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California Pharmacists to Offer Emergency Contraceptive Services

Kate Traynor

For California pharmacists, the new year brought a new professional privilege—the ability to dispense emergency contraception to women without a prescription from a physician.

The new privilege arises from a modification in the state’s Business and Professions Code that went into effect January 1. With this change, pharmacists who work with an "authorized prescriber" to develop an emergency contraception protocol and complete a training course approved by the American Council on Pharmaceutical Education (ACPE) can offer the service to women.

Emergency contraception consists of an oral progestin or estrogen–progestin regimen that is most effective when initiated within 72 hours of unprotected intercourse. FDA first endorsed the use of oral contraceptive regimens for postcoital emergency contraception in 1997. Two products—levonorgestrel (Plan B, Womens Capital Corp.) and levonorgestrel–ethinyl estradiol (Preven, Gynetics Inc.)—have been available for use as emergency contraception in the United States since 1998.

"Pharmacies offer a great opportunity to provide the kind of access [to emergency contraception] that busy women need," said Jane Boggess, director of the Pharmacy Access Partnership. The partnership is a division of the nonprofit Public Health Institute, which sponsored the legislation.

At the beginning of the year, about 80 pharmacies in California had been authorized to provide emergency contraceptive services. Pharmacists at these sites had been part of the demonstration project that preceded enactment of the law. Most of the sites are community pharmacies, but Boggess said some university pharmacies are also participating.

Boggess stated that the legislation behind California’s emergency contraceptive program is narrower than in Washington, the only other state in which women can receive postcoital contraception from a pharmacist without first seeing a physician.

"California’s law is therapy-specific—it’s just for emergency contraception," Boggess said. By targeting this use, the legislation avoided a "turf issue" with physicians’ groups over scope-of-practice concerns.

In fact, Boggess said, the American College of Obstetricians and Gynecologists and the California Medical Association actively supported the legislation. "They had all gone on record stating that [emergency contraception] is so safe and so needed that it should be [available] over-the-counter." Thus, she noted, it would have been difficult for the medical groups to oppose legislation that allowed pharmacists to provide emergency contraception.

Boggess said that the portion of the law describing the training a pharmacist must receive before before being able to provide emergency contraception is general. "It simply states that you must receive training by an ACPE provider," she said.

Specifically, the law states that "the training program shall include, but is not limited to, conduct of sensitive communications, quality assurance, referral to additional services, and documentation." The law also mandates that pharmacists provide a standardized fact sheet to women who seek emergency contraception.

Boggess estimated that it will take about two years for the program to completely "roll out."

"It’s not government funded," she noted. "This effort is being rolled out through foundation support and the private sector."

The law does not address the issue of compensating pharmacists for providing emergency contraceptive services.

Researchers in Washington explored the costs and outcomes of pharmacist-prescribed emergency contraception by using a decision model.1

The study, conducted by the University of Washington School of Pharmacy, relied on 1998 costs and outcomes from the state's pilot project, which originally allowed pharmacists in the state to directly provide emergency contraception to women. For comparison, the researchers gathered cost and outcomes information from the medical literature and other sources.

Whereas 1.8% of the women who received emergency contraception drugs from a pharmacist subsequently became pregnant, 4.9% of women who did not receive emergency contraception at all or who received it from a physician or clinic became pregnant.

Private insurers were estimated to have saved $158 for each woman who had unprotected intercourse and received emergency contraception drugs from a pharmacist instead of a physician or clinic. Pharmacist-prescribed emergency contraception was estimated to have saved public third-party payers $48 per patient.

The researchers concluded that policymakers should consider expanding the use of pharmacist-prescribed emergency contraceptive services.

1. Marciante KD, Gardner JS, Veenstra DL et al. Modeling the cost and outcomes of pharmacist-prescribed emergency contraception. Am J Public Health. 2001; 91:1443-5.