Birth control policies in pharmacies not enough to increase access, use

Expanding access to birth control through policies that allow pharmacies to prescribe them may not effectively address disparities in birth control use, according to research published in Health Affairs.

“The findings from this study suggest that regulations that authorize pharmacists to prescribe contraceptives are not enough,” Dima M. Qato, PharmD, associate professor of pharmacy systems, outcomes and policy at the University of Illinois at Chicago College of Pharmacy, said in a press release. “Regulations that mandate they dispense birth control regardless of age may also be necessary. Without a dispensing mandate, these restrictive practices are likely to persist and adolescents will continue to encounter additional barriers in accessing birth control, including at retail pharmacies.”

The study follows the FDA’s 2013 approval of the emergency contraceptive levonorgestrel (Plan B; Kyleena, Mirena) for over-the-counter sale without any age restriction and a 2016 policy passed in California to allow pharmacies to prescribe birth control to women and girls of any age, although pharmacies were not required to participate.

To evaluate the ability of pharmacist-prescribed birth control and emergency contraception, Qato and colleagues conducted a “mystery shopper” telephone survey of all pharmacies in Los Angeles County, California, from June 2017 through November 2017. The researchers chose the county due to its high rate of teen births and unintended pregnancies.

For the survey, a young woman trained to be an interviewer posed as a patient seeking emergency contraceptives and hormonal contraceptives without a physician’s prescription. Once speaking with a pharmacist, she followed a standardized script and documented pharmacists’ responses.

Of the 1,611 eligible pharmacies in the county, 1,482 participated in the survey. Among participating pharmacies, 35.4% were in predominately Black and Hispanic neighborhoods and 33.4% were in predominately low-income neighborhoods.

Qato and colleagues determined that just 10.1% of participating pharmacies offered pharmacist-prescribed contraception, and 77.4% had emergency contraception available over the counter in the store.

They found that 73.9% of pharmacies that offered pharmacist-prescribed contraception and 43.3% of pharmacies carrying over-the-counter emergency contraception required identification to verify patients were aged 18 years or older.

According to the researchers, fewer pharmacies in high-risk communities (8%) offered pharmacist-prescribed contraceptives compared with those in other neighborhoods (11.2%).

However, they found age restriction rates for pharmacist-prescribed contraception were lower in predominately Black and Hispanic neighborhoods at 61.9%, compared with 79% of pharmacies in other neighborhoods.

Less than 4% of predominately Black and Hispanic neighborhoods in the county had a pharmacy that offered pharmacist-prescribed contraception, compared with 7.9% of other neighborhoods.

Of the 1,292,437 women aged 15 years to 44 years in the county, 61.1% lived in a neighborhood with no pharmacy, and nearly half of those women lived in neighborhoods with high teen birth rates.

The findings suggest that policies focusing solely on expanding pharmacy access to birth control may not be enough to address disparities in contraceptive use, Qato said in the press release.

“Expanding the Affordable Care Act, or ACA, contraceptive coverage mandate to include pharmacy reimbursement for pharmacist-prescribed contraception services may increase its availability at retail pharmacies,” Qato said in the release. “Expanding eligibility for Title X funding to include pharmacies, which are often more accessible than health centers, including family planning clinics, may also provide financial incentives for pharmacies to implement contraceptive services as well as increase access to birth control to uninsured women and girls at no cost.”