying to expand clinical services, trying to figure out what my community needs and how I can help within my scope of practice, how to make it financially viable and sustainable, how to get the rest of my community pharmacy team members on board and that implementation piece, the advocacy piece, all of that, I've been there. I've been through all of it, and so I think that really helped inform some of the modules we have around billing and implementation and even advocacy because that is all part of what we're doing here with trying to expand clinical services.

READ MORE: Women's Health Resource Center

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